What is best for under eye wrinkles: Botox or Fillers? (Photo)

I am 32 and have several under eye wrinkles. Looks like crows feet under my eyes when I smile.

Doctor Answers 12

For Hollow Eyes, Use Fillers Like Restylane and Belotero

Thanks for your question and photo. For the hollow under your eye, a filler such as Restylane or Belotero are the most common HA fillers used here. Some also will use Juvéderm in this area. For the skin itself, we would recommend starting with skin care with eye creams such as Neocutis Lumiere. If needed, a fractional laser skin resurfacing or sublative RF fractional treatment can be done which will even enhance the results. Please consult with a board-certified dermatologist or plastic surgeon to learn the best optimal results for you.


Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

Under Eye wrinkle Options

I cannot say for sure from the picture, but it looks like you do have a mild tear trough deformity.  This can be corrected with hyaluronic acid fillers such as Belotero or Restylane.  Botox would work for the dynamic wrinkles on the sides of the eyes and may diffuse to help with your area of concern.  So I would start with Botox in this situation and then move on to filler if the area still has wrinkles.  You should also see your dermatologist in person to look at the texture of the skin because if the issue is loose or crepey skin, then a resurfacing laser would be a good option.

Karen Hammerman, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Fillers or Laser for wrinkles under eyes

For the appropriate patient, dermal fillers such as restylane or belotero, or laser work best to address wrinkles under the eye. Consult 3 experienced and expert board certified plastic surgeons to understand your options.

Kris M. Reddy, MD, FACS
West Palm Beach Plastic Surgeon
4.5 out of 5 stars 36 reviews

Laser Resurfacing for Under Eye Wrinkles

Hi GG.  In many cases we will recommend a dermal filler under the eye to help with wrinkles, but for the dynamic kind you have, we would likely recommend a laser resurfacing procedure.  No treatment is going to be perfect, but we wouldn't use Botox as the amount of product required to help would be extremely small, which would mean that it wears off very quickly.  In addition, the possibility for making the under eye area sag because of the Botox would be high.  Botox is not commonly used in this way.  

In person, we would be able to see you smile and discuss the benefits of filler vs. resurfacing.  For an example of Orange County eye rejuvenation using Restylane and laser resurfacing, check the link below.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.5 out of 5 stars 8 reviews

Undereye Wrinkles

Undereye wrinkles need to be treated with a combination approach of skin care, botox, lasers and/or radiofrequency. You can get amazing results, but you should see a cosmetic dermatologist with experience in treating this area which is sensitive and requires a meticulous provider to limit any complications.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 165 reviews

Treating Wrinkles Under the Eyes

Treating wrinkles under the eyes is a complex question.  If you are treating the sun damage and texture under and around the eyes then eMatrix or Fraxel are the best lasers for this purpose.  Botox will only treat the crow's feet which are dynamic wrinkles around the eyes.  If there is a depression under the eyes I inject Belotero or Restylane under the eyes to correct the problem.  Please consult a board certified dermatologist with a great deal of experience in this area for the best cosmetic results. 

Best Treatment For Under Eye Wrinkles

Thanks for writing,

Botox is helpful with the crow's feet area but nowhere else under the eye. Fillers help the tear trough, but you don't have one. Lower lid wrinkles can be and usually are dynamic wrinkles, caused  by smiling i.e. compressing the mid-face.
To go from simple to complex: topical creams ( not over the counter) can help to a degree, there are some good physician level products.
Fillers may have a little effect, not much, laser resurfacing ( be very careful who you choose). These are some of your options, find a Board Certified Plastic surgeon who will take the time to examine you and review your options, think about it and choose carefully.
Good Luck

Stephen M. Davis, MD FACS
Green Hills Plastic Surgery

Eye wrinkels- what's the best treatment

For eye wrinkels in the crow's feet area, Botox works well. For under the eye wrinkles, CO2 laser resurfacing works amazingly well. For the volume loss, I would consider a filler. 

Jose E. Barrera, MD, FACS
San Antonio Facial Plastic Surgeon
5.0 out of 5 stars 40 reviews

Best Treatment For Under Eye Wrinkles

Hi GG. You do have some volume loss in your tear trough areas underneath your eye. You would benefit from a superficial filler such as Belotero to naturally fill these. As for the creases directly under your eye, in someone your age what I would recommend is a series of chemical peels that may help improve their appearance. There are also at home prescription strength creams that you can use, but they are more for maintenence and prevention than actual treatment. Laser resurfacing would be a more aggressive treatment. I would stay away from Botox and fillers in those areas. Hope this helps.

Michael A. Zadeh, MD, FACS
Sherman Oaks General Surgeon
5.0 out of 5 stars 9 reviews

Undereye wrinkles when smiling - sometimes fillers, sometimes Botox needed

Without seeing you in person, it is hard to say what would work best for you. In the younger patient, usually only Botox is needed in the crows feet and maybe in the under eye area. Even if filler is needed, I always start with Botox.  If not improved, sometimes enhancing the lateral cheek and tear trough can help. If the problem is crepey skin under the eye, laser resurfacing or RF, like Infini can help. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 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.