Is still the case that under eye thin skin is difficult to treat with filler? (Photos)

Unfortunately, there is no easy fix for under eye crepe, and wrinkled skin. Under eye skin is too thin to inject wrinkles when present. I doubt resurfacing procedures would lead to results lasting over a year, but that may be your only avenue to pursue - possible chemical peel or laser resurfacing depending on your exam. Thank you. Dr Joseph

Hi @MAD333. I recommend PRP injections. PRP which stands for Platelet Rich Plasma is a natural and non-surgical solution to treat under eye circles and bags. PRP is highly effective for restoring sunken eyes. Generally, two vials of blood will be collected from the patient and placed into a centrifuge. The centrifuge spins and separates the platelets from the rest of the blood components. The plasma contains the valuable collagen and growth factors from the rest of the blood's components. The plasma is then drawn up into a syringe and injected in the tear trough area. Typically, 3 sessions is adequate for optimal results. Best of luck, Dr. Nima!

You are correct that filler will not help with the fine lines under the eyes. The game changer for me in treating this area is the Sciton TRL laser.  Under local anesthesia, in about 15 minutes, the skin can be tightened and smoothed with the laser.  The skin heals in 5-7 days, then there is redness for a few months that is totally coverable with makeup.  

For my patients who have thin undereye skin, I
prefer to focus on collagen-stimulating
procedures for this area such as microneedling
with plasma (also known as “PRP”), and in addition you could
use some lasering to improve the
wrinkles on your lower eyelids. You are correct,
however: very thin undereye skin can have issues with injecting filler (such as
the “tyndall” effect when the filler shows through a greyish-blue color), so it
is very important to have an in-person consultation with someone who will look
out for your best interests.

Hello there,
     In my experience, it takes targeting this area with many different treatments to see dramatic results. 
Firstly, I would recommend starting to use a medical-grade eye cream to really hydrate and replenish the tissue in this area. 
Secondly, I would recommend softening the muscle movement with neurotoxin. This will decrease the motion in this area, helping to decrease the severity of the wrinkling. 
Thirdly, I would recommend targeting the superficial collagen and elastin with treatments like micro needling or Halo. I then would target the deeper tissue with either Ultherapy or Exilis Ultra. These treatments will thicken and revitalize the tissue, making it appear smoother and tighter. 
Fourthly, under eye filler can support this area, filling some of the depression.
Lastly, filler along the cheek can further enhance this area, supporting the tissues that are adjacent to the under eye. 
Most patients will utilize some combo of these treatments. Targeting this area this way will have a dramatic affect on the appearance. Hope this helps!
Sarah RN BSN 

Recent advances in fat grafting eg microfat and nannofat have been very successful in treating under eye hollowness and thin skin

Hello and thank you for your question.  One option you might want to consider is PDO Threads.  Miracu just came up with a Elasty Meshfil PDO thread that can be used alone or in combination with a little filler for the tear trough area.  PDO Threads have a lifting, volumizing and rejuvenative effect on the skin with or without the use of filler.  Hope this answer helps and best of luck from the Art of Ageless Aesthetics.  

I think that there are two separate issue here but both can be tackled. The hollowness under the eyes is not difficult to treat nor is it even uncomfortable but the chance of bruising is high so I tell my patients to be prepared for that. The wrinkles on the upper cheeks , below the eyes, can be treated with fine threads of filler and if placed carefully and correctly this should improve. I would also use some filler in cheeks.