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Restylane, Botox, or Laser Treatment for Under Eye Wrinkles?

Hi there! I just turned 40 and noticed these horrible wrinkles under my eyes when I smile. They are just fine lines when not smiling. I don't really have deep troughs or hollows--just bad smile wrinkles, perhaps due to bleaching creams for dark circles, or lack of sleep over the years.

Nowadays, the concealer sinks into the wrinkle and looks really bad! I am trying to see what procedure is best for me. Which treatment is better among Restylane, Botox and laser treatment? I am desperate for help and guidance. Thank you!

Doctor Answers 11

Combination approach for under-eye wrinkling

For my patients with under-eye wrinkling, I have a combination of treatments, the first of which involves a laser to improve skin quality, decrease the wrinkles and improve the color. I generally use two laser light devices: an intense pulsed light treatment (IPL) device and an Erbium laser micropeel. Done over a series, it will require anywhere from 2-4 treatments, depending upon the extent of wrinkling and your own personal response to the lasering. This is then followed by a small amount of BOTOX in the lower eyelids.

I use fillers only if the above regimen does not create enough improvement. The reason I don’t immediately opt for fillers is that they don’t eliminate the wrinkles, and fillers do nothing to improve color.

New York Dermatologic Surgeon
3.5 out of 5 stars 4 reviews

Best Option for Under Eye Wrinkles?

Hi GoGo.  While we have the option of suggesting injections, lasers or surgery at our practice, for you, we would have to recommend surgery.  Lasers and injections are not going to fix your problems because of the amount of skin and the laxity (looseness).  

A lower blepharoplasty surgery would be our recommendation.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 6 reviews

Lower Eyelid Wrinkles

Dynamic wrinkles are much more difficult to deal with than static wrinkles. The reason is if you have severe static lower eyelid wrinkles then removal of skin will help. This can't be done with dynamic wrinkles. I recommend starting in a conservative, cheaper way first. Start with a good peel and follow it with tretinoin (Retin-A). If that doesn't give you enough improvement then I would recommend CO2 laser. I don't think fractionated CO2 really does all that so I wouldn't waste my time.

Crinkling lower lids

Dear GoGo,

You didn't mention surgery in your list of possible treatments. Is this an option for you? If so, it would probably represent the best and most effective option. Botox, fillers and laser would not be mutually exclusive and could be used in any combination for maximal effect. Good luck!

Treatment of the lower eyelids

Although some patients derive benefit from Botulinum toxin as an off-label use, when injected in the lower eyelid skin, it is done sparingly and closer to the eyelashes. The whole lower eyelid extending to the tear trough (the lowest crease between the eyelid and cheek skin) is not injected as that would cause a weakening of the muscle pump action and swelling or puffiness could increase. Furthermore there might not be enough strength of the muscle to keep the eyelid against the eye and the fallen eyelid would allow the eye to dry out and create an irritated dry eye possibly, and this could last a few months. With the significant pouches you demonstrate in the photograph, I don’t think laser would help that much. It is possible, if these are relatively new for you, that the lightening cream you’re using is stimulating the swelling. Some people get significantly irritated, and some allergic to the hydroquinone which is a common lightening ingredient. This will cause swelling. Try to avoid the lightening cream for at least four weeks. If the swelling decreases, then the lines will look better. Some lasers can improve the texture of the skin but they would not be expected to help the pouches you have. Surgical removal might not address the underlying problem and it may recur.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
5.0 out of 5 stars 33 reviews

There are options for eye wrinkles that work differently

Restylane is a filler and can be used to fill in the lost volume that is really the cause of the majority of the reason why your lower eyelid looks the way it does. Fat injections, the YoungLift, Juvederm, Perlane, Radiesse are other fillers that can be filled into the lower eyelid area. The temporary fillers last from 6 months (restylane) to a year or more (radiesse) with perlane and juvederm in between. Fat injections can last much longer but this isn't guaranteed but is the best shot for a long term correction.

Botox prevents the muscle around the eyes from squinting which can make the wrinkles less noticeable. Dysport is a great option. But these do nothing for the surface quality of the skin and neither does the filler. But the fillers can decrease the amount of wrinkles by filling up the volume.

This is where the laser or other resurfacing procedure can help with by decreasing the wrinkles and actually tightening the skin. A small amount of volumizing also occurs with lasers with their creating of a thin collagen layer deep to the skin.

I hope that helps some!

Philip Young, MD
Bellevue Facial Plastic Surgeon
3.5 out of 5 stars 43 reviews

Those Darn Lower Eyelid Wrinkles

Hi Go Go,

Restylane is good for filling the hollows under the lower lids. Botox in very low doses placed along the lower lash line will help a little with the wrinkles.

Fraxel repair laser works very well in many patients (almost as good as surgical blepharoplasty), in other patients it just helps a little.

Lastly, if all else fails, a skin pinch under local anesthesia will remove some of the lax skin.

Above all, choose your physician most carefully.

Good luck and be well.

Dr. P

Michael A. Persky, MD
Encino Facial Plastic Surgeon
5.0 out of 5 stars 28 reviews

Surgery Best for Lower Eyelid Wrinkles

Surgery (Blepharoplasty) remains to be the best option for reducing wrinkles in the lower eyelid. After that laser resurfacing or chemical peel would be the second best option. Fillers in that area are not good, they are only good for tear trough area. Botox can help some but not enough as too much Botox can cause saggy eyelids.


Tanveer Janjua, MD
Bedminster Facial Plastic Surgeon
5.0 out of 5 stars 31 reviews

Lower eyelid wrinkles.

This is a difficult problem because it appears that there are multiple associated conditions. There appears to be true hyperpigmentation but that may be due to the photograph. A light chemical peel or laser treatment could improve this. Botulinum Toxin may help the hyperdynamic component as well. Surgery with skin redraping may ultimately be your best solution. I do not see a role for fillers such as juvederm or restylane.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 58 reviews

Restylane, Botox, or Laser Treatment for Under Eye Wrinkles?

your description and photo don't match. the lady in the photo should consider surgical options as well. laser is not going to help you. I'm all for retin-A and good skin care but the photo looks like a blepharoplsaty preop picture. see a good surgeon and take the guesswork out of it. if you don't agree, then get a second and third opinion. but an exam is essential.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon
5.0 out of 5 stars 1 review

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.