How to treat under eyes - will filler make the bunching worse? (Photos)

Question

I am 39 years old and had Botox done for the first time a week ago. I've already seen some changes in the look of my wrinkles in the areas I iwas treated; forehead, between the brows, crows feet. But I still have under eye wrinkles when I smile. I knew that the Botox wasn't going to address this as I didn't have any injections there. My question is what should I do for this area? Will filler take care of the wrinkles or make the bunching worse?

Lexie Wang, MD · Answer

Why don't you try doing botox in that area? Also making sure you're doing really good skincare ot keep the quality good so that it's more resistant to mvoement.

Anna Chacon, MD, FAAD · Answer

Thank you for your thoughtful question and for sharing your photos. You’re absolutely right. Botox helps smooth dynamic wrinkles in areas like the forehead, between the brows, and crow’s feet, but under-eye lines can be more complex.

The under-eye area is delicate. When you smile, you see a mix of fine skin texture, natural movement, and sometimes a bit of volume loss. Filler can be useful in some cases, especially if there’s hollowing or shadowing. However, if it's placed incorrectly or too superficially, it can make the area look puffy or highlight any bunching when you smile.

Here are some options to consider:

- Very conservative filler in the tear troughs, if you have hollowing, to smooth the transition, but only in skilled hands.
  
- Skin-boosting treatments like microneedling with PRP, laser resurfacing, or radiofrequency microneedling to improve fine lines and skin quality.

- Topical treatments with retinol (specially made for the eye area), peptides, or growth factors to support skin texture over time.

- Light Botox, or "micro-Botox," under the eyes can sometimes be used in tiny doses to soften lines without affecting movement too much.

So, to answer your question: filler usually doesn’t help with wrinkles caused by skin bunching from smiling, and in some cases, it could make them look worse. However, the right mix of treatments can improve skin texture, soften lines, and refresh the under-eye area without overfilling.

You’re asking all the right questions, and with a careful approach, you can certainly improve this area in a natural way.

Nelson Lee Novick, MD · Answer

At least from the photos, it would appear that there is "jelly roll" type bunching under the eyes with smiling. For Jelly Rolls a c couple of microdroplets of Botox properly injected into the "belly" of these muscles can soften the muscular action responsible for their appearance. You would be wise to consult with an experienced, board certified cosmetic dermatologist injection expert. In experienced hands, treatment should not take more than a couple of minutes. Hope this helps and best of luck.

Edward Buckingham, MD · Answer

The wrinkles appear to come from contraction of the circular muscle around the eyes, called the orbicularis oculi, and you can anticipate a decrease in wrinkles with botox to this area. Beneath the wrinkles you may also notice a crease or tear trough, and this can be filled to improve your result.

Camille Cash, MD · Answer

Fillers can help improve the contour under the eye.  It is also important to treat the adjacent cheek area for a more harmonious look.  Other treatments such as Morpheus8 can be used in conjunction to improve overall skin tone and texture.

Leonard Grossman, MD · Answer

Your Lower eyelid area appears to be quite hollow. With photograph grafting into that area your lower eyelids/cheeks will appear much better proportioned and the wrinkles will be much less noticeable at the same time. I hope this helps and good luck from Leonard Grossman MD, organic Plastic Surgery in New York City.

How to treat under eyes - will filler make the bunching worse? (Photos)

Answers (6)

More Dermal Fillers Questions

WE SEND PRETTY
EMAILS

Answers (6)

More Dermal Fillers Questions

Are there any sort of procedures to fill in the mental crease area? (Photos)

What can be done about vertical lip line after weight loss? (Photos)

Lumpy between eyes over a year after filler. What could cause this and can it be fixed? (Photo)

Fillers make future facelift difficult, but are hyaluronic acid based fillers more acceptable?

What will improve the look of my marionette and nasolabial wrinkles? Also, my eyelids are sagging. (Photo)

What can help to slim down lower face area and give a more defined jawline? (Photos)

WE SEND PRETTY EMAILS

WE SEND PRETTY
EMAILS