The Upper Third

With the current global Covid pandemic most of us are wearing masks for large parts of our day. As a result, the lower two-thirds of the face is covered but the upper third is more visible than ever. Not surprisingly, I have seen many patients requesting treatments for skin conditions involving the upper third of the face.

Forehead and periorbital region

The most common request is for improvement to lines or wrinkles on the forehead, between the eyebrows and the crow’s feet at the corners of the eyes. There are two types of wrinkles in these areas, namely dynamic wrinkles which are caused by the contraction of facial muscles in these areas and static wrinkles which tend to occur in older people and are due to loss of collagen and elastic fibres in these areas, causing lines and wrinkles that are permanent even when the facial muscles are relaxed.

The dynamic lines respond best to injection with Botulinum toxin. This is a neurotoxin that temporarily relaxes muscles and as a result of the muscle relaxation, the dynamic wrinkles become less obvious. Botulinum toxin injection on average lasts for about 4-5 months and although it relaxes the muscles it doesn’t do anything to the quality of the skin as such. Because the mask covers the mouth, we cannot see that happy smile or the downturned mouth that may express anger or irritation. Crinkling around the eyes associated with a genuine smile is called the Duchenne marker. In other words, with a real genuine smile, you also ‘smile with your eyes’. With a fake or put-on smile, you do not get the periorbital wrinkling. Therefore, when you wear a mask and smile in a genuine way, the only part of your face that is visible, is the periorbital crinkling. If you have had the crow’s feet near your eyes injected with Botulinum toxin this will not happen.

The static wrinkles are best treated with topical creams that may contain antioxidants, Alpha-Hydroxy acids, Poly-Hydroxy acids, Retinol, Peptides and Growth Factors.

Recommendation: Dermaceutic Activ Retinol Serum 1%  & NeoStrata® Glycolic Renewal Smoothing Cream 

Eyelids

The eyelid skin is the thinnest skin on your whole body and as a result, all treatments need to be modified slightly to accommodate this thin delicate skin. The eyelids may become puffy, develop fine lines and wrinkles and the skin may droop or sag. Many of these changes are caused by the intrinsic ageing process as well as external factors such as ultraviolet radiation, smoking and pollution. Bagginess around the eyes can be improved by eye creams that contain caffeine. Because the eyelid skin is so thin this area will not tolerate the use of more potent topical retinol, so anti-ageing eye creams will often contain antioxidants, as well as growth factors or peptides. If the eyelids droop or sag excessively then the only option is Plastic Surgery in the form of a Blepharoplasty to surgically remove the excess skin.

As the eyelid skin is so thin and delicate it is a common area to get eczema or dermatitis. In people with atopic eczema, you can get the Dennie Morgan lines which are horizontal lines just below the lower eyelid as well as pigmentation and thickening of the skin. Again, as the eyelid skin is so thin, you should avoid the use of potent topical corticosteroid creams in this area and it is best to rather use bland moisturisers that do not contain a preservative or your doctor can prescribe a topical non-cortisone ointment in the form of tacrolimus which is safe to use in this area.

Recommendation: Avène Cicalfate+ Restorative Protective Cream & SBR Repair Cream

Eyes

Dark circles under the eyes is a commonly encountered skin concern. It has many causes and can be difficult to treat. An eye serum containing ingredients such as resorcinol, caffeine, ferulic acid and niacinamide can help to lighten these dark circles.

Recommendation: Obagi Elastiderm Eye Serum  & NeoStrata Brightening Eye Cream

More than ever, mask-wearing is making us rely on our eyes for non-verbal communication. We, therefore, want to have healthy shining or bright eyes! Staring at screens, exposure to dry air from air conditioners, smoke, dust and chlorinated water can cause our eyes to become red, dry and irritated.

Eye drops containing Euphrasia, a safe plant-derived ingredient used to treat eye disorders in Europe for centuries, can help brighten and clarify the look of eyes.

Eyelashes

Many strive for long, thick and beautiful lashes, but as we age our lashes become thinner and slower to grow. As a Dermatologist, I am concerned about the increasing use of artificial eyelash extensions as they are often glued in place with acrylate glues and with chronic use you can develop allergic contact dermatitis to these glues especially if the glue comes into contact with the eyelid skin. In addition, the eyelash extensions can pull on your own natural eyelashes causing what is known as traction alopecia i.e. can result in scarring or permanent loss of eyelashes. We recommend using a safe eyelash enhancement product that contains conditioning agents, biotin and peptides.

Recommendation: MD Lash Factor Eyelash Conditioner

Eyebrows

The shape, colour and width of your eyebrows will vary according to your sex and to the shape of your face. It is more desirable to have a nice curve to the eyebrow, giving you an ‘open eye look’. The female eyebrow is usually thinner and for the most natural look, the colour should match your hair or skin prototype. The male eyebrow tends to be thicker, darker and flatter but this will obviously vary from person to person.

As with alopecia on the scalp, there are many causes of thinning of the hair on the eyebrows. Hertoghe Sign is a loss of hair on the lateral third of the eyebrow, especially in older women. This is almost always caused by an under-active thyroid gland. As you get older, the hair on the eyebrows does tend to get more sparse and there are various eyebrow serums that contain peptides that can help to stimulate hair strength and improve hair growth of the eyebrows.

Recommendation: RapidBrow Eyebrow Enhancing Serum