Dear Vivy
It is very important for you to understand that there is no single best treatment for your crows feet and lower eyelid lines. Or for anyone's crows feet and lower eyelid lines for that matter. It is critical to understand that our needs and what is needed to address these concerns also change over time. What was unnecessary or over aggressive at one point in time might be essential at another time. How you feel about treatment approaches and what types of things you can afford, have recovery time for, and are comfortable with are also very important. So the simple answer is that the safest, most affordable approach tailored for your needs and concerns is the best approach. This will vary with the surgeon you are seeing as there is a unique chemistry between each and every patient and their doctors that influences what solutions make sense and work for you. I am not looking to get Zen here, I just want to emphasize that "Best" is a very fluid concept.
WIthin this clinical frame work, there are a range of options. It is critical for you and your surgeon to think long term about your needs. It is not enough to have a fix that works for the next 6 months. It is also important to think about the next 30 years. Treatments that use up facial resources (fancy doctor speak for damage) should always be avoided in favor of treatments that are less invasive.
For relatively mild changes, treatments like BOTOX and under eye Restylane are powerful treatments that provide results that rival or are better than surgical results. They do not last forever. BOTOX lasts 4 to 6 months and Restylane treatment lasts about a year. However, they do not require surgery or down-time and if there is ever an issue with a treatment, the effects are going to wear off or in the case of Restylane, can be dissolved with hyaluronidase. Yes over time the costs of these treatments can be more than the cost of surgery. However, because there is essentially no risk of damaging the face, there is tremendous value in these services (Don't you think that Daryl Hannah wishes her services could wear off?).
The next step in my arsenal very much depends on the individual situation. It might be a phenol chemical peel for the right situation. This might be combined with an arcus marginalis release to address fullness in the lower eyelid. The point is that the treatment approach must be individualized. I would caution you to avoid the early adopter trap: you see a brand new treatment on a talk show and the next day you are scheduling a consultation with someone offering that service. It is a good bet that how that service will be viewed will be very different with a little time. That is true of virtually all the technologies that have been introduced to aesthetic medicine. Let other be cut on the leading edge.
Do your home work regarding your surgeon. Yes credentials are important but understand what those credentials mean. For the services you are interested, you would do well with any of the core specialties: derm, plastic surgery, facial plastics, and oculoplastics. The key is don't let yourself get pushed into a service that you are not comfortable with. Try the work of the surgeon by seeing how things go with minimally invasive services like BOTOX and Restylane. Believe me, if the doctor is not good at these treatments he or she will also not be great for the surgeries either.
Please share your experiences with the RealSelf community once you have decided on treatment.
