What is the most effective treatment for my under-eye crepey skin? (Photos)

Question

I feel like I have great skin that maintains its youth with the exception of my under eyes. They are so crepey. I had one Resurfx treatment, and it didn't seem to do anything.

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

Sam Speron, MD, FACS · Answer

This is a common question.  Dark circles and eyelid wrinkles can be corrected with blepharoplasty or cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid surgery but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope my answer helps and if it does, please take a moment to up vote this answer on the “respond” button on the top right.  Have a great day.

Gregory S. Keller, MD, FACS · Answer

A Zoom or In-person consultation is necessary to give a better idea of solutions to your problem. You seem to have both dynamic and static wrinkles and excess skin. While we can use CO2 and erbium laser treatments, we have found microneedling RF treatments to give better skin contraction and smoothing of eyelid wrinkles. The results can be quite dramatic. We have both Intensif and Fractora RF treatments, but Intensif produces little pain or downtime.

Jason Emer, MD · Answer

this needs lower bleph skin removal / skin pinch and/or co2 laser (see attached video).

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules) should be started now and you can get virtually.

There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will be the best long term.  There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will be the best long term.  However, non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels and stem cells can all help give some improvement. I suggest. You get a formal consultation to see what is best for you and your goals.  Best, Dr. Emer.

Phillip Chang, MD · Answer

hi cassj2016

As we get older, the skin loses its ability to renew itself. The skin in the area under the eyes is particularly susceptible to the aging process because it is thin. There are various solutions to improve deep wrinkles around the eyes and one of these is an eyelid surgery (blepharoplasty). It can remove and tighten excess eyelid skin for a more alert, youthful appearance. To learn more about this procedure, please visit our website.

Camille Cash, MD · Answer

Crepey skin under the eye can be addressed with lasers.  They work well to improve texture and fine lines.  You can consider fillers under the eye to add volume and improve contour irregularities.  Neuromodulators such as Botox can help soften dynamic lines at the outer part of the eye ("Crow's feet') as well as between the brows and on the forehead.

Alexander Blandford, MD · Answer

Great question. An in person exam is necessary to best advise you. Careful examination of lower eyelid tone is important to decrease the risk of lower eyelid retraction. You most likely have a combination of lower eyelid skin redundancy as well as texture issues. Redundant lower eyelid skin can often be improved with a lower eyelid blepharoplasty. You may also be a good candidate for laser resurfacing. If your lower eyelid tone is inadequate, this may require a lateral canthoplasty to decrease the risk of lower eyelid retraction. There are other options available such as chemical peels, however will likely has suboptimal results combined to either lower eyelid surgery +/- laser resurfacing. Regardless, I recommend you see an oculofacial plastic surgeon to get you to your goal as safely as possible.
Hope this helps!
Alex Blandford, MDOculofacial Plastic and Reconstructive SurgeryVero Beach, FL

Anshul Gambhir, MD · Answer

Thank you for your question! I would recommend CO2 treatment for under the eye. You need to resurface the area in order to get rid of the crepey skin. You will need a more aggressive depth to achieve your desired results. There will be some downtime with the CO2 treatment and it should be done in the fall/winter months. Hope this helps!

Ivan Vrcek, MD, FACS · Answer

Thank you for your question and photo. In my opinion, this would likely be best improved with a lower eyelid skin pinch blepharoplasty and resurfacing, either with CO2 laser or a chemical peel. I would strongly recommend using an ASOPRS oculoplastic surgeon for this type of work. Best of luck!

Robert Singer, MD · Answer

Most expert experienced artistic plastic surgeons have a variety of procedures, both non-surgical and surgical, at their disposal to produce excellent cosmetic results in the appropriately selected patient: Botox or Dysport, lasers, temporary hyaluronic acid fillers like Restylane, long-lasting micro-fat grafts, blepharoplasties (often the most effective) , or combinations of procedures. Each has benefits and drawbacks and depends on desired outcome and individual anatomy.

Following the advice of anyone who would presume to tell you what to do without taking a full medical history, examining you, feeling and assessing your tissue tone, discussing your desired outcome and fully informing you about the pros and cons of each option would not be in your best interest. Find a plastic surgeon that you are comfortable with and one that you trust and listen to his or her advice. The surgeon should be certified by the American Board of Plastic Surgery and ideally a member of the American Society for Aesthetic Plastic Surgery (ASAPS). You should discuss your concerns with that surgeon in person.

Robert Singer, MD FACS

La Jolla, California

What is the most effective treatment for my under-eye crepey skin? (Photos)

Answers (10)

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