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

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

In your case, a skin-only, conservative blepharoplasty may be one of the options. However, you may also consider TCA peel; it is much cheaper and recovery is much faster then laser. TCA peel can be repeated multiple times. Or a combination of skin excision (pinch) and peel.You may also consider placement of fat grafts in the upper cheeks, around eyes and brows which will address the hollowing and improve skin tone and glow (stem cell effect). All of these procedures can be done in the same time or separately.I would suggest you to discuss these issues with a board certified plastic surgeon with experience in facial rejuvenation. Good luck.

To be honest, the skin pinch is probably a better option because there is actually less work for you to do while the lower eyelid heals.  

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!  

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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