What Can Be Done for Crepey, Saggy Skin Under the Eyes?

Without an examination, it is difficult to say for sure. If
the crêpey appearance is as minimal as it sounds, you could see great results
from laser resurfacing to tighten the surface of the skin and promote collagen
production. Alternatively (or perhaps in addition), you may consider a very,
very conservative blepharoplasty (eye lift surgery), but be sure to choose a
highly qualified cosmetic surgeon with a lot of experience working on the eye
area. And finally, invest in a nourishing night cream and an outstanding
sunscreen and use them both religiously to further protect your skin’s firmness
and elasticity.

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. 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

I would recommend a laser  treatment combination plan of Clear and Brilliant and Vivace with PRP.   You need to start stimulating your own collogen, to help strenghten your skin.  It will help smooth out the crepey skin, plus help reduce discloration from sun damage, reducing pore size and fine lines.   

Thanks for sharing your question. For redundant skin to the lower eyelid you have a few options to help tighten this area.  First a fractional CO2 laser will help treat this loose skin. Similarly a medium depth chemical peel such as Jessner's /TCA 35% will also work. Surgically a skin pinch or skin only lower lid blepharoplasty will help to remove the excess skin directly. Consult with a few board certified surgeons and dermatolgists to review your options. 

If your only issue is the skin texture that you are seeing under the eyes I would look into a resurfacing.  This can be done with a Laser or a Chemical.  In this procedure we are removing skin and letting new skin grow into the area, when we do this we get a collagen response from the body that will help to tighten the skin.  This is a procedure that we do often at our practice and see great results.  If there are multiple issues happening other than just the texture of the skin a combination of procedures will give you the best result.  These treatments could include filler, fat grafting, or a lower blepharoplasty.

Under the eyes wrinkles that occur with smiling are often very successfully addressed using an injectable neurotoxin such as Botox.  This area does have a slightly higher risk of bruising than other areas Botox is typically used.  With regards to crepey, loose skin there are several surgical and non-surgical options to improve the tone of your skin.  One option that is associated with no down time is skin tightening using a radiofrequency device such as Exilis or Ulthera.  These devices deliver a controlled amount of heat to the deeper layers of the skin which in turn stimulates fibroblasts to make new collagen.  Over the following weeks-months this new collagen contracts and tightens up the treated skin giving a more youthful appearance.  Exilis usually requires 4 treatments spaced 3 weeks apart while Ulthera usually requires 2-3 sessions.Laser resurfacing is another option that usually only requires one session.  The down-side is that the first few days after the treatment your skin will be swollen and red as it heals.  The upside is that it requires only one session and gives excellent results after just a couple of weeks. 

First I would address the reason for these lower lid  and crows-feet wrinkles. These type of wrinkles are often seen in patients that squint so first of all I would make sure that if you need visual correction then use glasses or contacts (if not sure, have your vision tested) and use sunglasses on bright days.                                                                                                                                                                                    Now for treatment options, other than the the frequent use of moisturizers, Retinoids like Retin-A, and sunscreens you can consider the use of fillers like Restylane and Juvederm are helpful to decide the degree of benefit from supporting the skin. If you like the effect then consider a more permanent solution like fat transfer. Secondly, a deeper TCA peel, Sciton SkinTyte laser or fractional laser treatments often help. Both fillers and resurfacing procedures are complementary and synergistic in your case. For redundant skin, a conservative skin pinch blepharoplasty may also be of benefit. A qualified board certified aesthetic surgeon will help you find the right treatment for you

Crepey, saggy under eye skin is primarily due to loss of collagen and thinning of the skin related to aging and past sun damage. Correction involves promoting collagen production and tissue remodeling which is best achieved with energy-based treatments. There is no doubt that the current gold standard in tissue remodeling is radiofrequency microneedling. I often use a combination of CO2 laser resurfacing for the upper eyelid with Morpheus 8 RF microneedling for the lower lid. This give beautiful, enduring results that look natural.

To give a better appearance to the skin under the eye, treatments like resurfacing laser of microneedling with PRP will improve this look you mentioned. If you are still worried about the hollowness under your eyes, fillers are the treatment you should get; if you’ve tried Sculptra before and were happy with the treatment, you can continue having it; however, you need to add something extra to have the desired look. Don’t forget that sunscreen, skincare, and makeup also play an essential role in skin maintenance, especially in this area. An evaluation to see the amount of loose skin needs to be done to choose the right treatment.

Hi,Thank you for your question. The most common signs of ageing skin around the eyes are fine lines, dark circles and puffiness.While the judicious use off dermal filler can temporarily improve fine lines and dark circles, the risk of increasing puffiness under the eyes is a limiting factor.So dermal fillers would not be my first choice.To improve the skin texture, I would advise the use of a good quality eye cream that can help with dryness, creepiness and loss of skin elasticity in that region.Zo Skin Health Skin Care has two types of eye cream, both very effective in minimising multiple signs of ageing skin in the eye area.Laser treatments like  SMOOTH EYE ( Fotona SP Dynamis laser) can tighten the skin in the eye area and further improve wrinkles, fine lines and dark circles. Microneedling using hyaluronic acid or PRP has also been effective in my practice.It is important to remember that all these treatments will result in gradual improvement with collagen remodelling and can take three to six months from the first treatment.Use sunscreen daily, use sunglasses when out and about and avoid heavy, thick, oil-based makeup or repetitive waxing of upper eyelids.Muscle relaxants ( Botox ) can be helpful in some cases.As always, you should choose an experienced Cosmetic Physician or Dermatologist to look after your eye rejuvenation treatments.
Best Wishes,
Dr Mirjana Janjic