Not sure what to pursue for under and side eye wrinkles (Photo)

Question

I am a 34 y/o female. I've never had any fillers or any other work done. I've become very self-conscious about my under and side eyes when I smile. I know that botox or a filler could help with the crow's feet, but I'm not sure what to pursue with the under eyes.

Jason Emer, MD · Answer

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 (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​), Renuvion (J-Plasma), microneedling/PRP, stem cells and microneedling RF like Fractora PiXel8 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. A surgical option to remove skin and/or fat might be the best solution long-term. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Jonathan Kulbersh, MD · Answer

Hello, and thank you for your question. Based on the images you provided, you may benefit from a combination of injectables. Botox can treat crow’s feet (lines around the eye area), while dermal fillers like Restylane and Juvederm can dramatically improve the appearance of deep tear troughs. The filler adds subtle volume under the eyes to diminish fine lines and discoloration. To learn more about how you can benefit from these procedures, I recommend scheduling an in-person consultation with a reputable, experienced injector. These experts are armed with a better knowledge of facial anatomy, as well as the most advanced injectable techniques that can achieve the most natural-looking results. During your consultation, your provider can assess your facial profile, recommend the best approach, and ensure the best possible outcome.

Nelson Lee Novick, MD · Answer

The non-smiling photo suggests the clear presence of volume depletion in the upper cheek region with the consequent development of tear troughs and incipient formation of under eye bags. If this is indeed so, then the revolumization of the cheeks with a robust HA filler would likely not only recreate an oval, more feminine heart-shaped contour, but would likely secondarily improve the under eye region. It also appears that the crinkling under the eyes becomes more significantly prominent with motion, so a couple of microdroplets of Botox might be additionally beneficial. You would be wise to consult an experienced, board certified cosmetic dermatologist. Best of luck.

Geeta Yadav, MD · Answer

Thank you for your question! Injectable neuromodulators &mdash; like Botox, Dysport, or Xeomin &mdash; can soften lines under the eye by minimizing the movement of the muscles that are causing the wrinkles to become visible when you smile. To improve the appearance of lines that occur when your face is at rest, or to reduce hollowness under the eyes, you might also want to consider filler in this area as well. Hope this helps!

Camille Cash, MD · Answer

From your photos it appears you would have the best results from a combination of treatments.  Botox can be used to help with crow's feet area.  Fillers can be used to help unify and improve contours of the under eye.  Morpheus8 treatments could be added to improve overall skin tone and texture.  See an expert injector near you to learn more.

Darryl J. Blinski, MD · Answer

Thanks for posted photos. Recommend micro dosed Botox for under eye wrinkling. Tear trough HA filer to effect smoothing result. Fees in the $5,000 ranges.

Leonard Grossman, MD · Answer

You can definitely treat the crows feet which are the lines that form on the side of the eyes. This can be treated with Botox. Wrinkles in the lower eyelid however are formed by the bunching up of the skin when the cheek moves up during a smile. These wrinkles should not be treated. However, it appears that you have slight lower eyelid bags which may need to be addressed by either adding volume to the cheek area or having a blepharoplasty. For that you need to be evaluated in person by a plastic surgeon. I hope this helps and good luck from York City plastic surgery

Robert T. Buchanan, MD (retired) · Answer

You have two problems. First is volume loss with creation of tear troughs. This is best treated with fillers. Your second is loss of skin thickness and elasticity. This is because all our bodies stop making collagen and elasticity in the skin at about 25 years of age. The main treatment of this is adding tretinoin (Retin-A) to stimulate collagen in the skin and Obagi's ELASTIderm to stimulate elastin. Microneedling or fraxel  laser can also increase collagen production. If the lines are static, you can inject them with a filler to reduce them. If they are dynamic and you can inject the muscle causing the wrinkles without losing an essential function, then Botox injection is an excellent adjunct. You do not have static lines and the muscle causing the wrinkling cannot be eliminated. Therefore, filling the tear troughs and skin care with tretinoin and ELASTIderm with or without microneedling are your choices.

Not sure what to pursue for under and side eye wrinkles (Photo)

Answers (8)

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