How Can I Remove Creases and Wrinkles in Tear Trough Area?

Hi, I am a 48 year old female. Used retin A/renova since my late 20's. Also had laser work done on face to restore smoothness, eliminate some discoloration..etc. with great results. Not many crows feet around my eyes when not smiling but when I smile...lots of wrinkles and creases under my eyes. I love to laugh and have a great time, but don't want to look older than I am while enjoying life. How does one go about fixing this since it seems like most Docs. frown on using fillers in tear troughs

Doctor Answers 6

Botox helps half the time with under eye creases.

Botox helps to improve under eye creases when you smile in half the cases.  When it works it is great.  Try botox 1st then if you don't see improvements then try fillers.  I like diluted radiesse injected a little at a time for 3 sessions a few days to a week apart. Sincerely,

David Hansen,MD

Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 42 reviews

Botox and Fillers to Eyelids

The presence of wrinkles and creases when you smile suggest that the use of Botox would be an appropriate initial treatment.  Botox can be judiciously used to lighten the effect of the muscle in the lower lid, but you do need to see someone experienced in treating this area.  When done properly, the risk of lowering the lid in someone your age is not great, although it can happen.   An oculoplastic surgeon would be your best source.

As for filler, sometimes when placed in the tear trough area it will attract water so that it diminshes the appearance of the line.  I would expect a combination of Botox and filler such as Restylane would achieve the best result.

Alan B. Brackup, MD, FACS
Philadelphia Oculoplastic Surgeon
5.0 out of 5 stars 29 reviews

Wrinkles and creases under eyes

The wrinkles and creases that are accentuated when you smile are due to the movement of your cheeks "pushing" your skin upward towards the lower lid area. Botox injections in the lower eyelid area are very meticulous and it requires an injector who is skilled and has a done a number of injections in that area with positive results.  I do not recommend injecting Botox in the lower eyelid area as there is a risk that your lower eyelid could pull down leaving you with temporary scleral show (the white portion is visible) as well as dry eyes and this could actually make you appear older if this were to occur after the Botox was injected. 

 As for filler in this area, I routinely inject a hyaluronic filler such as Juvederm to plump up depressions in that area which occur from a loss of natural fat that a leaves a diagonal crease between the lower eyelid and top of the cheek.  My advice is to consult with a Board Certified Facial Plastic surgeon who can determine the best solution for your problem.  You can visit the American Academy of Facial Plastic and Reconstructive Surgery website ( to find one in your area. 

Arnold Zweig, MD (retired)
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Treating Under Eye Wrinkles

As we age , it becomes more evident that the natural fat in cheeks begin to disappear, causing skin to sag and the face to look hollow. This can also make the eyes appear darker and more sullen. Dermal fillers such asRestylane Lyft orJuvaderm Voluma are specifically designed to add fullness to the cheeks and mid-face area, giving a more natural-looking, youthful appearance.

Restylane Silk more gently fills the inner eye troughs to make a more natural look to compliment .  Injectors with advanced expertise can offer you great results that will last 12- 18 months or more !

Botox can help relax the dynamic wrinkles on the outside of your eyes and give you a more wide-eyed appearance! The combination of both fillers and Botox is an excellent solution for the treatment of eye wrinkling!

Jed H. Horowitz, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 109 reviews

Tear trough injections

If you have depressed tear troughs, then fillers like restylane can be very helpful, but the crinkly lines you get when you smile is from the muscle contraction underneath the skin. .Loose skin can sometiems be removed with a blepharoplasty.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

With Filler or Botox

An injectable filler, such as Teosyal Redensity II, can help smooth the wrinkles that are permanently etched under your eyes. However, if these wrinkles only appear when you’re smiling and laughing, you may want to consider Botox.

Leila Kasrai, MD, FRCSC
Toronto Plastic Surgeon
5.0 out of 5 stars 66 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.