What can be done about under eye creases? Genetic not age related

You are correct that the lines on your lower lids are not age-related wrinkles but instead are normal creases.  These creases are a sign of youth, and often, they fade with age.  Medically speaking, the lower eyelid creases represent an attachment between your lower eyelid muscles (retractors) and your eyelid skin.  Botox injections may reduce the roll you see above the crease (but they may also widen the eye opening at the same time).  Surgery (I wouldn't necessarily recommend this for you) can reduce the crease but would also create a scar on your lower eyelid. Based on your photos I would consider leaving your lower eyelid "youth creases" alone.  You may find yourself missing them after they're gone!

whatever option you may decide upon just make sure its not the most aggressive one. perhaps start with Botox and see how much improvement you get and then consider other options.

The best nonsurgical options for this is botox, laser, and sometimes fillers (very small amounts).  I suggest an in person consultation with a dermatologic surgeon who has expertise in this area.  I would avoid any surgical options, scarring in this area looks worse than the wrinkles you are showing.  Best, Dr. Emer.

Thank you for your question. Your analysis is correct and that the appearance of your lower eyelid is a genetic trait rather than being an age related change. Although there is a crease it forms a youthful eyelid cheek junction and I do not feel it detracts from the appearance of your eyes. As it is not related to excess skin or fat mal-positioning I would be conservative in the treatments offered. You could try a small amount of botox in the lower lid or a filler such as belotero - best of luck.RegardsDr Guy Watts 

It's important to realize that not all wrinkles can be removed from the lower lids with any technique, especially when you are smiling.  I would try small dose Botox injections under the lashes first and see if you are satisfied with the result.  If you wanted to be more aggressive, you could consider surgically removing a very small amount of skin and orbicularis muscle (after the Botox wears off so that the eyelid can withstand the incisional surgery safely).  Just remember, even though you can expect an improvement with either technique, the results cannot be guaranteed to be picture perfect in everyone.