What is the best option to treat dynamic under eye wrinkles? 31 y/o (photos)

Question

Hi, I have dynamic under eye wrinkles that appear when smiling. This is likely due to years of squinting while working outside. I am 31, and looking to explore treatment options for this. Thank you.

Anna Chacon, MD, FAAD · Answer

At 31, you're actually in a great position to address dynamic under-eye wrinkles because your skin still has a good amount of collagen, and there are several effective options depending on what's causing the lines.

From your description, these appear to be dynamic wrinkles, meaning they become visible when you smile or squint and are caused by repeated muscle movement over time. If the wrinkles are minimal or disappear when your face is at rest, they're often very treatable.

One of the most effective treatments for true dynamic under-eye wrinkles is a very conservative amount of botulinum toxin (Botox, Dysport, Xeomin, etc.) placed in the lower portion of the orbicularis oculi muscle. The goal is to soften the muscle activity while preserving a natural smile. The under-eye area is delicate, so it's important not to over-treat, as too much can affect facial expression or even make the lower eyelid feel weaker.

If the skin has started to develop fine crepey lines that remain visible even when you're not smiling, combining neuromodulators with treatments that improve skin quality often produces the best results. These may include:

Fractional laser resurfacing
Microneedling (with or without radiofrequency)
Platelet-rich plasma (PRP)
Skin boosters or hyaluronic acid microinjections in appropriate candidates
Prescription-strength topical retinoids to stimulate collagen production over time

Looking at your photos, your wrinkles appear to be relatively mild and primarily movement-related, which is reassuring. I don't see significant skin laxity or volume loss that would make under-eye filler the first choice. In fact, filler is generally not my first recommendation for treating fine dynamic wrinkles alone, as it addresses volume loss rather than muscle movement and can sometimes create puffiness if used inappropriately.

Since you've spent years working outdoors, don't underestimate the role that UV exposure has played in accelerating collagen breakdown. Daily broad-spectrum sunscreen, UV-protective sunglasses, and a consistent skincare routine with antioxidants and a retinoid can help prevent these lines from becoming more pronounced over time.

The good news is that at your age, subtle treatments combined with good skin care often provide very natural-looking improvement. Rather than trying to erase every line, the goal is to soften the wrinkles while maintaining the warmth and expressiveness of your smile.

Charles Riccio, MD · Answer

Hi Nurturing410228,
Thank you for your question. Based on your photos, your under eye wrinkling is caused by hyperdynamic muscle activity. The best treatment in this case would be Botox injections into the areas in order to decrease the excessive muscle activity. As this is an off-label application of Botox, I would strongly recommend consulting with a board certified plastic surgeon or dermatologist familiar in performing this procedure. 
Hope this helps!
Charles Riccio, MD

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Since these are dynamic wrinkles, Botox, which works to diminish overactivity of muscles of facial expression, has been used for years to diminish the "jelly roll" like bulges that some people exhibit under their eyes with smiling.  In experienced hands, treatment takes about one to two minutes to perform and the results are typically seen one to seven days later. You would be wise to make sure to  consult with an expericed, board certified cosmetic dermatologist injector and best of luck.

Lisa Vuich, MD · Answer

Thanks for your question. Two of the most effective devices I have worked with for this indication are:
Sofwave- utilizing microfocused ultrasound to deliver heat to the deep dermis at a depth of 1.5mm, generating new collagen and elastin in the skin. It's a very popular treatment also as it has no downtime!
Morpheus8- utilizing RF energy delivered at the tips of micropins. With this approach you get the collagen stimulation of the heat PLUS the collagen stimulation of the microneedling, so you can potentially get more result per session, but at the expense of 'some downtime'- puffiness, faint redness for a day or two, potential bruising. Morpheus8 could of course also be combined with PRP.
Both work very well, both require topical numbing. Both have small sized applicators for treating the under eye region: "Precise Handpiece" for the Sofwave, and "Prime Tip" for the Morpheus8.
I hope that helps!

Camille Cash, MD · Answer

You can consider Moprheus8 to help improve overall skin tone and texture under the eyes.  This treatment combines microneedling with RF technology.  Another option is lower blepharoplasty which can address the excess skin and smooth the under eye.  I've included a video that I hope you find helpful.

What is the best option to treat dynamic under eye wrinkles? 31 y/o (photos)

Answers (6)

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