Restylane, Botox, or Laser Treatment for Under Eye Wrinkles?

Hi there! I just turned 40 and noticed these horrible wrinkles under my eyes when I smile. They are just fine lines when not smiling. I don't really have deep troughs or hollows--just bad smile wrinkles, perhaps due to bleaching creams for dark circles, or lack of sleep over the years.

Nowadays, the concealer sinks into the wrinkle and looks really bad! I am trying to see what procedure is best for me. Which treatment is better among Restylane, Botox and laser treatment? I am desperate for help and guidance. Thank you!

Doctor Answers 22

Combination approach for under-eye wrinkling

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For my patients with under-eye wrinkling, I have a combination of treatments, the first of which involves a laser to improve skin quality, decrease the wrinkles and improve the color. I generally use two laser light devices: an intense pulsed light treatment (IPL) device and an Erbium laser micropeel. Done over a series, it will require anywhere from 2-4 treatments, depending upon the extent of wrinkling and your own personal response to the lasering. This is then followed by a small amount of BOTOX in the lower eyelids.

I use fillers only if the above regimen does not create enough improvement. The reason I don’t immediately opt for fillers is that they don’t eliminate the wrinkles, and fillers do nothing to improve color.

New York Dermatologic Surgeon
3.3 out of 5 stars 4 reviews

Botox for under eye wrinkles

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Thank you for your question and for sharing your photo. Botox may help to soften the wrinkles under the eyes. It does require a very small amount and it will help to soften the lines. It will not necessarily reduce all the wrinkles like you might see in the forehead or crows feet region. You will notice a soft relaxation of the dynamic lines under the eyes, and you may notice a slight opening of the eyes. I would start with 1-2 units under the eyes on each side. If you like the effects, then it is very easy to incorporate this into your future treatments.

Dermal fillers such as Restylane can be used to fill in shadows under the eye and achieves a more rested look. You can combine the two treatments but it would require a thoughtful approach and careful analysis of your concerns to ensure that treatment options will help you achieve your goals.

I would recommend visiting with a board certified plastic surgeon in your area to address your concern as it is an advanced area to treat.  In addition, a plastic surgeon will be able to discuss surgical alternatives.

Best Option for Under Eye Wrinkles?

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Hi GoGo.  While we have the option of suggesting injections, lasers or surgery at our practice, for you, we would have to recommend surgery.  Lasers and injections are not going to fix your problems because of the amount of skin and the laxity (looseness).  

A lower blepharoplasty surgery would be our recommendation.  Good luck.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

Lower Eyelid Wrinkles

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Dynamic wrinkles are much more difficult to deal with than static wrinkles. The reason is if you have severe static lower eyelid wrinkles then removal of skin will help. This can't be done with dynamic wrinkles. I recommend starting in a conservative, cheaper way first. Start with a good peel and follow it with tretinoin (Retin-A). If that doesn't give you enough improvement then I would recommend CO2 laser. I don't think fractionated CO2 really does all that so I wouldn't waste my time.

Under Eye Wrinkles and Botox, Thermage, eMatrix, Restylane, Fraxel, Retinoids

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From the photos it seems that you have wrinkles/skin laxity in that area.  I would try some simple non-invasive ways first such as the eMatrix laser for winkles combined with the Thermage for skin tightening.  The eMatrix has a special hand piece for under eye wrinkles and generally takes three treatments spaced one month apart to see improvement.  Botox will help with Crow's feet and fillers for the tear trough but I would not suggest that to you for the under eye area based on your photos.  If nothing works then you will only have a surgical treatment left to consider.  Please consult an expert in this delicate under eye area.  Best, Dr. Green

Treatment of the lower eyelids

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Although some patients derive benefit from Botulinum toxin as an off-label use, when injected in the lower eyelid skin, it is done sparingly and closer to the eyelashes. The whole lower eyelid extending to the tear trough (the lowest crease between the eyelid and cheek skin) is not injected as that would cause a weakening of the muscle pump action and swelling or puffiness could increase. Furthermore there might not be enough strength of the muscle to keep the eyelid against the eye and the fallen eyelid would allow the eye to dry out and create an irritated dry eye possibly, and this could last a few months. With the significant pouches you demonstrate in the photograph, I don’t think laser would help that much. It is possible, if these are relatively new for you, that the lightening cream you’re using is stimulating the swelling. Some people get significantly irritated, and some allergic to the hydroquinone which is a common lightening ingredient. This will cause swelling. Try to avoid the lightening cream for at least four weeks. If the swelling decreases, then the lines will look better. Some lasers can improve the texture of the skin but they would not be expected to help the pouches you have. Surgical removal might not address the underlying problem and it may recur.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Best treatment for wrinkles under the eyes

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As women reach their late 30s and early 40s they start seeing more wrinkles under their eyes than ever before. This appearance is very bothersome for many women, but luckily there are a few treatment options available to help decrease and remove the appearance of these wrinkles. In my practice I usually recommend Restylane under the eyes or Voluma in the cheeks to restore volume and create a naturally youthful appearance. If fillers will not do enough to improve the appearance, then a surgical lower eyelid lift (blepharoplasty) may be best to truly give you the results you want. While you did provide a picture of your eyes, I like to examine a patient's entire face, as I take a more comprehensive approach when treating the face and want to make sure whatever treatments I perform make the entire face look better. The best and most natural looking results are achieved when we take a holistic approach to facial rejuvenation. Good luck! 

Jimmy S. Firouz, MD, FACS
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 18 reviews

Lower eyelid wrinkles.

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This is a difficult problem because it appears that there are multiple associated conditions. There appears to be true hyperpigmentation but that may be due to the photograph. A light chemical peel or laser treatment could improve this. Botulinum Toxin may help the hyperdynamic component as well. Surgery with skin redraping may ultimately be your best solution. I do not see a role for fillers such as juvederm or restylane.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Fractional Laser is the best option

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When it comes to fine lines under the eyes, the best method to use is the laser. The laser that would work best for you is the Fractional Laser. This type of laser stimulates the collagen production under your skin, In our clinic we recommend getting between 3 to 5 treatments. Botox will not help under the eyes, because it is used for other areas in the face such as crows feet lines and Fillers are only helpful if you have loss of volume. The Fractional Laser fits your situation perfectly. 

Restylane, Botox, or Laser Treatment for under eye wrinkles

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In certain patients, any of these might be the right answer. Based on the photo provided, a combination of blepharoplasty surgery and/or laser treatment such as fractional CO2 might be the best options. Fillers like Restylane are unlikely to improve the skin laxity and muscle activity seen in the photo. Botox is an option for lower eyelid wrinkles, but can sometimes worsen the overall appearance of the lower eyelid complex. A good skin care regimen is also important and can be focused to address the problem areas of the lower eyelids as well.

All the best,

Matthew Richardson, MD
Frisco Facial Plastic Surgeon
5.0 out of 5 stars 7 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.