Filler or Botox for dynamic under eye wrinkles?

Question

I am unconcerned with the slight discoloration & unevenness under my eyes when my face is ‘static’, but the dynamic wrinkles & shadow under my eyes when I smile seems dramatic. I’m slowly introducing Retin-a into my routine & NOT interested in lasers/peels/microderm at this point. Could light well-placed botox help? Could filler address ONLY my dynamic lines without making my undereyes look puffy & unnatural when stationary? Thoughts?

Gregory A. Buford, MD, FACS · Answer

Filler will do very little for dynamic lines but is great for static lines and loss of volume.  Here, my suggestion would be a combination approach including the following:-BOTOX Cosmetic (to help reduce muscular movement and help soften dynamic lines)-Platelet rich Plasma (direct injection to this area to help increase collagen and elastin)-Medical skincare (to help maintain the skin)-Series of Microneedling treatments (to help encourage collagen growth on the entire face)-Series of ThermiSmooth treatments (to help tighten the skin locally and encourage collagen growth)I hope that helps and wish you the very best.  Look for an injector who not only is experienced but who also knows how to combine combination approaches for an even better result.  Warmest regards,-Gregory A Buford MD FACSBoard Certified Plastic Surgeon and AuthorCertified Allergan MASTER Facial Injectables Trainer

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Benjamin Barankin, MD, FRCPC · Answer

Generally speaking, BOTOX is the treatment of choice for dynamic wrinkles, be they forehead frown or horizontal lines, or Crow's feet most commonly. I would try 2u under each eye and see if you liked the result. Otherwise, I would try PRP or even a little tear trough filler. Most importantly would be to get your treatment from a highly trained expert physician injector such as a dermatologist to optimize safety and results.

Heidi A. Waldorf, MD · Answer

For this very common problem, I generally recommend a combination treatment to reduce the muscle movement and improve the skin quality.  Your photo only shows your lids -- one question is whether the lines are dynamic due to the muscles of the eye or if some are due to the lifting of your cheek with smiling.  If it is the former - then a botulinum toxin (botox, dysport, xeomin) can help.  If not, then you need to be careful not to flatten the eye area -- it can give a hound dog look when the cheek pushes upward.  In that case, filler of the temple may be needed first.   To improve skin quality, a series of fractionated laser treatments, like the fraxel dual, can be very helpful to tighten the skin and reduce the crepeyness that shows up when you squint or smile.  All of your results will be maximized with a good skin care regimen.I hope this answer was helpful.  Best wishes!

Shaun Patel, MD · Answer

I would start with treatment using a neuromodulator like Botox or Dysport which will help address the dynamic lines around the under the eyes.

Filler or Botox for dynamic under eye wrinkles?

Answers (5)

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