Deep Double Thick Under Eye Lines

Hi I wonder if anyone can help....I have recently developed some deep lines under my eyes that are creating a middle puffy area? I feel this is making me look years older...Does anyone have any suggestions for what I can do about them? Thanking you all in advance.

Doctor Answers 7

Loose skin and lax lower eyelid

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Your best bet for reducing this problem is to tighten the lower eyelid skin.

In order to avoid a change in eyelid shape, this will have to be a supported procedure such as a cheeklift with lower eyelid canthoplasty.

If a conventional lower eyelid blepharoplasty is done, you are likely to develop rounding of the eye or pulling down of the corners of the eye.

Laser alone, while helpful as an extra procedure, will not in itself solve your problem.

Below are referenced some articles and chapters we have written on the subject.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 188 reviews

Undereye lines

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This may be treated by a pinch excision of skin below the lash line or by laser tightening.  Good luck!

Keshini Parbhu, MD
Orlando Oculoplastic Surgeon

Lower eyelid wrinkles

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It looks like you may need a simple excision of some skin in the lower eyelid.  Go to a plastic surgeon for evaluation.

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Combination treatments are best

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My approach is to be sure that allergy is controlled as much as possible, use Botox or Dysport throughout the crow's feet with mini- or micro doses in the fold to relax the underlying muscle. If this is not completely satisfactory, the next step is to tighten the skin with a "pinch" blepharoplasty, and to further tighten and lighten the skin with 1-2 sessions of fractionated laser resurfacing (ActiveFx).

Maintaining allergy control is definitely helpful, but it is only a part of the problem.  Ultimately the best results are acheived when conservative application of each modality is applied.

Good Luck!

Reginald Rice, MD
Folsom Facial Plastic Surgeon
4.3 out of 5 stars 8 reviews

Dennie-Morgan folds (lower eyelid lines)

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From the photos, these look like something called a Dennie-Morgan fold, also known as an "atopic pleat." Typically, patients with these folds have atopic dermatitis and allergies. Treatment is usually a combination of treating the underlying cause (the atopic dermatitis and/or allergies, if present) followed by a "skin pinch" excision. The skin pinch removes a small slip of excess skin under the eyelid leaving a very fine (near invisible) scar. I typically do such eyelid surgeries in the treatment room of our office under local anesthesia (numbing medicine). A good dermatologist might be able to help with diagnosing and treating the underlying dermatitis.

All the best,


David C. Pearson, MD
Jacksonville Facial Plastic Surgeon

Treatment of Lower Eyelid Lines

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All three of the proeviously mentioned methods can treat your problem very nicely. The peel (or Laser-both do the same thing) would be my least favorite, as it has the most likelihood of not correcting your problem and causing other problems. The injection is temporary (though most fillers last longer around the eyes than they do elsewhere). The blepharoplasty is lasting but is more involved. Do see someone skilled in all these methods and discuss what is right for you.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

One option is delicate filling of these lines with fillers.

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Another approach is a chemical peel of the lower eyelids.  Occasionally both options are needed.  The nice thing about the fillers is there is usually a minimal recover period and treatment is very comfortable.  However, because this is delicate work it is bet done by an oculoplastic surgeon who performs a lot of this type of work.  Drs. Ana Morley and Raman Malhotra at the Queen Victoria Hospital and McIndoe Surgical Center in East Grinstead, UK had a nice recent paper on filling the lower eyelid.  You might consider looking them up if you are having trouble finding a physician for this service.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.