Any suggestions for under eye hollows and deep smile wrinkles? (photos)

Question

Hi, I'm 44 years old, and my eyes make me look much older than I am. I have hollows as you can see in the photo. The bigger problem, though, is deep wrinkles when I smile (you can also see from the photo). What are my options? Thank you!

Jed H. Horowitz, MD, FACS · Answer

Hollow aging eyelids and #deepwrinklesCombined therapy with resurfacing, muscle repositioning , fillers and botox  will help

Manish H. Shah, MD, FACS · Answer

Hello Eyequestion,Thank you for your inquiry.In my eyelid surgery patient population, your question is very common.As we age, bone around the eye recedes making fat protrude and creating the mix of hollow and over filled appearances.  The added bonus is that skin that used to be tight has lost collagen and elastin, creating big wrinkles with smiling.One option that I offer to patients is the following combination: 1. fat repositioning blepharoplasty with orbicularis muscle repositioning and skin tightening, 2. crow's foot area Botox every 3-4 months, and 3. anti-aging eyecreams.  This series of modalities addresses every aspect of your current situation.The rest is up to you.  That means good sunblock, oral vitamin C for collagen creation, and bone building supplements to keep your bone mass as strong as possible as you age.I hope this helped?Warmest regards,Dr. Shah

John Q. Cook, MD · Answer

HelloAs we age the area beneath the lower eyelid becomes hollow.  Some people refer to this as the tear trough.  It is important for you to have a complete examination by an experienced eyelid specialist, such as a board certified plastic surgeon to sort out your treatment options.  From the pictures you have provided it might be wise to start with something relatively simple.  This might very well be a combination of volume restoration with your own fat or with fillers and a relaxant such as Botox to soften excess muscle activity.  These are high skill procedures that require an experienced surgeon with good artistic judgement.  Best of luck

Robert Singer, MD · Answer

Most expert experienced
artistic plastic surgeons have a variety of procedures, both non-surgical and
surgical, at their disposal to produce excellent cosmetic results in the
appropriately selected patient: temporary fillers, micro-fat grafts, Botox or Dysport, and
blepharoplasties. Each has benefits and drawbacks and depends on desired
outcome and individual anatomy.

In a patient with your inherited anatomy, a
blepharoplasty including micro-fat grafts to the tear
troughs will produce the best and longest lasting cosmetic result.

Following the advice of anyone who would presume to tell you what to do without
seeing photos and without taking a full medical history, examining you, feeling
and assessing your tissue tone, discussing your desired outcome and fully
informing you about the pros and cons of each option would not be in your best
interest. Find a plastic surgeon that you are comfortable with and one that you
trust and listen to his or her advice. The surgeon should be certified by the
American Board of Plastic Surgery and ideally a member of the American Society
for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with
that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

James H. Scheu, MD, FACS (retired) · Answer

Thank you for your question and the photos. I do not see much in the way of lower lid "bags", but cannot see the full extent of the eyelids either. The tendency of the lids to look "hollow" though, tells me you would be a good candidate for adding some contour enhancement.  I think that the careful addition of some of your own fat from another area in your body could "fill in" the contour nicely. The other option would be the use of a "filler" injectable,  and there are several different products which are available. There are pros and cons to each of these options, so I recommend you consult with a board-certified plastic surgeon.  As far as the wrinkles are concerned, since you only see them with smiling, this means they are what we call "dynamic" lines (not present without muscle action beneath the skin), and this type of line, if not improved with the addition of the fat or filler, could be treated with some "Botox" injections (but we almost never use "Botox" in the eyelid muscles farther in than the level of the pupils). The last option would be to have laser resurfacing, and there are several available (I recommend the CO2 fractional laser), so, once again, have a thorough exam/consultation with a plastic surgeon to discuss your goals and evaluate the options best suited to your situation. Good luck!

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