Eye Bunching and under eye wrinkles when smiling - what procedure would correct this?

Question

What procedure(s) would correct this? I've already done co2 twice & do Botox/microneedling w/PRP regularly & nothing helps. I've been to 4 oculoplastic surgeons & they all say I'm not a candidate for a lower Bleph. I had a lower smas lift 3 years ago & noticed it got worse after that. I definitely need a redo but was wondering if a cheek lift or temporal lift would help? I hate smiling & always wear glasses to cover my eyes. I also have ridges under my eyes from past filler from 4 yrs ago

Nelson Lee Novick, MD · Answer

The problems you here are far from unusual in any active cosmetic dermatology practice. I have found that the periorbital "eye bunching" can be significantly improved by injecting a low viscosity, cohesive, malleable HA filler in a fanning fashion beneath and at right angles to the folds. In this way, the filler acts as a kind of buttress, thereby diminishing the prominence of the folds with smiling. As to the ridges below the eyes related to the prior filler treatment, these usually result from the use of an inapporpriate choice of filler and/or too superficial placement of the filler, which gives rise to lymphatic obstruction and the formation of what has come to be called under-eye "puffy pillows."  These are generally very difficult to treat. However, I have been able to achieve gratifying improvement using an algorithm of intralesional injections of anti-inflammatory agents in varying combinations, concentartions and amounts. You would be wise to consult an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Randal Haworth, MD, FACS · Answer

If this resulted from your past facelift, it is clear to me that your skin of your upper cheek and lateral eye needs to be redraped more superiorly into your temple region.

I hope this helps,
best of luck !

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Eye Bunching and under eye wrinkles when smiling - what procedure would correct this?

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