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.   

The specific treatments depend on the degree of laxity and whether you are prepared to consider surgery. I would introduce retinol into your skin care regardless of the specific approach. My favorite cosmeceutical lines, Environ and ZO, have specific eye products which will be useful. Sun protection is important: use sun glasses when directly exposed. Where there is significant loose skin, blepharoplasty ought to be considered.To address the issue of thin, crepe-like skin, treatment with the CO2 laser (Madonna Lift) produces good results (if there are no contra indications). The down time associated with this treatment is relatively short and a series of 3-6 monthly treatment should produce visible improvements.

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

This is a very common problem. Botox is usually the "go to" option for treatment of wrinkles related to excessive muscle movement. However, overtreatment of the area below the lower eyelid (not crow's feet) can result in temporary drooping of the lower lid. Therefore, these lines are best treated either with CO2 laser resurfacing or lower blepharoplasty. I hope this information is helpful.Stephen Weber MD, FACS

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.