Crepey and puffy under eyes - are there any treatment options? (Photo)

Question

I have really bad crows feet and lumpy fat looking puffiness under my eyes when I smile. I feel like when I smile big for photos I look so much older because of it. I've done a series of prf, and even did co2 once. Is there any other treatment options? Would desperately like this area smoothed out, I hate it!

Kenneth D. Steinsapir, MD · Answer

That is far easier said than done. I will make some general remarks. It is critical to understand that there is simply no substitute for a detailed, in person assessment. No one can diagnose and plan what you actually need based on a "Zoom consultation." Be skeptical of surgeons who really can't spend time speaking and assessing you. Nothing they are doing is more important than you needs during your assessment. Generally this area is composed of a series of very delicate glide planes. Many of the seemingly accepted services performed for this area can gum up and scar these delicate planes include laser and chemical peeling, even services like PRP. It would be helpful to know you filler history. This ridge is consistent with aging, neglected filler. If you do have a history of hyaluronic acid fillers in the past, a first step is to have this old material removed. One does not need ultrasound or MRI to determine where this material is located. Other options can included mid face surgery, lower eyelid surgery but less is more. There is no substitute for that detailed in person consultation. Your eyes can be your best feature.

Gary M. Horndeski, MD · Answer

I recommend Botox for the crows feet or a mid face lift.  You also have a high forehead and may want to consider an extended brow lift that will lift the eyebrows higher, decrease the vertical height of the forehead, lower the hairline and pull up the corner of the eyes to help resolve the lateral crows feet.  You may also want to consider fat injections of the cheeks to fill them out more.

Best Wishes,

Gary Horndeski, M.D.

Anna Petropoulos, MD, FRCS · Answer

Hello and thank you for your question! To combat fine lines, laxity, and puffiness a radiofrequency treatment such as Thermage or Sylfirm (RF with microneedling) will be your best bet for strengthening the delicate skin around the eyes. In addition, using light dosages of a tox will help to soften the movement that creates the "crow's feet" while still maintaining a natural smile. RF should be done yearly to maintain results, and tox would typically be done every 3-5 months. I hope this helps! Best, Genie Alexander, RN BSN for Anna Petropoulos, MD FRCS at Center for Classic Beauty, Boston & Danvers, MA.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photos. There are a few modalities that might improve your skin: pinch technique blepharoplasty, erbium laser skin resurfacing following Botox injections, RF devices, etc. Please make an appointment with an experienced oculoplastic surgeon for proper guidance. 
Good luck!

Zoran Potparic, MD · Answer

It appears that you may be a candidate for lower blepharoplasty. In person consultation with a board certified plastic surgeon is recommended. Good luck.

Crepey and puffy under eyes - are there any treatment options? (Photo)

Answers (6)

Answer: Puffy eyes and wrinkled skin

Answer: Puffy eyes and wrinkled skin

Answer: Lower blepharoplasty

Answer: Lower blepharoplasty

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Crepey and puffy under eyes - are there any treatment options? (Photo)

Answers (6)

Answer: Puffy eyes and wrinkled skin

Answer: Puffy eyes and wrinkled skin

Answer: Lower blepharoplasty

Answer: Lower blepharoplasty

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Recommended reading

Everything you need to know about Eyelid Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.