I have under eye wrinkles I’d like to try and minimize. What would be the best recommended treatment? (Photo)

Hi Lesl11, If there was a perfect solution for the under eye wrinkles when smiling big, we would all already be doing it. When patients have a concern, and our current techniques don’t seem to be solving the concern, instead of throwing other procedures which don’t have a track record of improving the problem, it might make more sense to sit back and figure out why this problem happened in the first places and start from there. Whether there is a current solution to the problem remains to be seen, but would you rather your cosmetic injector do stuff because you asked them to or be upfront and tell you that there aren’t any great solutions currently, but what is currently offered may help 5-15% only.
Having said that, your concern is a common one. Most likely when you are not smiling the wrinkles are not there. As detective work, I would want to see younger photos where the wrinkles were not there. If you had them when you were 21 then it will be a problem, since it may be an issue you have always had. Most likely when you were 21 you didn’t have wrinkles, but instead had smile bags which the Korean plastic surgery term is called “Aegyo Sal” which is also called love bands or youth-lites (highlights). These smile bags form when you smile big, but disappear when you are not smiling. Look at children when they smile big and most will have it.
I have a theory on why this happens, but I am not ready say since I don’t have a solution to solve the problem yet.
Other responses may recommend some kind of skin tightening with RF Microneedling, but that would be an off-label use, since their FDA indications does not say it will work for fine lines and wrinkles under the eyes while smiling. If you see them when you are not smiling, then maybe there is some indication to offer that procedure, which may help when you are not smiling, but unlikely help when you are smiling.
Botox placed directly into the lower eyelid wrinkles will relax the muscle which can help with wrinkling, but may can eyebags to form because the orbicularis oculi muscle loses muscle tone which will cause a different problem. All of this is documented on different RealSelf reviews by RS members.
Sorry this isn’t the response you wanted to hear, maybe other doctors have a different experience and can confidently recommend procedures which you can see their before and after results fixing the problem on their RS profile photos or on their website.
Hope I provided some value. Keep doing your research. You are on a good website to do it. Best, Dr. Yang

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.

Patients typically have the best results from a combination of treatments. Filler is often used to help with volume deficits and to disguise contour irregularities. Lasers or treatments such as Morpheus8 can help improve skin tone and texture. Botox can help soften lines in the crow's feet area. We also recommend using medical grade skin care products and wearing sunscreen every day.