Crepey skin under eye treatment suggestions? I'm 40 years old and have tried fillers. (photos)

Question

Dear Doctors, could you please advise on the treatment ( lasers, etc) to resolve the crepey texture under eyes (on upper cheek margin) developed a year ago. I have Botox regularly. Eye product used - AOX and Environ C-quence eye gel, diligent with SOF. I am 4O and very upset about the issue. I am prone to keloid scarring. I had a filler a year ago but it didn’t help the issue at all. Thank you.

Adam Scheiner, MD · Answer

Dear Sophia,It appears from your photos that you've had some sun damage to your face in the past. That sun damage is responsible for the fine wrinkles in the lower lid and festoon starting to form on the left cheek. 1st: Its important to start wearing sunblock every day and sun glasses to protect you skin for getting worse2nd: Festoons and Malar mounds are difficult to treat but lasers have been helpful in improving them.I'll include some links below.I hope this was helpful.

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, peels and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

David A. Caplin, MD · Answer

You should seek out a provider who has experience with Fractora RF treatments.  That might be a good option and it is an easy office procedure usually performed with a topical anesthetic.

Raffy Karamanoukian, MD, FACS · Answer

Dark under eye circles can make you look tired and older than you are. I would use a combination protocol that includes topical Melarase creams first, followed by a combination of injectable fillers, fractional laser, and RF to blend out the eyelid hollowness and tighten the skin. 
Recommended Creams: Melarase Brightening Kit
MelaClenz
Melarase AM
Melarase PM
Melapads
Replenish Retinoid Cream
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Zoran Potparic, MD · Answer

Based on these photos and short of in person evaluation, I would suggest moderate cheek augmentation with fat grafts or Voluma. Possibly treatment of eyelid/cheek junction with nano fat grafts. Chemical TCA peel may help to treat fine wrinkles. Good luck.

Matthew C. Camp, MD · Answer

Hi SophiaIt seems like you are doing a lot of the right things. I have found that an intense treatment with retinol product can improve the texture of this very thin skin. During treatment sun protection is very important. If this does not work, laser treatment can give some improvement, but keep in mind this skin is very delicate and can easily be over-treated by ablative laser (CO2/YAG). If you were older, and had more hollowed out I would recommend fat grafting - which delivers stem cells that stimulate regeneration of collagen and elastin. Another alternative to fat grafting would be platelet rich plasma, which imparts growth factors without the volume of fat. Best of luck!Matthew C Camp MD

Diana Tamboli, MD · Answer

SophiaB1112,
I understand your frustration and hear this complaint often when patients come to see me. Filler is wonderful in helping manage undereye hollows however it doesnt address the loose thin skin of the lower eyelids. I think the best way to approach this issue is with ablative laser skin resurfacing. You could use the CO2 or Erbium laser safely. I do laser resurfacing for 95% of my lower eyelid blepharoplasties to improve the texture and quality of the skin. This is a great wat to rejuvenate the area with little downtime and lasting results.
Dr Diana Tamboli

Kami K. Parsa, MD · Answer

You may try co2 laser resurfacing. Unfortunately a picture is not a sufficient way to give you my final impression. We recommend an in person consultation with an oculoplastic surgeon who specializes in the eyes. For more information visit our website.

Camille Cash, MD · Answer

There are several options that are helpful to improve tone and texture.  Microneedling, lasers, and chemical peels are all beneficial treatments.  PRP is another option that can be considered.  See an expert in your area to learn more about what is best for you.

Crepey skin under eye treatment suggestions? I'm 40 years old and have tried fillers. (photos)

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