Dynamic wrinkles/creasing under eyes (when smiling) - possible treatments? (Photo)

I am 31 y/o and have noticed in the past 1-2 years that the dynamic wrinkles under my eyes have increased and become pretty pronounced when I smile. I have not (yet) developed notable static wrinkles, but I do have a fairly deep, dark tear trough. It seems like botox under the eyes is controversial because it can potentially affect lower eyelid, smile, etc. And maybe it's not always effective. I am hoping to get thoughts this as well as any other possible treatments for me and associated risks.

Doctor Answers 5

Under eye wrinkles

Botox can be injected laterally and extended a little under the eyes to help with the wrinkles.  You can also consider a filler like Restylane to help fill in your tear troughs.  I would schedule a consultation with a plastic surgeon to determine the treatments that would be best for you.

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Laser Resurfacing, Clear+Brilliant, Micropen, Viva, Ultherapy/Thermage

Eyelid skin improvement requires lasers, microneedling/prp, fillers and sometimes botox. I suggest you see an expert. Skin care makes the darkness appear less as well.  Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews

Smile lines under the eyes

Dear bradnsmith1:These wrinkles that occur only when you smile are due to excess activity of the portion or the periorbital muscle just under your eye. By placing only one or two units of concentrated Botox (100 units per ml) just under each eye one can avoid side effects such as ectropion or migration to other muscles.Tightening the eyelid skin using a bulk heating device such as Pellevé may augment the result and prevent further wrinkling in the future.  All the best,  Dr. Clark

Sheryl D. Clark, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Lines under eyes

I have had good results with placing a very small amount of botox under the eye & when needed in the crow's feet region. Also I frequently use a skin resurfacing treatment (such as erbium or fractional Co2 laser) or microneedling  to tighten the skin under the eye. Good luck. Best, Dr H 

Sanaz Harirchian, MD
Houston Facial Plastic Surgeon
5.0 out of 5 stars 11 reviews

Under Eye Botox

Thank you for your question. I have had great success treating the lower lids with Botox. It will not completely rid the wrinkles of your lower lids but has the potential to dramatically improve them. You are correct that this is not a simple procedure and it must be done by someone with experience in this anatomical region. I typically do only 1 - 2 units per eye, very diluted. The main complication of this treatment is ectropion, or a sagging eye. It is rare in young individuals with good skin tone. Most importantly if this occurs it will resolve as the Botox effect fades.

Anthony J. Wilson, MD
Portsmouth Physician
5.0 out of 5 stars 5 reviews

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