Ultherapy vs Fraxel for under eye smile wrinkles only?

Ultherapy is not done to the skin immediately below the eyelashes as this skin is too close to the eye and the transducer is too wide to safely place on the eyelid.Fraxel, regardless of which type such as Clear & Brilliant, Restore (Dual) or Repair has a risk in patients with skin of color to induce post treatment darkening which usually is temporary but can be long tern. As the lines in the area below the eye are accentuated by muscle movement such as squinting and smiling, no treatment can remove them entirely so I prefer safer gentler treatments such as a series of ThermiSmooth radiofrequency treatments which do not cause downtime nor darkening.

In my practice we combine these treatments and even add PRP injections/microneedling and/or fillers to get the best results.  Please see an expert for combination treatment. Dr. Emer.

If you have dark skin your options are limited.  The non-ablative resurfacing may help a little, but I never think it provides much tightening for wrinkles.  Unfortunately you can't do ablative with the darker skin.  Ulthera is not a good option in this area.Botox injections are the best option for the crow's feet. Another thing you might consider is microneedles with radiofrequency.  This stimulates new collagen growth and tightens skin.  Because there is no laser light involved, it is safer on darker skin tones.     

I would be very hesitant to do Fraxel if you have a darker skin type!  A picture would really help out here also, as I have nothing to base my answer on, and the answer is a complex one.  Fraxel CAN work well for what you're describing, but Ultherapy can also work.  It depends on other factors.  Based on your skin type, I'd go with Ultherapy, but you really need to see a PS and figure this out first.  RealSelf can be helpful, but it is not always the most effective way to get your answer.

Hi and thank you for your question! Ultherapy is great for lifting the eye and brow area. We find it helps to open the eye and relive some of the heaviness that some patients start to see in this area. You will also see improvements in the crows feet and the skin around the eye. We use the 1.5mm transducer on everyone to allow for the superficial stimulation of collagen that is very helpful in this area. For lines and wrinkles around the eyes, especially close to the lower the lower eye lid, we also like to use Venus Viva. This is fractional radiofrequency, so you can safely treat close to the eye. This is also safe for all skin types. Best, Dr. Grant Stevens

Unfortunately you have given us very little information to help you. You have posted no pictures so we don't know what you are trying to improve and if the under eye is full with fat or saggy with excess or loose skin. We also don't know what you mean by fraxel. Do you mean the non-ablative 1550nm or 1920nm or the ablative CO2 which you should not have. We don't even know your age. I recommend you have a consultation with an experienced board certified dermatologist, facial plastic or occuloplastic surgeon to address your questions.

If you have darker skin type, lasers such as co2 or preferably erbium can be conducted with caution. This is because skin darkening can occur. With low density passes, this is safe, however you will need multiple treatments. I do not like Fraxel for darker skin types (especially the Re:Pair) as it has too many side effects. For lighter skin types, it is a good laser. Ultherapy can not be used too close to the margins as skin is very thin there. My treatment of choice, without reviewing your skin (blind assessment) would be either micro needling combined with PRP, or eMatrix RF. All the bestDr Davin LimLaser and aesthetic dermatologistBrisbane, Australia.