Are dermal fillers the best option to get rid of the wrinkles/bunching that form under my eyes when I smile? (Photo)

Question

I had upper and lower blepharoplasty almost three months ago to remove excess skin on my upper eyelids and remove lower eye bags. As the swelling went down I noticed some hollowness under my eyes and when I smile the wrinkles are deep and bunch under my eyes. I did not have these deep wrinkles prior to surgery. When I asked my surgeon about fillers he was against doing that and didn't seem to be bothered by my concern. Can I please have some advice on what I should do? See photo attached

Eric M. Joseph, MD · Answer

Lower eyelid fat pads cause a convexity by pushing the  lower lid skin out. When fat is removed from the lower eyelids, the resulting concavity may lead to excessive lower eyelid wrinkling. Sometimes a "pinch blepharoplasty" can be performed with local anesthetic to remove excess skin, if that's your issue. Do discuss your concerns with your surgeon. Hope this helps! Dr Joseph

Raffy Karamanoukian, MD, FACS · Answer

I would use a combination of co2 laser, Botox, and stimulate the skin with a good cream program that includes Melarase creams and Replenish to improve skin tone.

Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Nima Shemirani, MD · Answer

Hi @MissTralela! You would be a great candidate for PRP injections. PRP which stands for Platelet Rich Plasma is a natural and non-surgical solution to treat under eye circles and bags. PRP is highly effective for restoring sunken eyes.  Generally, two vials of blood will be collected from the patient and placed into a centrifuge. The centrifuge spins and separates the platelets from the rest of the blood components. The plasma contains the valuable collagen and growth factors from the rest of the blood's components. The plasma is then drawn up into a syringe and injected in the tear trough area. Typically, 3 sessions is adequate for optimal results.

Harold J. Kaplan, MD · Answer

Hello Ms. Tralela.  Both dermal fillers and full field CO2 or Erbium laser resurfacing are appropriate for under eye wrinkles, especially since you already had the surgery.  Both can help.  Resurfacing can tighten the skin and fillers can add volume if it has been lost previously or even due to surgery.

Camille Cash, MD · Answer

I'm not sure why your surgeon would be against them, but based on your photos it appears you would have improvement from HA fillers.  This would add volume to improve the contour. See an experienced injector for treatment.

Darryl J. Blinski, MD · Answer

Based on the posted photos I recommend low dose HA fillers like VolBella to tear troughs with micro BOTOX injections over 2-3 sessions. Fees fro $4,000. Best to virtual consult with....

Are dermal fillers the best option to get rid of the wrinkles/bunching that form under my eyes when I smile? (Photo)

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