Thin 32 y/o female heavy lower eye bagging and crepey skin only when smiling & loss of volume in cheeks & mid-face.

There are many ways to 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.

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

Thank you for your question and posting appropriate pictures. Neuromodulators such as Botox and Xeomin can help improve the fine lines. Dermal fillers like Juvaderm Voluma and Radiesse can enhance the hollowness of the cheeks or midface due to volume loss.  This combination can make one look young and well rested. You would need a consultation for precise recommendations. 

Thank you for sharing your concern. To help combat crepey and sagging under eyes, we recommend looking for a product that contains hesperidin, methyl chalcone, dipeptide, and centella asiatica. These ingredients can be found in SkinCeuticals Eye Cream. Designed to address early signs of aging such as fine lines and crow’s feet, Eye Cream features a unique complex of ingredients to combat loss of firmness, puffiness, sagging skin, and dark circles. This product helps hydrate skin and enhances the feel of skin firmness.For the PM, we would recommend SkinCeuticals A.G.E. Eye Complex. This product is a multi-dimensional treatment formulated to improve the appearance of dark circles, wrinkles, puffiness, and crepey skin caused by glycation, a process that occurs when excess sugar molecules bind to collagen and elastin fibers and weaken the skin’s underlying support structure. This rich, dry finish balm immediately boosts eye-area radiance while visibly improving firmness and elasticity for a more well-rested appearance.Best of luck on your skincare journey.

Hi,First of all, you have beautiful eyes.  From the photos you submitted and your concerns, it seems likely you can manage this situation with neuromodulators (Botox) and probably some fillers aesthetically administered over time to deal with the inevitable volume loss.  These treatments are all reversible as needed should you get something you are not entirely happy with.  I would guess that surgery would not be indicated at this time and maybe not for a long time which at your age is ideal.  If the fine lines are problematic, then conservative laser resurfacing would likely improve those nicely with minimal risk.  Best of luck with management of these concerns.

A transconjunctival blepharoplasty with arcus marginalis release, fat grafting and skin pinch blepharopasty is the only procedure that i know of to achieve your goals.You need to find a expert-do not have standard lower blepharoplasty -search for one who knows how to do this relatively new, sophisticated procedure. For more read the following link: