Which procedure would minimize the appearance of my deep under eye bags and wrinkles? (photos)

Question

Hello. I have a question and hoping to find some answers :). I am in my mid-20's and have really bad deep under eye bags and wrinkles. I wanted to know if fillers/botox would help or what advice would you recommend. I have always been inscure about my eyes. Unfortunately, I've had these bags since I was a baby.

Anya Costeloe, DO · Answer

Thank you for the photos and your question. Your wrinkles may be in part due to orbicularis oculi muscle hypertrophy as well as some skin laxity. To address the muscle component, a temporary treatment for this would be under eye toxin (Botox, Dysport etc.) injection. A permanent solution would be a lower blepharoplasty with orbicularis tightening procedure. 
To tighten up the under eye skin. I would recommend a resurfacing laser treatment. I have had great success with under eye Erbium:YAG laser treatment. It is safer than CO2 for darker skin tones. If you decide to proceed with surgery, the lower lid skin can be tightened surgically at the same time the muscle is addressed. The best way to determine the most optimal procedure for you is to schedule an in-person consultation with an experienced facial plastic surgeon. Best of luck!

Anna Chacon, MD, FAAD · Answer

Hello, and thank you for sharing your concerns. Under eye bags and wrinkles can be particularly distressing, especially when they have been present for a long time. Here are a few treatment options that may help improve the appearance of your under eye area:

Dermal Fillers: Hyaluronic acid fillers, such as Restylane or Juvederm, can be injected into the tear trough area to add volume and reduce the appearance of deep under eye bags. This can create a smoother transition between the lower eyelid and the cheek, making the bags less noticeable. The results are typically immediate and can last anywhere from 6 to 18 months.

Botox: While Botox is not typically used for under eye bags, it can be effective in reducing the appearance of fine lines and wrinkles around the eyes (crow's feet). By relaxing the muscles that cause these wrinkles, Botox can create a smoother and more youthful appearance.

Microneedling: This procedure involves using fine needles to create micro-injuries in the skin, which stimulates collagen production. Over time, this can help to improve the texture and firmness of the skin under the eyes, reducing the appearance of wrinkles.

Laser Treatments: Fractional laser resurfacing, such as CO2 or Erbium lasers, can help to tighten and smooth the skin around the eyes. These treatments work by removing the outer layers of damaged skin and stimulating collagen production in the deeper layers.

Topical Treatments: Retinoids and other topical treatments containing ingredients like vitamin C, peptides, and hyaluronic acid can help to improve skin texture and reduce fine lines. Consistent use over several months is often necessary to see significant improvements.

Lower Blepharoplasty: For more severe cases, a surgical procedure called lower blepharoplasty might be considered. This involves the removal or repositioning of excess fat and skin under the eyes to create a smoother, more youthful appearance. This is a more invasive option but can provide long-lasting results.

It's important to consult with a board-certified dermatologist or plastic surgeon who specializes in cosmetic procedures around the eyes. They can evaluate your specific situation and recommend the most appropriate treatment plan based on your individual needs.

Warm regards,

Mehryar (Ray) Taban, MD, FACS · Answer

You are likely candidate for lower blepharoplasty. It is important to see a specialist and have proper evaluation and discussion.

Eric M. Joseph, MD · Answer

Morpheus 8 is radio frequency microneedling. We have seen very nice results insofar as tightening lower eyelid wrinkled skin. Surgery may not be the best option for excessive lower eyelid wrinkling. I hope this helps. Sincerely, Dr Joseph

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. For deep under-eye bags and wrinkles in your mid-20s, combining dermal fillers and CO2 resurfacing lasers could provide significant improvement. Dermal fillers can effectively address volume loss under the eyes, which often contributes to the appearance of dark circles and hollows. By adding volume to the tear trough area, fillers can smooth out the under-eye region and reduce the prominence of bags. On the other hand, CO2 resurfacing lasers can improve skin texture and firmness, helping to address fine lines and wrinkles. This laser treatment stimulates collagen production, which can enhance the overall appearance of the skin and reduce the depth of wrinkles. Using these treatments in combination can provide a comprehensive approach to rejuvenating the under-eye area, addressing both volume loss and skin texture, leading to a fresher and more youthful look. I hope this helps and best of luck!

Michael A. Persky, MD · Answer

Hello there TW,
For young patients I recommend the 100% natural EZ Gel treatment.  EZ Gel is made from your own blood without anything added.  Two tubes of your blood are centrifuged, one is cooled to form plasma rich fibrin while the other tube is heated forming the blood protein albumin.  When these are mxed together, they form a gel that is injected with a canulla around your eyes resulting in natural improvement of the hollows, lines, and wrinkles without the worry of future swelling and edema (which can happen years after hyaluronic acide fillers are injected aroung the eyes.)  I would also treat you with a drop of Botox in the lower eyelid muscle bulge.  Make sure that you choose an expert master physician injector to treat this delicate and unforgiving area.  Good luck and be well.
Michael A. Persky, MD
Encino, CA

Camille Cash, MD · Answer

Fillers may help to improve the appearance of the wrinkles for the under eye area.  You can add Morpheus8 as well to enhance your results.  This treatment combines RF technology with microneedling to improve overall skin tone and texture. We always recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Daniel Ruter, MD · Answer

Hello! Dr. Ruter here from Syracuse NY. I personally avoid fillers in the undereye area. While they would help to smooth your tear trough (the lowest area of your folds), there are serious risks. You could get a small injection of botox to the orbicularis oculi muscle that is sometimes referred to as the jelly roll. This could help smooth the wrinkles. Other options that focus on skin tightening include laser resurfacing with a fractional CO2 laser or a chemical peel. Surgical options include lower lid blepharoplasty with skin excision. You have many options each with their own risks and benefits. I know a great plastic surgeon in your area, Dr. Deepa Bhat who owns Ravive Plastic Surgery in Tampa. I'm sure she'd be happy to discuss further with you.

Jacquelline Leva, DO · Answer

So i notice that you have a lot rhytides aka wrinkles more than hallowing in your under eye area. I would love to have the opportunity to perform a snap test to see how the quality of the skin is underneath your eye. I am seeing that you may benefit from the obicularis occuli injection with Botox and then consider doing a series of co2 fractional laser to help with skin elastics and collagen production. I hope that helps.

Stefan Weiss, MD · Answer

There are a number of possible options. Sometimes botox around the eyes can soften the wrinkles, especially if they are most pronounced when smiling. If they are resulting more from lack of volume, then fillers are a good option in the infraorbital hollows. Finally, laser can be an option to thicken the collagen reduce the appearance of the fine lines.

Which procedure would minimize the appearance of my deep under eye bags and wrinkles? (photos)

Answers (11)

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