Best non surgical under eye wrinkle treatment? (photos)

Question

I have pretty bad wrinkles under my eyes. I just had Botox done about a month ago and it hasn't helped at all. I also had Juvederm done about 5 years ago but it gave me horrible bags under my eyes so injectables are not an option for me. I'm not quite ready for a bleph surgery either so I'm wondering what kind of laser or chemical peel could help my under eye area? Thank you in advance!

Jason Emer, MD · Answer

There are many ways t o treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

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

John L. Burns Jr., MD · Answer

We have had great success with a laser called Halo.  Another great option is Instantly Ageless which is a skin care product which can tighten the lower eyelid, see link below

Tracy Mountford, MBBS · Answer

As we age, the forehead gradually descends, causing the eyebrows to lower – which in turn causes the upper eyelids to look heavier. This is compounded by the decrease in the amount of collagen and elastin in our skin. Surgical procedures, such as blepharoplasty, possibly combined with a brow lift, will deliver excellent results. However, if you are looking for a non-surgical alternative, the ‘Instant Eyelift‘ is a great option.
I have found a combination treatment that is very effective, which involves Thermage Eyes and Ultherapy. Thermage is a non-invasive radio frequency treatment than can treat both the upper and lower eyelids, to promote new collagen production and stimulate existing collagen. This helps to remodel and tighten the skin, making it look more youthful. It will also reduce under-eye sagging and soften fine lines and wrinkles. Your eyes look brighter; skin also feels tighter and smoother, making it easier to apply eye shadow and eyeliner. For added lift where the eyelid is very heavy, Ultherapy ultrasound treatment to the brow targets the muscle, as well as the skin, to further remodel and tighten collagen further at a deeper level to add more upper eyelid lift.
After a single treatment, you will continue to see improvement for up to six months. There should be no swelling or bruising and you can return to your regular routine straight after the procedure. This treatment can last for a year or two, depending on your skin condition and natural ageing process.

Rebecca Jackson, MD · Answer

Under eyelid wrinkles can be treated with many modalities. Botox is helpful laterally but if the wrinkling is centrally located or just under your eyelashes botox won't help. If there are no bags ( fat pads ) I like to treat that area with a trichloroacetic acid peel ( TCA 25% ) It takes about 5 days for the skin to peel off but underneath it is healed and smooth. I reserve laser treatments for severe wrinkling.

Elizabeth S. Jacobson, MD · Answer

Hi Womerj,The  under eye area is an issue for many people, especially after the ages of 30-40 years old. As we mature, we start lose the padding of our cheeks under the eyes. These natural changes make the tear trough area even more noticeable, making us look tired. (even though we are tired, we don't want to look it!)There are many treatment modalities that work nicely under the eyes. Under eye filler is the most popular filler treatment other than the cheeks and lines around the mouth in our practice, but there are treatments other than filler that work very well under the eyes including CO2 laser and Exilis Protege Elite Skin Tightening. Hope this helps!Dr J

Darryl J. Blinski, MD · Answer

I recommend based only on internet info, micro Botox series of injections with very thin HA filler........

Best non surgical under eye wrinkle treatment? (photos)

Answers (7)

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