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

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.

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.

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.

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!

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

Unfortunately, there is no great effective long-term treatment for sun damage to the lower eyelid and midface area.
Many people will recommend laser treatment, chemical, peels, and volume restoration but as you probably know from firsthand, these are going to give temporary improvements at best.
While it may not be helpful at this point previous damage wearing daily sunscreen, and avoiding excessive sun exposure is the best way to prevent this from starting in the first place grad.
You can at least prevent it from getting worse by protecting your skin from the sun.
The combination of sun damage with loss of skin elasticity due to aging simply doesn’t have a good reversal treatment.
I’m probably in the minority of providers who don’t recommend any treatment but I just haven’t been impressed with anything I’ve seen to date.
Unless something works, I’m hesitant to recommend it.
Botox can work to some degree but has its drawbacks.
Best,
Mats Hagstrom MD