Your eyes may be the window to your soul, but beware: they’ll also speak volumes about your age – and how late you went to bed last night. Commonly considered as the very first sign of ageing to appear on your face, crow’s feet are eye wrinkles that start at the outer corners of your eyes and radiate outwards, like the feet of a crow.
Wrinkles occur when fault lines develop in ageing skin . When you are young, the wrinkling of the skin is transient with expressions and animation. However, as we get older, our skin loses its elasticity. Our body produces less collagen and elastin, two key proteins responsible for our skin’s elasticity. 
Even if you have been religious with your skin care regimes in your 20s, you may still see visible signs of crow’s feet when you turn 30. This is because the skin around the eyes are the thinnest  and most fragile so it lacks in fatty tissue which can help to “plump out” the skin as you age. If you’re lucky enough to have kept crow’s feet at bay, here are some preventive measures you should take note of to keep it that way!
Crow’s feet and eye wrinkles can leave you looking older than you feel – if you’re looking for ways to banish these pesky age-adding lines, these four dermatological treatments will go a long way to help you regain your fresh, dewy 20s skin.
“#1. Botox injections”
While trying out a whole suite of anti-aging eye creams that promise to halt the clock can certainly help with elevating crow’s feet, there’s nothing as effective as a Botox injection. Relatively controversial but extremely common, Botox is an injection treatment used by millions over the world to eliminate facial wrinkles.
In fact, “Botox” is a brand of botulinum toxin by Allergan, made from spores of a bacteria called clostridium botulinum. It was the first neurotoxin to gain FDA approval to treat frown lines in between the eyebrows.
How it works: Using a micro needle, the doctor injects Botox directly into the specific muscles responsible for causing wrinkles with movement. The toxin prevents the release of a neurotransmitter chemical called acetylcholine, blocking nerve signals from reaching the muscles. This temporarily relaxes and freezes the muscles that surround the corners of your eyes.
Once Botox is injected, it takes a few days for the muscles to relax and temporarily stop contracting. When these muscles are relaxed, your overlying skin appears smoother and less wrinkled.
Treatment time and downtime: There is no down time and this is why various aesthetic clinics in Singapore offer “lunchtime Botox”. The treatment only takes 10 to 15 minutes with numbing cream and you can go straight back to work after a Botox injection. Just take care not to rub the skin around your eyes and you’re all set.
Botox is also used for other medical purposes such as treating problems like eye twitching, crossed eyes, muscle spasms, migraines and excessive sweating.  Each injection lasts for 4 to 6 months; after which, you will need to come back to visit your dermatologist for another shot of Botox to maintain the results.
Cost in Singapore: Botox is used in very tiny doses, i.e. biologic units. These units are also diluted with saline. The cost generally ranges from $12 to $20 per biologic unit. As a gauge, treating crow’s feet may require around 3 to 4 biologic units per eye in general.
“#2. Dermal Fillers”
Dermal fillers are popular alternatives to Botox for treating crow’s feet. They are smooth injectable gels consisting of active good-for-skin ingredients, of which the most popular fillers are hyaluronic acid fillers.
How it works: The dermatologist injects a hyaluronic acid filler after applying numbing cream to the area. Hyaluronic acid is naturally present in our bodily fluids and tissues. Instead of relaxing muscles and preventing them from contracting as with Botox, dermal fillers fill areas which are experiencing a loss in collagen and thinning and helps to lift the skin. It helps replace volume fat in the skin, strengthening the skin structure and contours the face. It is common for doctors to use Botox and fillers together to reduce wrinkles and smoothen out skin. In general, the effects of fillers tend to be immediate and last for 9 to 16 months.
Brands: Juvederm, Restylane.
Cost in Singapore: Each filler injection is about 1cc filled with hyaluronic acid gel and its cost ranges from $600 to $1,200 per syringe in general.
“#3. Chemical Peels”
Did you know that chemical peels are one of the oldest cosmetic procedures in the world? Ancient Egyptians used animal oils, salt and sour milk to improve their skin while the Greeks and Romans used pumice and tree resins to lighten the skin and remove wrinkles. In the 1800s, dermatologist Tilbury Fox used phenol to lighten the skin and Viennese dermatologist – Ferdinand Hebra – considered the father of topical dermatology – first treated freckles at that time using a combination of exfoliative agents. 
How it works: All chemical peels use a variety of dilute chemical solutions to exfoliate and remove damaged skin, promoting increased production of new skin cells which helps to tighten and smoothen out skin texture. It is useful for treating: wrinkles, scars, acne, etc.
Common chemical solutions used are: glycolic acid, lactic acid, trichloroacetic acid, salicylic acid, malic acid and phenol. The treatment helps to rebuild collagen and spur cell regeneration from the deeper layers of the epidermis, making the skin look brighter almost immediately. The goal here is to remove damaged skin, which subsequently allows for skin healing and rejuvenation, while at the same time, minimize complications such as scarring and pigmentary. 
Chemical peels range from superficial peels to deep chemical peels:
Light and superficial peels – also called “lunchtime peels” – typically use glycolic acid, salicylic acid, alpha-hydroxy acids or beta-hydroxy acids. There may be mild redness and only requires a 1 to 2 days downtime. Light peels can be done monthly and if you have an event coming up, doing a light chemical peel a few days before will work wonders for your complexion.
Medium peels target at remove the outermost epidermis and upper middle dermis layers. These peels use trichloroacetic acid and glycolic acid, and may cause temporary redness and stinging sensations. Medium peels can be done regularly every 6 to 12 months and they are best for treating skin with a significant amount of sun damage or dark eye circles. The skin is red and raw for about a week, which means you’ll have to take quite a bit of leave and downtime from work.
Deep chemical peels target more serious skin issues such as severe acne scars, excessive sun damage etc. Deep peels typically use a higher concentration of trichloroacetic acid or phenol acid to stimulate the regeneration of skin cells from within the skin. Downtime is about two weeks to a month and you will experience redness, white spots followed by flaking of the skin.
Cost in Singapore: A chemical peel typically starts from $300 per session.
“#4. Thermage / Ultherapy”
Thermage and Ultherapy are considered as “non-surgical and non-invasive facelifts”. No injections or needles are used but they are great for facial rejuvenation for those of us in our 30s and 40s.
Thermage: Originating in 2002, thermage is a radiofrequency treatment that heats up the inner layers of the skin to stimulate collagen production. As we age, we produce less collagen, resulting in crow’s feet and wrinkles. Thermage helps the skin produce more collagen, which will in turn tighten and lift the skin. Collagen takes about 6 to 12 weeks to regenerate, so don’t expect something immediate.  The main downsides of thermage is that the treatment is uncomfortable as you may experience burning sensations and there is also risk of skin burns. A caveat: thermage is not suitable for severe signs of facial ageing such as saggy skin.
Ultherapy: Instead of using radiofrequency as in thermage treatments, Ultherapy uses ultrasound energy to similarly heat up the inner layers of the skin to stimulate collagen production. The best thing about Ultherapy is that it provides an instant and visible facelift, and collagen is stimulated over the next few months, resulting in even better skin. The machine allows ultrasound visualisation of the structures beneath the skin, thus doctors can accurately and precisely target the right tissues so that the risk of skin burn is minimal. However, one downside is that it is considerably painful but a nerve block can be used to reduce the discomfort.
Cost of Thermage or Ultherapy in Singapore: Both Thermage and Ultherapy treatments are expensive. A full-face treatment typically ranges from $2,000 to $5,800 per session and takes about 60 to 90 minutes.
It’s inevitable that the skin around our eyes loses its elasticity and collagen as years go by. Radicals from the sun’s UV rays and pollution will further exacerbate this.
Call it age-revealing wrinkles or heart-warming crinkles – these lines of crow’s feet will only get deeper and deeper as we age and with medical technology today, we can now decide whether to keep them or not. After all, beauty is something we define for ourselves.
 Anson, G., Kane, M.A.C., Lambros, V. (2016). Sleep Wrinkles: Facial Aging and Facial Distortion During Sleep. Aesthetic Surgery Journal, Volume 36, Issue 8, September 2016, Pages 931–940, https://doi.org/10.1093/asj/sjw074
 Bailey, A. J. (1978). Collagen and elastin fibres. J Clin Pathol Supplement.
 Vrcek, I., Ozgur, O., & Nakra, T. (2016). Infraorbital Dark Circles: A Review of the Pathogenesis, Evaluation and Treatment. Journal of cutaneous and aesthetic surgery, 9(2), 65–72. doi:10.4103/0974-2077.184046
 Cherney, K. (2017). Is Botox Effective for Treating Crow’s Feet? Healthline Website, https://www.healthline.com/health/botox-for-crows-feet.
 Brody, H. J., Monheit, G. D., Resnik, S. S. and Thomas, H. (2001). A History of Chemical Peeling. Dermatologic Surgery, Volume 26, Issue 5, Pages 405-409.
 Soleymani, T., Lanoue, J. and Rahman, Z. (2018). A Practical Approach to Chemical Peels. The Journal of Clinical and Aesthetic Dermatology, Aug; 11(8): 21-28.
 Dover JS, Zelickson B. Results of a survey of 5,700 patient monopolar radiofrequency facial skin tightening treatments: Assessment of a low-energy multiple-pass technique leading to a clinical end point algorithm. Dermatol Surg. 2007;33(8):900–7. [PubMed]
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