Are Fillers Or Botox Best for Fine Lines Under the Eyes?

Generally,when addressing rejuvenation around the eye, botox is used to treat the wrinkles caused by muscle contraction (ie crows feet) and fillers are used to fill in the tear trough region (hollowing beneath the eyes). With respect to fine lines and wrinkles of the lower eyelids, focusing on good skin care is paramount. Products such as Retin-A and a good eye cream can give very nice aesthetic improvements. For a more invasive option, laser resurfacing will tighten the skin to achieve wrinkle reduction.

The goal with these fine lines which form as a result of smiling is improvement not complete correction.  Some individuals, due to the way the muscles of the face contract, form fine lines under their eyes.  As in your case, these are not due to aging.  I find that what often gives an improvement is a very small amount of Botox placed under the eye in the lower eyelids.  This has two subtle effects: it slightly improves the formation of these lines when smiling and it ‘opens’ the eyes to a degree.

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.

Undereye fillers are the most technical challenge of placing fillers.  Improvement and not perfection is often a better goal as overfilling this area can lead to a boggy and heavy look.  Usually a multifaceted approach works best here with a combination of the following:
Filler- Expert placement of filler to fill in the groove seen at the border of the orbital rim and lower eye fat.
Botox- Can help minimize lines seen caused by the orbicularis oculi
Skin resurfacing- Thin skin and crepey skin often responds to resurfacing such as chemical peels and lasers
Radiofrequency- Both RF needling as well as external radiofrequency such as Forma can help improve skin texture
Skin care- Using appropriate skin care products containing growth factors and retinols as well as other ingredients can help improve the appearance of the skin.

Thank you for your question and for sharing your photo. Botox may help to soften the wrinkles under the eyes. It does require a very small amount and it will help to soften the lines. It will not necessarily reduce all the wrinkles like you might see in the forehead or crows feet region. You will notice a soft relaxation of the dynamic lines under the eyes, and you may notice a slight opening of the eyes. I would start with 1-2 units under the eyes on each side. If you like the effects, then it is very easy to incorporate this into your future treatments. Dermal fillers such as Restylane can be used to fill in shadows under the eye and achieves a more rested look.  You can combine the two treatments but it would require a thoughtful approach and careful analysis of your concerns to ensure that treatment options will help you achieve your goals.I would recommend visiting with a board certified plastic surgeon or dermatologist in your area to address your concern as it is an advanced area to treat.

It has been my experience that a combination of fillers, Botox, and skin care is the best option. Restylane and Belatero are the best fillers for under the eyes. The eye cream that I recommend is by Obagi ZO Olluminate Intense eye repair.

For treatment of fine lines around the eye, a diluted Botox works best in small amounts. However, it is natural to have some lines when you smile.  At the age of 20 I would focus on skin care with eye creams that can help to hydrate the skin in that area.  I would reserve Botox for later in life and with some preventative skin care you may not need it as soon as you think.  Keep smiling!

Photos would really be necessary to provide you with the best advice. In general, an appropriate skincare regimen, resurfacing procedures such as peels and lasers, and finally Botox or Dysport injections can address fine wrinkles under the eyes. I would recommend an examination by a board certified plastic surgeon, facial plastic surgeon, or dermatologist. They will be able to assess your eyes in person and provide you with advice. I hope this helps, and best of luck to you. 

It is very difficult to answer your question without first assessing you in person or viewing pictures. You should consider posting pictures for a better review of your concerns.

Thank you for your question jkaclark123. I understand your concern. Botox is a purified protein used to address wrinkles associated with facial expression. When injected into the skin Botox will relax the muscles and smoothen out the overlying wrinkles. The most common areas of treatment are in the upper face. These include the horizontal lines seen on the upper forehead when one raises the brows, the vertical lines seen between the brows when one frowns (frown lines), and the crow's feet seen around the eyes when one smiles.It is difficult to make an assessment without a formal exam in the office where I can view the skin in multiple angles and observe wrinkles formed with facial expression. However, I hope the information provided here is useful.Botox and fillers are two dermal (skin-related) products are both very popular for their anti-aging features. Unlike Botox, which relaxes muscles to smoothen out wrinkles associated with facial expression, fillers restore lost volume in various areas of the face and body. Common fillers include the Juvederm family (Juvederm Ultra, Juvederm Ultra Plus, Voluma, Vollure, and Volbella), the Restylane family (Restylane, Restylane Lyft, Restylane Silk, Restylane Refyne, and Restylane Defyne), Belotero, Radiesse, Sculptra, and Bellafill. With age changes occur in the bony structures as well as fat pads, both of which contribute to a youthful appearance. Over time bones move and change shape while fat pads get smaller by losing volume and move downward. Fillers restore such lost volume. Common areas of volume loss include the temples on the sides of the face, the upper cheeks, the tear trough area under the eyes, the nasolabial folds which go from the sides of the nose to the corners of the mouth, the marionette lines which are the continuation of the nasolabial folds to the jawline, the chin, and the jawline. Often times combining fillers with Botox treatments yields superior results.In addition, depending on the individual, skin care products, chemical peels, and/or laser treatments may be used to help the appearance of the area around the eyes.With any injection, there are risks such as pain, bleeding, bruising, redness, swelling, tenderness, and infection. We take special precautions to minimize these risks such as using a painless technique. We also treat bruises with a laser as early as the next day. Bruises usually resolve within two weeks if untreated. After a laser treatment bruises usually resolve in 1-3 days, but may still take two weeks for full resolution. In addition to these risks, with Botox there is also a risk that the product spreads or diffuses to nearby structures. Spread to nearby muscles can lead to side effects such as the temporary appearance of droopy eyelids or a temporary asymmetric smile.After a Botox treatment, I recommend that my patients avoid heat exposure, alcohol consumption, and strenuous exercise for 24 hours and not lie down flat for four hours. This is because all of these activities may possibly lead to the movement of the product and consequent side effects such as droopy eyelids as described above. Although there have been no definitive studies shown that these actually occur and some physicians do not provide such aftercare instructions, in the absence of data I err on the side of caution and recommend that my patients avoid such activities.Please consult with a doctor for specific recommendations. Good luck!