Kellie Satterfield, MD

Thanks for your question. Botox helps relax muscles -- but muscles don't cause bumps like these. I would recommend seeing an oculoplastic specialist or facial plastic surgeon in person to evaluate for possible cysts/lesions deep in the skin (that if rubbed, can be painful and cause inflammation). Unfortunately, botox isn't the answer, but that doesn't mean there isn't something that can help!

Thanks for your question. The skin under the eye is actually the thinnest on the body! Thus the most sensitive to sun damage. I would recommend first starting with a vitamin-A based derivative such as retinol nightly (building up to nightly over time). This will improve skin texture and tone. Next use a hyaluronic acid based serum to provide hydration to the area every morning (be sure to use on a damp face so the serum uses that water and not water from your skin). If you tried botox and didn't feel the effect was enough, the dose given could have been too little, so consider stepping up the dose. Lastly, if you want big improvement, you need to do laser resurfacing with a laser such as a fractionated CO2 laser. All the best!

Thanks for your question. The area that still has wrinkles that you are seeing is not caused by botox, but is more apparent since the skin next to that area has been treated appropriately. This specific area, right above the lateral brow, is a tough one to treat, because placing neurotoxin here can drop the brow and cause a more heavy sensation of the brows. Most injectors avoid this area because most people tend to be unhappy with a dropped brow. I would talk with your injector about testing tiny doses here to soften these lines and would consider adding under brow botox to lif the brow to counter-act this. All the best!

Thanks for your question. When it comes to filler I would say that it can be done in more subtle ways or more dramatically. The most important answer to your question is filler selection - the wrong filler placed in the wrong area can cause problems and be more prone to migrate. There are also many types of filler - some dissolving (hyaluronic acid based) and some not dissolving (hydroxyapatite based). You are correct in that there are several good research studies that acknowledge that filler can linger in the face and migrate for much longer that we initially gave it credit for -- but this is very dependent on location placed, type of filler, and volume of filler placed. All that being said, I would recommend if you are flirting with the idea of filler, I would start small - you can always add more - and use a filler that is dissolving.

All the best,
Dr. Kellie Satterfield, MD
Seattle, WA

Thanks for your question. Depending on the severity and type of depression, filler can work wonders to build an area back up. The most important choice would be selecting the proper type of filler. Most fillers, if place too close to the surface of the skin, can give off a blue hue - called the Tyndall effect. Filler can be placed deeper if the defect is large. But what I typically recommend for most of these defects is using a laser to drill tiny holes in the area and then fill the defect by rubbing filler into the surface. This is a very effective and targeted way to get volume back to thinned skin. I would caution with chronic steroid injections you may get skin lightening as well which is very challenging to treat- so if you see this forming, I would weight the benefits of the steroid injections vs other treatments such as botox or oral therapies.