40 - Which treatment will improve these deep lines that appear like scars? (Photos)

Question

I have had these 2 deep lines under my eyes for a few years now. Ive tried TCA chemical skin peels., glycolic peel, RF microneedling and there’s zero improvement. Any ideas on what i can do, its often mistaken for a scar its that deep. Im 40 and had upper lid blephopastry a few months back which I’d hoped might have made a slight improvement to the lines but sadly not.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photos and providing a clear history — I understand how frustrating it can be to try multiple treatments and still feel like nothing is improving. Those deep lines under your eyes, especially when they appear like scars, can be stubborn because they are often caused by loss of volume, fibrotic tissue, or structural changes in the skin, rather than just surface texture issues.

From your description and treatment history:

Peels and microneedling are great for improving skin texture and fine lines, but they usually don’t address deep structural lines or depressions.

Volume restoration with filler is often the most effective way to soften deep lines under the eyes. Carefully placed hyaluronic acid fillers can lift and fill the area, improving the shadow and “scar-like” appearance while keeping results natural.

Subcision or laser resurfacing can sometimes help if there is tethered fibrotic tissue contributing to the line, though these approaches need to be tailored carefully for the delicate under-eye area.

Since you recently had upper lid blepharoplasty, it’s unlikely that procedure would significantly improve lines under the eyes, as it primarily affects the eyelid, not the mid-face volume or dermal depressions.

At 40, a combination of strategic filler placement and, if needed, targeted resurfacing usually provides the most noticeable improvement for deep, persistent lines under the eyes. These areas are delicate, so subtlety is key to avoiding overcorrection and maintaining a natural look.

Kally Papantoniou, MD, FAAD · Answer

When lines in this area start to look deeper or more "etched," treatments like peels and microneedling with radiofrequency can still stimulate collagen production. Still, they don't always address the underlying issue if there is a loss of support or structure beneath the skin. This is why patients often feel like nothing worked; it's not necessarily that the treatments failed, it's that they weren't targeting the main cause. In many cases, improvement comes from restoring support in the area, often with filler, sometimes combined with resurfacing treatments like Fraxel to help refine the skin itself. A proper in-person evaluation can help determine the best approach for you.

40 - Which treatment will improve these deep lines that appear like scars? (Photos)

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