Skin and facial aesthetic concerns are not just skin deep, but often in fact require knowledge of the anatomy, including muscle and bone structure, to understand. One condition may be easily mistaken for another without medical knowledge of the face.
Dr Heng Wee Soon responded to DoctorxDentist reader questions about common skin concerns, with advice and things to take note of when seeking a holistic analysis and treatment. Here is a round-up of what he said.
Fine lines under the eyes? They may not be fine lines at all
Some people may seem to have lines which look quite significant in the undereye region. However, in fact, they may not originate from the superficial part of the skin and therefore not be fine lines at all.
They may just be lines formed by natural muscle anatomy around your eyes. A doctor familiar with aesthetic treatment can have a look to determine this. 
These natural muscle lines can be treated too
For example, a person with hyperactive, strong pre-tarsal muscles may have this condition. It can be treated with small amounts of Botox placed at the right depth to relax the section of the face. Some patients may also opt for additional filler to improve the general undereye appearance.
But if they really are fine lines, they may be caused by three main things
Fine lines in the undereye region are typically caused by one of the following:
• UV damage from sun exposure
• A loss of intrinsic collagen through ageing
• Static wrinkling as a result of repeated dynamic wrinkle formations. 
Dermal fillers and eye rejuvenation lasers can improve the appearance of skin near the eyes
Dermal fillers can support underlying tissue around the eyes and increase skin elasticity, while eye rejuvenation lasers can brighten the area and reduce pigmentation. 
Experiencing upper eyelid hollowness? It can be caused by two main issues
For the most part, upper eyelid hollowness is either caused by an age-related volume loss that happens over time or volume loss related to previous eyelid surgery. 
Yes, fillers can be used to fix eyelid hollowness too
The administration of fillers usually includes hyaluronic acid or calcium hydroxyapatite, leading to improved appearance with age caused by the hollowness.
Done safely, these fillers can make for a quick and effective solution, with results almost immediately visible after treatment. 
There may be some side effects to filler treatment
Bruising and local infection may occur. Both can be treated.
Rarely, more severe complications may include:
- skin necrosis,
- nerve damage,
- or even blindness.
The eyelid area can be a challenging area to treat with fillers, so find a doctor who has experience with the procedure. 
Keloids after surgery? There are some factors to watch out for
Keloids are a common skin condition that may arise after surgery. These include scars forming at high-risk sites such as upper arms or the chest, genetic predisposition, or general wound infections. 
There is one quick solution for keloids
In Dr Heng's opinion, direct intra-lesional steroid injections can offer a simple, hassle-free solution to managing keloids to some patients, reducing the keloid size without drastic measures. 
Are toners important for effective skincare?
Toners are commonly known as skincare products used after cleansers. However, there are many forms of and definitions for "toners" these days, so it can get a little confusing.
Be safe and keep things simple
Dr Heng suggests keeping your home-use skincare routine simple. Astringent-type toners can be used for oily skin types after your cleansing routine. But if you have sensitive skin, you have to stay away from these products. Be careful of the ingredients in your skincare products and always consult your doctor if you have doubts.
Hopefully, these tips from Dr Heng will give you better insight and help you tackle these common skin issues. Do check in with your doctor before undergoing any injectable or drug-related skin treatment.
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