Which treatment is best fix my crepey skin under eyes? (Photos)

Question

The last photo with my hair straight is 13 years prior to the ones I just took. I used to have fat pads under my eyes that I disliked. I never got them removed because I knew I would lose the fat as I got older. Here I am now and the skin under my former puffier eye is loose and crinkly. I would prefer not to get surgery but want it fixed. I'm Spanish so my skin tends to hyper and hypo pigment. Is microneedling and Botox the answer? Fractura? Plasma tightening? What would you do? Based in park city and Raleigh - help please!

Raffy Karamanoukian, MD, FACS · Answer

Morpheus 8 is a non-invasive skin and soft tissue tightening treatment that is consistently amazing in our patients. We use the Morpheus to exact fractional induced RF into the skin or tissue in order to tighten collagen and stimulate contraction of the tissue. For acne scars, it is quite useful to build collagen in patients who have atrophic scars but is not very productive for ice-pick scars which require TCA Cross. For tissue tightening, Morpheus is ideal for the face and neck and we often combine it with CO2 laser or Ultherapy to further enhance results. Chemical peels and skin resurfacing should be done at least 5 to 7 days after, but can be performed earlier, depending on treatment severity. Avoid exfoliating skin treatments before Morpheus and expect a period of 2-4 weeks for skin contraction to set in.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Ron Shelton, MD · Answer

I would avoid microneedling on skin that close to the eyelashes.  ThermiSmooth which is a gentle radiofrequency heat treatment can help provide better skin integrity along with the use of Alastin cream. Botox is very helpful for the outer eye creases but not all patients can have the lower eyelid creases treated with Botox as it can cause an exacerbation of pre treatment puffiness. In patients less prone to hyperpigmentation, fractional laser (erbium and carbon dioxide wavelengths) can help tighten the skin.The information provided in Dr. Shelton's answer is for educational purposes only and is not intended to constitute medical advice.  The information provided should not be relied upon as a substitute for consultations with a qualified health professional who may be familiar with your individual medical needs

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers, and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

Zoran Potparic, MD · Answer

It appears that you would be candidate for transconjuctival blepharoplasty. Incision is placed inside of the eyelid and minimal skin excision may be needed in some cases. This can be safely combined with chemical peel (skin wrinkles) and fat and nano-fat grafts to improve overall appearance. In person consultation with a board certified plastic surgeon with expertise in facial rejuvenation

J. Phillip Garcia, MD, FACS · Answer

Ideally, surgery would be your best option. It would allow for removal of the fact that is causing the bags as well as any excess skin. Short of that, any sort of resurfacing from chemical peels to lasers would help tighten your lower eyelid skin. In your case I would be very cautious with any sort of resurfacing due to your skin type and the risk of hyperpigmentation. A filler below the fat bag would help camouflage the fat bag.  Best of luck.

Jeffrey Joseph, MD, FACS · Answer

Thanks for the question.  I would recommend Botox injections followed by laser resurfacing.  I would also recommend medical grade skin care.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question.   Although you may prefer not to do surgery, based on
your photographs, the best shape and contour could be achieved with a lower eyelid blepharoplasty with septal reset.   Make sure you specifically look
at before and after pictures of real patients who have had this surgery
performed by your surgeon and evaluate their results.   
Best wishes and good luck.
Richard G. Reish, M.D.  FACS
Harvard-trained plastic surgeon

Monika Soni, MD · Answer

Thank you for your question! To treat the outermost crows feet lines, I recommend Botox. The rest of the contour irregularities can be treated nicely with scarless (transconjunctival) fat repositioning blepharoplasty to smooth the prolapsed fat pads, with simultaneous resurfacing of the eyelid skin (either CO2 laser or chemical peel). Best of luck!

Michele S. Green, MD · Answer

I recommend a combination of Botox or Dysport around the eyes and a hyaluronic acid filler such as Restylane or Volbella under the eyes.  Lasers such as Fraxel, Thermage, and procedures such as PRP with microneedling can help the lines and texture as well.  Please consult an expert in eye rejuvenation for the best cosmetic results.  Best, Dr. Green

Shaun Patel, MD · Answer

When it comes to nonsurgical treatment of the eyes, I usually recommend a combination of treatments to get the best results. This includes neuromodulators like Botox and Dysport to help with dynamic lines and wrinkles (i.e. crow's feet), hyaluronic acid based fillers like Restylane to correct undereye volume loss, and microneedling/lasers/skincare to improve the quality of the skin around the eyes.