Under eye wrinkles, hollows and dark circles. What are my options to restore youth? (photos)

I think that you would see the most benefit from Fat transfer under your eyes and skin resurfacing with a fractional CO2 laser.  There is little pain from this procedure and the recovery period is about 5-7 days.  Botox to the crow's feet is also a good start.  Restylane injections work well also but the results will fade in about 6 months.

Hi Katie.  You are an excellent candidate for tear trough injections under the eyes.  This service is great for patients that do not want to consider surgery, but have volume loss or genetics that cause the under eye are to appear concave.  This concavity can make the area appear darker and contribute to a tired appearance.  Restylane is excellent as a remedy.  Click on the link below to review photos that address the issue with Restylane injections.

I think that a filler , like Restylane, would do exactly what you want. You might get some bruising but otherwise it is very simple.

RF (Radiofrequency) is helpful for the wrinkles, but may take multiple treatments depending on severity of the wrinkles and healing. The IPL and 1064nm Yag laser is best, in my experience, at getting undereye redness and blue/purple veins.  Filler is helpful to lift a hollowed under eye, and fill a tear trough groove, and mask some of the darkness, and I would recommend hyaluronic acid fillers for this - like Restylane, Perlane, Juvederm, all of which I have used with success in this area.  In addition, a little Botox in the mid lower eyelid will help to open the eyes better, and reduce a roll of skin that many of us have in that area.Nowadays, physicians tend to advise the device that they carry in their office, and due to the high cost of these devices, the average cosmetic physician will have only one or two devices to choose from for a given cosmetic problem.  Another factor, is the physicians skill and experience with the device.  At my office, we have over 48 cosmetic devices, and conduct research of these devices for cosmetic treatments.  We have had the most success for mild to moderate periorbital wrinkles with repeat treatments 3-5 of RF or a single more intense treatment (and more downtime) with either fractionated CO2 or Erbium/CO2 laser.  We have also succeeded at eye wrinkle tightening with the gentle Fotona Yag laser, 3-5 treatments, with less downtime than RF, but crucial that it is done by a skilled laser surgeon, as Yag lasers can cause blistering/scarring in the wrong hands.

You have loss of volume around the eye which is best treated with Restylane.  I would recommend using someone that uses blunt cannulas for this injection so the chance of bruising or complications is reduced.  For crepey skin around the eye, I would use the Infini, which is a new microneedling RF device.  Botox might help as well.  I written a blog all about this very situation, see below.  Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.