Treatment for Under Eye Wrinkles While Smiling?

What is the best treatment for under eye wrinkles when you smile

Doctor Answers 4

Botox and fillers are effective in treating under eye wrinkles

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In order to treat under eye wrinkles, one has to understand the causes:

  • Thinning out of collagen creaking more crepe skin appearance
  • Loss of volume beneath the skin results in a relative excess of skin
  • Increased resting tone in the lower eyelid muscles from a) can be caused by Botox when injected only in outer part of eye lid and the area under the eyelashes compensates by squeezing harder and creating more lines b) vs. natural increase in muscle tone in the face with age.

Treatment depends on the cause and usually a combination of treatments

  • Botox injections help with the over expression of of the eye lid muscles. Should also be injected in low dosages under the eye lashes if indicated to avoid a compensatory over expression in that area.
  • Fillers to replace lost volume under the eyelid using Sculptra, Juvederm, Restylane or fat.
  • Laser skin resurfacing if the skin has thinned out and become crepe i.e. Fraxel re:pair or Fraxel re:restore
  • Lower Blepharoplasty (eye lift) for more extreme cases.

Manhattan Facial Plastic Surgeon
4.9 out of 5 stars 158 reviews

Botox helps to soften the appearance of smile lines.

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If the lines worsen with smiling Botox may help soften the appearance of these lines by diminishing the underlying muscle activity. Unfortunately if they are associated with smiling, it is likely that they will recur.


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

Unlike crow's feet, under eye wrinkles are difficult to treat.

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Most lines in the upper third of your face that appear with smiling will soften with BOTOX. I have found these under eye wrinkles particularly difficult to eliminate with BOTOX. And this delicate skin is too thin to use Injectable Fillers.

I like to check all of my BOTOX patients around one week following their treatment. I have added BOTOX to these stubbron under-eye wrinkles so many times with only marginal improvement.

This area is called the "orbicularis-roll", and I have not found a great way to minimize these wrinkles. In fact, since the crow's feet respond so well, these wrinkles may look more prominent after a BOTOX treatment.

The reality is that these wrinkles are not unattractive, and are seen in youthful smiling faces.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

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Under eye wrinkles

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Under eye wrinkles are not such a problem as some patients think because the observer is seeing someone smile at them. This is a pleasing experience so the observer is not at all critical of the lines.

Since they are muscle related, the only way to soften them is with Botox. You can smoothe the skin with lasers or peels also but the wrinkles will come back after the muscles start to work on the skin again.

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.