Would laser resurfacing or filler and Botox be a better procedure for under eye skin that bunches with expression? (Photo)

Question

The area under my eyes bunches up a lot when I smile. It didn’t used to do this, but I’m 49 now so my face is definitely changing. Anything I do will be a splurge for me so I am hoping to get the most bang for my buck with whatever I decide. I

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. 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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Harold J. Kaplan, MD · Answer

Hello SM.  The reality is that the procedures you have identified help with different issues.  If you are looking to tighten the crepey skin under the eye, either surgery or laser resurfacing is the way to go.  If you would like to get rid of the indentation seen in the middle of the photo, you're better off with surgery or dermal filler injections.  Botox (Dysport) can help with the fine lines present right at the cheekbone as well.  Sometimes one procedure or another will achieve your goals.  In this case, you may need multiple procedures to really achieve yours.

William Groff, DO · Answer

Thank you for your question. Based on your photos, it appears you have developed some crepey skin under the eyes, as well as the lines you mention. Laser resurfacing would rejuvenate and tighten up the skin in the area to create a more youthful appearance. You will also likely need some Botox in the outer corners of the eyes to treat your crow's feet there. I encourage you to schedule a consultation with an experienced, board-certified dermatologist for further assessment and treatment recommendations.

Laurie A. Casas, MD, FACS · Answer

Thank you for your question. The best treatment is combination therapy. Skin resurfacing to help improve the skin quality, Botox for wrinkle reduction and filler for volume loss! When you treat all of what is causing the problem, you get the best results!

Jason Emer, MD · Answer

lasers or plasma pen will help/ botox to stop movement lines. skincare and eye rollers should be used now.

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

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 such as lower eyelid blepharoplasty with or without fat pad repositioning will be the best long term.  There are many things you can do to treat under eye hollows and dark circles without surgery.  Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture.  I suggest you get a formal consultation to see what is best for you and your goals.  Best, Dr. Emer.

Patrick Flaharty, MD FAACS · Answer

Your photographs demonstrate mild laxity of the lower eyelid skin.  One possible treatment option for you is a TCA peel. This is a medium depth chemical peel which can be done in the office without anesthesia. The chemical is applied to the skin and coagulates the protein in the surface of the skin. There is some immediate burning which resolved within a few minutes with cool compresses. The skin surface will gradually turn reddish brown and peel off taking the wrinkles with it in 5 to 7 days. The new skin is pink and sensitive for a few weeks but much tighter and firmer with fewer wrinkles. Consulting with a surgeon experienced in TCA peels to the lower eyelid would be a great way to learn more about this procedure.

Would laser resurfacing or filler and Botox be a better procedure for under eye skin that bunches with expression? (Photo)

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