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 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.