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What Can I Do to Improve Undereye Wrinkles when Smiling? Kind of Like an Accordion Under my Eyes when I Smile?

I know there are so many potential ways to address this problem - Botox, fillers, lasers, etc. Is this a skin texture problem or fullness issue?

Update: Photo added.

Doctor Answers (17)

Undereye wrinkles

+2

When evaluating wrinkles it is important to analyze whether they have a component due to underlying muscle motion.  Eyelid wrinkles that have a component due to muscle motion usually improve when treated with a neuromodulator.  There are three neuromodulators currently available in the U.S.: Botox(R), Dysport(R), and Xeomin(R).  Currently Xeomin has only limited availability but there should be greater availability in 2013.

Eyelid wrinkles can have more than one cause and may also benefit from fractional ablative resurfacing such as with a fractionated carbon dioxide (CO2) laser.

For some patients the best result can be obtained by sequential treatment with a combination of a neuromodulator and a fractional CO2 resurfacing laser.

If you decide to have treatment for these eyelid wrinkles it is best to see a physician who has significant experience and expertise in relation to eyelid wrinkles, neuromodulators and  fractional scarbon dioxide laser resurfacing. 

In your question you asked whether it is a fullness issue.  Typically people with fullness issues have visible depressions or volume loss.  Fullness issues do not usually cause wrinkles when smiling. It should be noted that it is not possible to decide if there is a fullness component to your problem without examining you.

 

 


Summit Facial Plastic Surgeon

Improving undereye Wrinkles

+2

Skin wrinkles under the eye can be addressed with fillers, most commonly Restylane, because it is a smaller molecule.

In the past we have also used Fat injections to fill the eye hollows and improve eye wrinkles.

 

In some cases you can also use dysport to freeze and soften wrinkles around the eye.

 

It is most likely a volume loss in the area that is causing the skin to wrinkle, however I would need to see pictures to judge more completely.

 

Hope this was helpful!

 

Dr. Young

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.0 out of 5 stars 38 reviews

What Can I Do to Improve Undereye Wrinkles when Smiling? Kind of Like an Accordion Under my Eyes when I Smile?

+1

Applying Botox would help relax the muscles and soften fine lines around the eyes, you may need a filler like Belotero for deep creases. For a long term result you may want to consider having a lower blephorplasty. Seek a reputable medical provider who can ensure a result you want to achieve.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
5.0 out of 5 stars 230 reviews

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Combining Volumizing Fillers, Fillers, And Neuromodulators Can Nonsurgically Rejuvenate The Eyes and Eyebrows

+1

The upper inner cheek region, i.e. that inner area immediately under the eye and extending diagonally upward and inward toward the inner angle of the eye, plays an important role in supporting the lower lid. Loss of fat and downward displacement of the remnant of the upper cheek fad pad with age contribute to wrinkling and tear trough formation (and even dark circles) under the eyes.


Revolumizing that region nonsurgically with the use of injectable volumizing fillers, such as Radiesse and Perlane L (or a combination of these agents) can go far to reestablishing the buttressing to the lower lid and diminishing wrinkles and crinkles. In experienced hands, the procedure takes about five minutes per eye. If necessary, tiny droplets of Restylane L or Belotero Balance may be layered above this region to further smoothe the undereye area and diminish the crepeyness. If there is drooping of the brow over the upper lid and falling of the outer third of the eyebrow, a volumizing filler may be injected to restore the outward projection to the outer third of the eyebrow and to lift the brow off the upper lid. 


When there is accompanying hypertrophy of the thin muscles under the eyes, the additional injection of a microdroplets of a neuromodulator, such as Botox, Dysport or Xeomin, can diminish this effect and further improve the lid area immediately under the eye. Likewise, if there are significant crow's feet wrinkles, these can be easily dealt with by very superficial instillation of any of these neuromodulators. When needed, an additional lift to the lateral third of the eyebrows can be achieved with a drop of neuromodulator placed right into the tails of the eyebrows. 


Nonsurgically rejuvenating the periorbital region should only be performed by a board certified aesthetic physician with extensive experience in treating these areas. Because of the profound cosmetic impact that can result from treating the eye region, be sure to insist upon seeing the befores and afters of any physician that you consider.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Under eye wrinkles can be treated with combination Dysport and Restylane

+1

 Wrinkles like these are not that simple to tackle with nowe type of treatment but a good combination can give you good results. I would use Dysport  or Botox to relax the wrinkles and stop those that occur from movement. I would then use a filler such as Restylane or Belatero to add some volume to the area to decrease the folding

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 12 reviews

Wrinkles around and under eyes

+1

There are several treatments that address different aspects of your problem. Some of your wrinkles are dynamic, meaning they worsen with movements and some are due to the looseness of your skin around your eyes.    Neurotoxins such as Botox or Dysport work by weakening part of the circular muscle that surrounds your eye.  Partially weakening this muscle will reduce the "crows feet" wrinkles that form when you smile.  You also have laxity in the skin under the eyes that appears more noticeable when you smile and bunch it up. Either a chemical peel or laser resurfacing can be performed to improve the wrinkles that are present even when you are not smiling by tightening the skin and improving the overall texture. 

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Lower eyelid wrinkles are caused by one of three things: muscular tone/contraction, volume loss, or creepy skin. I

+1
  1. If you are relatively young and the wrinkles disappear when you aren't squinting or smiling , the lines are caused by muscular contraction and can be treated with a neuromodulator like Dysport or Botox.  If the wrinkles don't disappear with relaxation and there are minimal lines, fillers can be used to restore volume to the area.  If the skin has significant wrinkles with creepy skin, the skin needs to be tightened to reduce the crepiness and or redundant skin.  You would need to be seen in consultation to determine which procedure would be best for you.  Normally, CO2 laser resurfacing (either full CO2 or fractionated CO2 resurfacing) or excision of the excessive skin (lower eyelid blepharoplasty) is required.  

Carla R. Retief, MD
Nashville Dermatologic Surgeon
3.5 out of 5 stars 6 reviews

Hello

+1

 

 

Thank you for your question, yes you have a few options to get rid of the wrinkles and excess skin. You can do lasers, that will improve but it will not be long lasting results. For best results it would be a Blepharoplasty (eyelid tuck) that will remove the fatty deposits and excess skin. That surgery in itself will take away about ten years from your face. It is surgery and it is longer lasting results. Fillers cannot correct any of your issues. You should go to a Certified PS to get your options. Good Luck

 

Stuart B. Kincaid, MD, FACS
San Diego Plastic Surgeon
4.5 out of 5 stars 7 reviews

What to do for wrinkles under the eyes

+1

We have had a great deal of success having our patients use NeoCutis Lumiere Bio-restorative Eye Cream for treating under eye wrinkles. Several well done studies reported significant improvement in color, texture, sagging, and wrinkles under the eyes when used twice daily.

Mitchell Schwartz, MD
South Burlington Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Aging Eyes - Multiple causes and treatments

+1

Basically there is aging of the Periorbita (eyelids and tissues surrounding the eyes including the mid-face)

I would look at the smiling and non smiling appearance to determine the options and priorities.

For a non surgical choice, Botox to the squint/smile lines and a small amount to the muscle below the lashes may get you to your goal. If there is still a sunken area between the cheek skin and the lower lid then a filler would offer additional help. If there are still wrinkles and crepe loose, skin laser resurfacing is another choice.   

Richard W. Maloney, MD
Naples Facial Plastic Surgeon
4.0 out of 5 stars 4 reviews

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.