Age 41 - Wrinkles under eyes (photo)

Question

Hello, I am a 41 year old woman with deep wrinkles under my eyes. I have botox around my eyes, and my Dr does put a little underneath but it's not helped in this area. My dr has said I'm not a candidate for tear trough as I'm not hollow under my eyes and he says my skin is too thin and it will show. I've tried 2 polyneucleotides and 3 lumi eyes too. I'm getting married in 4 months and desperate to lose these lines. Would welcome advice please. Thank you.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Edward Buckingham, MD · Answer

Hello and thank you for your question. Various options exist for adding volume to the lower eyelids, including injectable filler vs autologous fat transfer. The photo provides a somewhat limited view for assessment, however you may have volume deficiency of the lower eyelid and cheek. A detailed in person consultation with a facial plastic surgeon experienced in fillers and fat transfers may be of benefit to you.

Chet Mays, MD · Answer

Thank you for your inquiry! By your photos, it looks like you would be a great candidate for a lower bleph procedure as that procedure will remove excess skin to your lower eyelids. I recommend scheduling a consult appointment with a board certified plastic surgeon like myself so we can assess your eyes, listen to your goals, and create a surgical plan that is best for you and your goals!

Jeffrey M. Darrow, MD · Answer

For people who have wrinkles of their lower eyelids, but do not have the need for a formal lower blepheroplasty, smoothing of the lower eyelid skin can be achieved with a pinch lower blepharoplasty. This is performed under local anesthesia and the lower eyelid skin, just below the eyelashes, is simply repeatedly pinched between the tips of forceps until a standing ridge of the loose excess eyelid skin is formed.  This excess skin is trimmed off with scissors and closed.  The incision line is hidden just barely below the lower eyelid lashes and is very well camouflaged and as only skin is removed the muscle support of the lower eyelid remains intact.  Four months is completely adequate time for the incision line to mature and be nearly invisible.   Best wishes.

Kyle Kimura, MD · Answer

Thank you for your question and the photo you provided! 
I think it is always a great idea to start with the more conservative treatments to address minor issues around the eyelids like you have done (botox, nucleotides, etc). However, some patients reach a point where the non-surgical options begin to make less of an impact than what is advertised. My opinion is that you should consider something like a laser resurfacing of the lower eyelid or a lower blepharoplasty with the focus on addressing excess skin. I think either would be an option for you based on your overall goals. Fortunately, both of these options have a reasonably quick recovery time (laser likely shorter than surgery) that may fit with your timeline. 
Hope this helps!Kyle Kimura, MDFacial Plastic and Reconstructive Surgeon

Lexie Wang, MD · Answer

It's unlikely that you will "lose " lines completely. However, in general, for dynamic wrinkles, the best options are botox to slow down the movement and then maximizing skincare to increase the resiliency/strength of your skin. Sounds to me like you need to work on the latter.

Eric M. Joseph, MD · Answer

Based on your photo, I agree that you would not be a candidate for fillers, or even for lower eyelid surgery. If the wrinkles under your eyes are bothering you, Morpheus 8 is radio frequency microneedling, and we have seen this result in rejuvenation of under eye wrinkled skin. Procedures have minimal downtime and inconvenience, and maybe performed with either topical or local anesthetic.

Michael A. Persky, MD · Answer

Hello Gemma,
Congratulations on your upcoming wedding.  I would recommend a fractionated CO2 laser of your eyelids, the sooner the better.  Good luck and be well.
Michael A. Persky, MD
Encino, CA

Camille Cash, MD · Answer

An in person evaluation is best but it appears you could consider carefully placed under eye filler.  If you are wanting a different option you may consider AccuTite or Morpheus8.   These both use RF technology to tighten skin and are safe to use under the eyes.  I've included a video I hope you find helpful.

Thomas Spalla, MD · Answer

Given that you are getting married in 4 months, I would recommend that you look into a resurfacing procedure such as CO2 laser. Make sure you go to an experienced surgeon who ensures no lower lid laxity (unlikely given your age and pictures) prior to the procedure. They may require some pretreatment topical agents, so don't necessarily expect to have it done the same day. You have plenty of time to heal from this prior to your wedding.

Age 41 - Wrinkles under eyes (photo)

Answers (10)

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