Always Look Tired with Creases and Wrinkles Under my Eyes

Should I go with a filler? I bought creams, and they don't work. What should I do?

Doctor Answers 3

Lower eyelid creases and wrinkles

Patients not desiring surgery benefit most from fillers, chemical peels and Botox.

Patients with a fat bulge often benefit from transconjunctival fat reduction or fat redistribution procedures.

Patients who have loose lower eyelid skin are often candidates for a cheeklift with tightening of the lower eyelid skin. In our practice we do not favor removal of skin from the lower eyelid without commensurate support.

In all surgical cases, we evaluate whether addition of volume, i.e. grafts of fat or untraumatized fascial fat (LiveFill) will be helpful.

As Dr. Rand has indicated, we would need a photograph to guide our recommendations more precisely.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 178 reviews

Lower Eyelid Rejuvenation Requires Careful Consultation

No one treatment is the answer for every lower eyelid concern. In fact I give talks on this subject in which I describe the thought process that I go through when evaluating my own patients.

If the problem is puffiness alone, then the correction involves a transconjunctival (incision free) removal of prolapsed infraorbital fat. If the problem involves puffiness and skin excess or laxity, then the correction may require an incisional blepharoplasty where both fat and skin are removed in a conservative fashion. If the problem is skin excess or sagging alone then, skin removal using a well camouflaged incision below the lashes or a "mini-blepharoplasty" using the pinch technique.

Finally if the problem is simply lines and creases without sagging or excess skin, then resurfacing with either a phenol based chemical peel or a carbon dioxide laser is indicated. We use all of these techniques routinely and sometimes combine techniques when indicated. The lower lids are the most complex area of the face in my opinion and whoever you go to must have all of these "tools" in their "toolbox" or you are in the wrong hands! Conservatism is absolutely mandatory in this area ,however, as complications can and do occur if proper judgement is not exercised.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

We need a picture of you to say what is best

There are many treatments for the lower lids and what is best depends on your anatomy. Fillers are excellent if you have volume loss (tear troughs) and have young healthy skin. They do not work well in older patients with thin skin. Topical treatments, lasers and peels, and surgery are other ways of rejuvenating the eyes. Make sure you go to someone who can offer all treatments so you can sort out which is best for you, not just the only one they offer.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 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.