Can I fix under eye wrinkles when smiling? (Photo)

I had my eyes done 13 years ago when I smile the wrinkles are awful and my doctors says botox won't help.

Doctor Answers (1)

Improving the skin quality with regenerative medicine before any thermal wrinkle treatments because you appear to have thin skin

+2
As a cosmetic oculofacial plastic surgeon practicing for over 20 years, one of most challenging issues is skin quality under the eyes. Eyelid skin is the thinnest skin in the body - it’s half a millimeter in thickness, and as we get older and with many environmental challenges, the skin quality becomes diminished.

Prior to the 90s, there were chemical peels. During the 90s, the solution was some type of thermal energy treatment. First it was the CO2 laser then it became the erbium laser. Then different types of lasers developed over the past several years until the advent of fractional lasers. These all use heat to stimulate collagen generation. Recently, radio frequency has been the rage.

As we age, skin diminishes at many different levels. In my practice, I have been frustrated of not being able to heat the skin enough to get the quality we want. Overheating the skin not only results in potential scarring but it has been my observation that many people who have had laser treatments, their skin gets thinner. I’m not going to offer you the typical solution that uses lasers.

In our practice, we have been using a material called platelet-rich plasma. Platelet-rich plasma is your blood and the growth factors that are critical for healing are isolated. It is done in our office by a simple blood draw and we spin down the blood and inject this platelet-rich plasma on your skin. We have observed that the quality of the skin improves.

As long as you’re smiling or moving, you’re going to have wrinkles under your eyes. Improving the skin quality with platelet-rich plasma stimulates new blood vessels, new collagen as well as improves the skin quality at a multiple levels. It activates your own stem cells that are distinctively different from the effect of thermal energy. It has become my routine to actually do platelet-rich plasma for our patients prior to doing any thermal energy when it’s appropriate.

Looking at the photo you submitted, your skin looks very thin. So, in the combination approach of a neurotoxin like Botox and the use of thermal energy like fractional CO2, I would probably do platelet-rich plasma and allow a gap of 3-4 months between treatments to see how much of the skin quality we can improve. That would be my approach as part of the overall game plan.

Youth and smoothness don’t necessarily go together. Improvement of the quality of the skin and getting this glow is very unique with platelet-rich plasma that we've achieved with our patients. As you do your research, you would have probably come across a solution, but you can at least learn to categorize what those solutions are. Too many people are chasing the latest and most hyped laser. It is my opinion that too much heat is being generated these days in the pursuit of smoothing out skin. Know that there are some alternatives that can hopefully guide you in making a decision that would helpful to you in the long run. I hope that was helpful, I wish you the best of luck, and thank you for your question.


New York Oculoplastic Surgeon
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