How to help jelly rolls under eyes? (photos)

Question

When I smile I have “jelly rolls” under my eyes. I get dysport for my crows feet, would that help for my under eyes? I’ve heard that it could make my under eyes look more “puffy”. Any other suggestions besides blepharoplasty, or is that the only option?

Randal Haworth, MD, FACS · Answer

Hello !

Dysport can help and in good hands, it shouldn’t look puffy. You might want to consider microneedling, chemical peels, or laser treatments.

However, the most effective/durable option would be a blepharoplasty. It would remove/replace the extra skin causing this issue.

As always, it is recommended to consult with a skilled board-certified facial plastic surgeon who can provide you with a fully informed recommendation after a thorough examination.

Best of luck!

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

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. Treating this area with a conservative amount of Botox or Dysport may minimize the appearance of the rolls you’re referring to. Other treatments such as laser resurfacing and RF microneedling can also diminish under-eye lines and improve your skin’s elasticity. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or expert injector. They will be able to review your treatment history, assess your concern, and determine the best treatment plan for you.

James M. Economides, MD, FACS · Answer

I have had great success in this area with microdosing botox to the jelly roll area to help smooth out the wrinkles. This area is commonly treated incorrectly with filler which will damage the very thin and privileged skin. Rather, the jelly roll is created from a hyperactive orbicular muscle which a small amount of botox will help relax.

Eric M. Joseph, MD · Answer

In my opinion, the rolls under your eyes are from lower lid orbicularis muscle that heaps up. In our experience, Botox doesn’t work, and neither does surgery. I wish there was better news for the jelly rolls! Dr Joseph

Paul Flashner, MD · Answer

This is a great question and yes botox or dysport would work well with the jelly rolls as well as the crows feet. This should not add any puffiness at all to the under eye.  Good luck!

Nima Shemirani, MD · Answer

Hi @krick17. Thank you for sending your photos. The "jelly roll" you are noticing is due to orbicularis muscle hypertrophy. This can be softened with a neuromodulator like Botox, Dysport, or Xeomin. The fine lines  can be addressed with a CO2 laser,  Erbium laser, or microneediling. Best of luck, Dr. Nima!

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.

Philip S. Schoenfeld, MD, FACS · Answer

You have a few issues taking place.  The "jelly roll" is due to orbicularis muscle hypertrophy and non surgically this can be addressed with about 5 units of Dysport to start.  The fine lines and wrinkles are skin quality issues and does not appear to be skin quantity issues so non surgical interventions like CO2 or Erbium laser, chemical peel, and microneedling can be effective for that.

Nelson Lee Novick, MD · Answer

Neurotmodulators, like Botox, Dysport, and Xeomin have long been used to soften so-called "Jelly Rolls" under the eyes that become more prominent with smiling. The jelly roll is simply hypertrophy of the small infraorbital muscle and hence is amenable to the aforementioned neuromodulators that can soften  the muscular contraction and make it less prominent. You would be wise to consult with an experienced, board certified cosmetic dermatologist.

How to help jelly rolls under eyes? (photos)

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