What is the best procedure for my under eye wrinkles? (photo)

Question

I’m 40 years old, a non-smoker, with fairly good skin except around my eyes. My under eye area has always been very wrinkly and ages me. A course of Elexis Elite did nothing. Botox only helps the crows feet. I’m not sure what to try next. Thank you

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. Since you didn’t achieve the desired results with Botox injections or RF microneedling treatments, you may benefit from an eyelid surgery known as blepharoplasty to reduce the appearance of the wrinkles you’re referring to. 
Specifically, lower blepharoplasty can tighten loose muscles and reposition fat below the eye to add volume and create a firmer, more youthful appearance. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concern and suggest the best treatment option.

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.

Dilip D. Madnani, MD, FACS · Answer

You have a few options. Laser skin resurfacing will improve the skin wrinkling and provide some tightening of the wrinkles around the eyes. Usually a few sessions are needed for best results. Keep up  with the botox for sure to minimize wrinkling, especially over time. 
Other options includes surgical approach with removal of the excess skin. Easier to show you during consultation.

Sam Speron, MD, FACS · Answer

This is a common question.  Horizontal eyelid wrinkles can be corrected with blepharoplasty or cosmetic eyelid surgery. It is one of the first cosmetic surgeries people usually get. While the average age might be 30 to 50's, some patients get this done in their 20s. It really depends on your unique anatomy as well as what exactly is bothering you.

Botox injections as well as laser treatments can also be a tremendous benefit if you are not interested in surgery. Of course, there are also many combinations.

I would recommend that you see a board-certified plastic surgeon in your area that is a member of both ASPS & ASAPS and performs a lot of eyelid surgery but also offers all the nonsurgical options such as injectables and laser treatments. Go over your concerns with them and make sure above all, you walk out of there with several options and an idea of the pros and cons to each of them as well as realistic expectations.

I hope this helps and wish you all the best in your surgery and event. If it does, please take a moment to up vote this answer on the “respond” button on the top right.

Nelson Lee Novick, MD · Answer

No surprises about the disappointment with the energy-based device; unfortunately, I have been cautioning my readers for years that these relatively expensive, faddish, gizmos are far more backed by marketing hype than hard science. Sorry. Although a full-face photo showing more of the cheeks would have been helpful, there appears to be some volume deficit in the upper cheeks regions, which are important supports for the under eye areas. If indeed so, then the appropriate use of a robust volumizing filler to the upper cheeks would likely result in improvement in the infraorbital region, which then can be complemented by a use of a series of in-office superficial peels, if felt to be necessary. Make sure to consult a board certified cosmetic dermatologist and best of luck going forward.

Michael I. Echavez, MD · Answer

An examination of you would be helpful to give you the best advice as to treatment options for the wrinkles under your eyes.  I would say possible treatment options would include CO2 laser resurfacing, radio frequency micro needling, or a surgical procedure to remove a thin strip of skin below the lashes to produce some tightening.

Robert T. Buchanan, MD (retired) · Answer

The wrinkles are caused by laxity and thinning of the skin from loss of collagen and elastin in the skin which has been progressing in you for the last 15 years when your skin stopped producing them on its own. The only devices that really do any good are a Fraxel Laser and microneedling. However, these do much better if you are on tretinoin (Retin-A) to stimulate collagen production and Obagi's FLASTIderm to stimulate elastic tissue. If this does not give enough improvement, then an external blepharoplasty is the only option.

Fatih Ceran, MD - Account Suspended · Answer

Hi. I think the best treatment options for you are skin pinch lower eyelid surgery and upper eyelid blepharoplasty. Of course after exact examination canthopexy could be added. Have a nice day!

What is the best procedure for my under eye wrinkles? (photo)

Answers (8)

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