What's the best treatment for under-eye wrinkles and crepiness? (Photo)

I’m a board certified cosmetic surgeon, practicing in Manhattan and
Long Island for over 20 years. I also had fellowship-certified training in
oculofacial plastic surgery. Eyelid surgery and eye rejuvenation is a focus of
my practice.



The majority of treatments for the under eye area have to do with some
type of thermal energy, but there is a limit to what thermal energy can
accomplish. In the 90s, we were using the original, very aggressive CO2 laser
and it created a lot of good, tight results but it also created undesirable
results in depending on the hands of the doctor who used it. The pendulum swung
towards less aggressive lasers such as the erbium laser which I have used for
many years. I also observed that people who came for consultations also did several
chemical peels or another type of laser before trying another, which lead skin being excessively thinned by repeat
treatments.



During aging, the skin loses collagen, blood supply and it becomes
irregular. For the past several years, my practice has been in the forefront of
certain regenerative medicine and technology. We have been able to help people
using platelet-rich plasma (PRP) which uses the body’s own healing factors injected
under the skin. Generally, when someone has this much crêpiness as you are describing,
with strategic placement, it has been able to significantly improve skin
quality without using lasers.



Building skin quality is not a onetime treatment. In the modern world,
people want quick or immediate results. However, when you are treating skin, it
can’t be improved overnight. There are certain limitations especially when someone
has reached a certain age, has a certain amount of sun exposure and if they
have been smoking. They have to eliminate a lot of those potential toxic
reasons for the crêpiness.



We’ve also done PRP with Acellular matrix for hair loss, and have used
it to build up eyelid skin, but not with the same concentrations. With PRP, we
build tissue rather than heating. Sometimes, if someone’s skin is a little bit
thicker, we’ll combine the effect of PRP with laser at the same time.



I suggest that you learn more about this modality and see what you can
do from a more holistic approach. Clearly, there’s only so much you can do to build the collagen. I agree with you and don't
recommend more laser treatment because you’re probably not going to get a
significant improvement with more thermal treatment. I hope that was helpful, I
wish you the best of luck, and thank you for your question.



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Your images demonstrate mild skin excess, textural changes, and some hollowing.  The skin excess can be addressed by the removal of skin, either through a simple pinch or more formal skin blepharoplasty.  As removing excess skin does not change the texture of the skin that remains, the crepiness could be addressed by resurfacing, either through chemical peels or lasers.  While you have had a suboptimal experience with CO2, you should know that other devices are commonly used on the lids (for example erbium), and ultimately the result is influenced by the settings chosen and the energy delivered.  In addition, you could consider the conservative use of HA fillers, softening the transition from your lid to your mid face and filling the skin envelope.  Finally, I would suggest periorbital botox, as many times, these lines are the result of activity of the muscles around the eyes.  With their contraction during facial expression, and especially with smiling, the skin folds, and over time it remembers its creases.  Good luck!