Treatment for crepey skin under eyes? I'm 40 yrs old. (photos)

Question

What is the best treatment for crepe skin under eyes? I have deep hallow under eye sockets and translucent skin. Aging rapidly. Big smile and 40 years old with protruding periorbital veins. Can you suggest a treatment option for me that isn't extremely invasive? How can I treat this with the optimal results. I've been doing Botox, etc. Or what is best option? (Plz excuse my not so cute pics) :)

Marc Polacco, MD · Answer

Hi!
You have a great question, and I can help! When patients approach me with this concern, the first step in developing a treatment regimen is assessment of skin thickness, tone, and age. You have very fair, thin skin, and I would recommend a 3-step approach for optimal results:1) Filler in the tear trough to restore volume and thus reduce appearance of the orbital rim and shadowing, 2) botulinum toxin to reduce dynamic lines, 3) laser skin resurfacing to treat resting lines as well as tighten the lower eyelid and reduce the crepe concern. Hopefully that helps!

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Mitchel Goldman, MD · Answer

Crepey skin like yours can be improved with a laser procedure to rejuvenate the skin and boost collagen levels in the dermal structure. Once that treatment is completed, injectable treatments may be added to eliminate any remaining lines. Wrinkles in the outer corners of the eyes are usually best treated with neuromodulators like Botox, while fine lines under the eye can be addressed with small amounts of well-placed dermal filler. I recommend scheduling a consultation with a board-certified dermatologist for an in-person evaluation and customized treatment plan that will meet your needs and goals best.

Jason Emer, MD · Answer

crepe skin needs lasers regularly and at home peels and dermarolling. this can be improved grately in office with a few agressive laser treatments ,see my IG for examples.  start rolling and peels now at home (see link).

As we age the skin sags there is  nothing  you can do that but try preventative  energy-based or thread-based  treatments or get a neck/facelift earlier in the aging process.  There are numerous options and some can be used in combination to get best outcomes but you need a consultation with an expert.
 
Options include for skin tightening :
1. thermage radiofrequency to heat skin and tighten it over time and prevent the aging process
2. ultherapy highintensity ultrasound to contract muscle and tighten the face and neck and prevent the aging process
3. PDO nova threads or instalift threads for immediate lifting without surgery and long term collagen production
4. sculptra injections for collagen production to areas of the face and neck with crepe skin or early sagging
5. btl exilis ultra, venus legacy, thermi250 , or inmode forma/contoura  for constant collagen stimulation monthly with facials
6. facelift/necklift with fat grafting/fillers if you need a big improvement
7. ThermiRF or J plasma /Renuvion or Inmode FaceTite   internal heating and tightening to long term internal heating and tighting with or without surgery
8. Platysmaplasty to tighten the muscles of the neck long term and create contour
9. Facial implants or fillers to contour the jawline and chin to improve the apperance of the nec k
10. Fractora/Morphenus8 or Intensif microneedling RF for improve superficial tightening, neck and chest wrinkling and crepe skin 
You need to see an expert in facial sculpting and age prevention.  Best, Dr. Emer.

Elizabeth Whitaker, MD, FACS · Answer

Hello SuzAtlanta, Thank you for sharing your pictures and your concerns.  The quality of the skin can be helped with energy treatments such as radiofrequency or fractional laser with no significant downtime.  CO2 laser resurfacing would have more significant results but also about 5-7 days of downtime for healing.  I would recommend you see a facial plastic surgeon to explore your options.  I hope this is helpful.
All my best!  Dr. Elizabeth

Mitesh Kapadia, MD, PhD · Answer

The under eye veins can be treated with a Nd:Yag laser. The mild wrinkles are more difficult. Botox in the upper cheek can cause smile asymmetry so its probably not the best treatment. Resurfacing the skin with a CO2 laser often helps.

Camille Cash, MD · Answer

Lasers work well to improve skin tone and texture.  You could also consider FaceTite which helps improve tone and tightens skin up to 40%.  We also recommend using medical grade skin care products and wearing sunscreen every day.

Matt Tahsini, MD · Answer

Hello and thank you for your question. I think CO2 laser resurfacing would be a good solution for you. I suggest seeing a reputable doctor, one who is very experienced with laser. Best wishes.
Dr. T

Treatment for crepey skin under eyes? I'm 40 yrs old. (photos)

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