Ask a doctor

Best Treatment for Under Eye Loose Skin and Wrinkles? (photo)

Can you please advice on the best treatment for my under eye loose skin and wrinkles. I am 40 years old, They only form when I smile, but then seems to take over much of my appearance. I have also lost a lot of volume in my face, despite no major weight loss. I have dry eyes and I am also worried about the pulling down of the lower eyelid that seems to sometimes (often?) be the result from lower bleph. I would appreciate your opinions!

Doctor Answers 17

Aging Eyes

I agree with much of what has already been written.  Dr. Atkins in our office, cosmetic dermatologist,  has another opinion and after seeing these pictures she suggested these options.

The lower lid is thin and fragile, so if you elect for surgery make sure you work with a board certified surgeon that does alot of these procedures. Also ask to see before and after pictures. 


  • There are lasers that could help improve the lower lid for skin tightening, and while someone did suggest the Co2, I find that this laser could leave your skin very red for a long period of time.  Therefore, this is not my favorite.  I do like the Er-Yag fractionated laser in this area, as it is not as aggressive and therefore not likely to leave the area as red.
  • The Exilis laser at the lower lid line operated only by your doctor gets great results in skin tightening.  This should never be turned over to a technician or a nurse, as the area is too close to the eye.
  • Then, you need a good eye cream.  Oil of Olay makes a good one for this region, Regenerist. Make sure you get the cream for the eye and not face.  What I find is that when products are designed for the eye they are more carefully tested for allergies, etc.  Or you could go see your dermatologist or see us online for a product called Teamine by Revision.  This product is a little bit more pricy but the ingredients are full of peptides and antioxidants that will help to revive the skin. Revision also makes a Teamine concealer for those late nights.
  • Finally, mix all of that up with Botox and this will give you the best result.

Most importantly see a qualified Facial Plastic Surgeon, Plastic Surgeon or Cosmetic Dermatologist for the best results.  Care in the wrong hands would become a nightmare!  Good Luck

Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

1232 Johnson Ferry Road
Marietta, GA 30068

You can't treat animation artifacts with surgery

You are correct in that your lower lids are a very fragile area and need to be treated with the utmost respect as any aggressive treatment can lead to disasterous complications. The only thing treatments like surgery and lasers can do is to make you look good at rest - but you already do.  The best thing to do for your animation artifact is to use some judicious Botox to soften the strength of the muscles causing the wrinkles.  But realize that nobody looking at you smiling back at them will be looking critically at those wrinkles :)

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.5 out of 5 stars 58 reviews

1135 116th Ave. NE
Bellevue, WA 98004

Best Treatment for Undereye Loose Skin and Wrinkles

Hi U,

Properly placed Botox or Dysport will be very helpful.  I have found that a combination of first using Ulthera (micro-focused ultra-sound) over the inferior orbital bony rim immediately followed by fractional CO2 laser (Fraxel repair) has resulted in impressive improvement.  As you noted, augmenting the volume in your face would also be overall helpful.  Most importantly choose your treating 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

16311 Ventura Blvd
Encino, CA 91436

There are a number of ways to treat under-eye wrinkles

Botox can relax the muscles that make wrinkles when you smile. However if you have early or inherited "eye bags" relaxing the muscles under the eyes might make the bags look bigger since the muscle isn't holding the fat back any more. Other treatments include chemical peels, lasers and even surgery. Blepharoplasty is designed to smooth and improve the lower eyelids.

Steven J. Pearlman, MD
New York Facial Plastic Surgeon
5.0 out of 5 stars 61 reviews

521 Park Ave
New York, NY 10065

Dynamic lines around the eyes

Looking at the two pictures you provided, its appears that most of your wrinkles form with contraction of the circular muscle around your eye when you smile.  Botox and Dysport injections both work well to reduce the movement of outer part of your muscle to soften the appearance of those lines.  From the picture you have provided, it is hard to assess the volume loss in your face that you mentioned.  There are many fillers such as Restylane and Juvederm that are great for restoring volume in the face.  From your pictures, I don't think that a lower blepharoplasty (eyelid surgery) would be appropriate option for you or accomplish any of your goals.  

Jessica Kulak, MD
Fairfax Facial Plastic Surgeon
4.5 out of 5 stars 19 reviews

5454 Wisconsin Ave
Chevy Chase, MD 20815

Botox for dynamic wrinkling about the eyes, but smooth that crepey skin with a peel

Botox will smooth lines around the eyes that appear when you talk, smile or animate.  This is one of my favorite areas to treat because the eye  still narrows when you smile -so you look natural, like you're smiling with your whole face.  But the corner just doesn't wrinkle up.  That being said, the skin under the eye, being the thinnest skin on the body, thins further with age and takes on a crepey appearance.  This crepey skin wrinkles even more easily when you smile.  A laser or chemical peel to the lower lids, or a no-recovery wrinkle laser like Fraxel ReStore would smooth and firm this skin, helping even further.  

Lawrence Bass, MD
New York Plastic Surgeon
5.0 out of 5 stars 8 reviews

568 Park Ave
New York, NY 10065

Best Treatment for Under Eye Wrinkles When Smiling

Your description of the issue and photographs are very useful. As Plastic surgeons we were trained to approach each person we see by considering a "ladder" of potential solutions (where the lowest and safest rung is doing nothing, the one above is the simplest / least risky yet least likely to result in drastic changes and so on) contrasted to a scale of benefits VS recovery and complications for each treatment.

In your case, I completely agree with my friend Dr. Rand. Careful use of small doses of botox in these areas would smooth the wrinkles on smiling BUT I would see a Plastic surgeon (not an aesthetician, RN etc) to administer the treatment. that should do a great job for the arinles ON ANIMATION. if you wanted to tighten the skin, I would use a Sciton Microlaser peel and Profractional treatment to get a nice result with minimal down time.

Good Luck.

Peter A Aldea, MD
Memphis, TN

Peter A. Aldea, MD
Memphis Plastic Surgeon
5.0 out of 5 stars 81 reviews

6401 Poplar Avenue
Memphis, TN 38119

Best treatment for under eye loose skin and wrinkles?

An appropriate skincare regimen, resurfacing procedures such as peels and lasers, and finally Botox or Dysport injections can address fine wrinkles under the eyes. During an in-person consult, you can discuss your needs with your physician and he/she will determine the best procedure for you. 

For restoring volume in the face, the vampire facelift is a great option. For this procedure, we use PRP, or platelet rich plasma. The PRP is injected into the face, just underneath the skin. Over time, you can get around 10-15% more volume in your face, which can last a few years. It takes about 8 weeks to see. The procedure also gives you a better glow. It helps with your pores and your blemishes, and it gives you overall healthier looking skin.

While your cheeks are full from the PRP injection (cheeks will be full for four or five hours), we also take filler, and will put that in the cheeks and lower eyes. The filler is injected through the same little cannula (hole). The filler will remain for six or seven months. Overall, everything is performed in one procedure that typically only lasts an hour. Please feel free to ask me any specific questions and I would be happy to answer them for you.


Paul S. Nassif, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 37 reviews

120 South Spalding Drive
Beverly Hills, CA 90212

A Combination of Volumizing Fillers and Neuromodulators Work Well For Under-Eye Crinkles and Wrinkles

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 may be layered above this region to further smoothe the undereye area and diminish the crepeyness.

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.

Treating 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 16 reviews

500 E 85th St
New York, NY 10028

Best treatment for under the eyes

Based on the images you've posted, I think a thorough assessment with a well-trained and experienced injector (we have 4 in our office), will help provide you with the best options for a smoother look around your eyes. They will help inform and educate you about all of the products available today that restore volume, smooth out fine lines, and improve this area with prevention care.

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 172 reviews

1110 112th Ave NE
Bellevue, WA 98004

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.