While many of us learn to love the character lines around our eyes, a growing number of women are looking to the latest cosmetic surgery and non-surgical options

When our skin loses its elasticity and muscles begin to slacken, our eyes are one of the first places we notice signs of our age and experience. And this doesn't necessarily happen only after we hit 40. Some of us, even by our mid-30s, feel that our eyes no longer look wide and youthful, but are instead framed by wrinkles, lines and seemingly excessive folds of skin.

For some people, these changes are something that must be eradicated by any means possible. Last year, even 32-year-old Catherine Zeta Jones was rumoured to have had her lids altered in the pursuit of wider, childlike eyes (she later denied this). But however keen you are to cosmetically enhance the appearance of this delicate area, it is vital that you carefully consider all the surgical and non-surgical options - including possible side effects - before making any decisions:

Surgical options

The main type of surgery for eyes is called blepharoplasty, and it alters the upper and lower lids to improve the appearance of your eyes. You can, however, also improve the area around the eyes by having an endoscopic brow lift, otherwise known as an endoscopic forehead lift.

Blepharoplasty
Approximate cost: around #3,000 for upper and lower lids

How it works: By removing excess fat, skin and muscle from above or below the eyes, you can get rid of bags that are caused by the gradual stretching of the skin and from fatty deposits, or ease drooping eyelids to make you look more alert. However, blepharoplasty will not eliminate all wrinkles, crow's feet or dark circles under your eyes.

Surgical procedure: You are given a local anaesthetic and tiny incisions are made along the natural lines of your upper eyelids. Then excess fat, loose skin and muscle are removed before the eyelid is rejoined. Surgery usually takes one to three hours, depending on whether you're having both upper and lower lids done.

Effects and side effects: According to the American Society of Plastic Surgeons, you may experience some side effects, including tightness of the eyelids, bruising and swelling, particularly at the corner of the eyes. An itching and burning sensation may last for two or three weeks. You may also have temporary eyesight problems such as double or blurred vision, and it may also be hard to close your eyes completely for a while. However, scarring is minimal and you'll be able to read again in two to three days and go back to work after a week or 10 days. The cosmetic effects will last for years.

For detailed step-by step pictures of this operation, see www.facialsurgery.com.

Endoscopic brow lift
Approximate cost: £2,000 plus

How it works: The idea of this operation is to raise the brow, reduce or eliminate horizontal creases in the forehead, erase frown lines and give your face an 'open look,' according to American plastic surgeon Dr Oscar Ramirez, a clinical assistant professor at the Johns Hopkins University School of Medicine and the University of Maryland School of Medicine. The British Association of Aesthetic Plastic Surgeons states that an endoscopic brow lift is an extension of the forehead lift, designed to tighten the skin of the upper half of the face.

Surgical procedure: Though this operation used to be done by having an incision from ear to ear (either along the top or the back of your head), it can now be done endoscopically. Dr Ramirez describes endoscopy as 'a type of surgical technique that prevents the need for long incisions, allows faster healing and generally results in fewer side effects than traditional techniques.'

During the procedure, a fibre-optic tube connected to a camera (which is then connected to a video) enters an incision. Using the video for guidance, the surgeon inserts small surgical instruments into the incisions and proceeds to remove unwanted 'frowning' muscles. 'Then the temple areas, the entire forehead and brow is lifted as a unit upwards,' says Dr Ramirez.

You can see before and after pictures at www.ramirezmd.com/browlift/browlift.html

Non-surgical options

There are now many cheaper, painless and less invasive non-surgical procedures that can help eliminate laughter and frown lines.

Botox
Approximate cost: around £175 for one site (the vertical line between your eyes counts as one site), around £275 for two sites and £325 for three sites.

How it works: 'Botox - short for Botulinum Toxin Type A - is used to treat facial lines caused primarily by the action of the muscles on the skin, such as the deep crease between the eyebrows and crow's feet wrinkles,' says Mr Roper, director of the Colchester Clinic of Cosmetic Surgery in Essex.

The treatment: 'Botox blocks the nerve impulses by temporarily paralysing the muscles that cause wrinkles. In other words, by injecting Botox you are effectively freezing your muscles to prevent further wrinkles from developing,' says Roper. Repeat treatments are usually needed every three to four months, 'though clinical trials show that people who have treatment over 12 months only need further treatments once or twice a year.'

Effects and side effects: Treatments take around half an hour and will leave you temporarily red and swollen. There is a risk of allergic reaction, bruising, numbness, swelling and headaches. The other downside of this procedure is that you may lose some of your natural expression - you may find it difficult to look surprised, for example.

Laser resurfacing
Approximate cost: £200 plus per eye

The procedure: This relatively new treatment can be used to reduce the appearance of fine lines and dark circles around the eyes, and it can be done in conjunction with a facelift or eyelid surgery. A laser beam is passed back and forth over the skin to remove areas of damaged or wrinkled skin, layer by layer. You may need more than one treatment for deeper lines and wrinkles.

Effects and side effects: If you've got olive, brown or black skin, you may be at increased risk for pigmentation changes, according to the American Society of Plastic Surgeons. Side effects include some mild swelling and discomfort that can be controlled with ice packs and medication. You may be red for several weeks and some pinkness may remain for up to six months. Results aren't permanent, as new lines will form from using your facial muscles. Risks include burns or other injuries from the heat of the laser, scarring and obvious lightening or darkening of the treated skin.

Collagen injections
Approximate cost: around £45 for an allergy test; collagen injections vary from £150-#350.

How it works: Collagen is a protein that supports the skin and gives it a youthful tone and suppleness. By replenishing your skins own collagen, you can improve the appearance of crow's feet.

The procedure: Collagen injections are a speedy procedure that takes around 15 to 20 minutes and results last for approximately eight to 12 months. You'll first need an allergy test, though, to make sure you don't have a negative reaction to the procedure.

Further details
For a list of reputable surgeons, send an SAE to:
The British Association of Aesthetic Plastic Surgeons
The Royal College of Surgeons of England
35-43 Lincoln's Inn Fields
London WC2A 3PN

The British Cosmetic Surgery Advisory Bureau can send you literature on cosmetic surgery and give advice over the phone. Call 0800 0136723 for more information.