I have wrinkly crow's feet & crepey sagging under my eyes. I'm Botox/Xenomen intolerant. Any suggestions? (photo)

Question

I have tried very expensive creams I use 2-3 times a day and none of them work. What can I do?

Raffy Karamanoukian, MD, FACS · Answer

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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Donn R. Chatham, MD · Answer

The eyelid skin is very thin, moves a lot, and almost always develops fine wrinkles and textural changes as we age. Sometimes this begins very early in life. As an adult, then this becomes bothersome, and daily topicals have not helped (tretinoin, hydration, etc), then it may be time to consider 'resurfacing'. This is done with a chemical pee solution or one of the ablative lasers. Usually an office procedure, this is somewhat uncomfortable for a brief time, one looks worse for a few days, and new skin then grows in place of the (wounded) lasered or peeled skin. The results can be long lasting. But these procedures should only be performed on the right patients by a well trained physician who specializes in this sort of skin rejuvenation.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question about skin rejuvenation.Injectable fillers and laser resurfacing might be helpful for you.To be sure, see two or more licensed and board-certified providers in your area for a complete evaluation to make sure you are a good candidate and that it is safe for you to have these treatments.I hope this helps.

Jason Emer, MD · Answer

Undereye wrinkles need to be treated with a combination approach of skin care, botox, lasers and/or radiofrequency.  You can get amazing results, but you should see a cosmetic dermatologist with experience in treating this area which is sensitive and requires a meticulous provider to limit any complications.

Hratch Karamanoukian, MD, FACS · Answer

It is unfortunate that you are 'intolerant' of Botox and Dysport. I really don't know what that means ... but .. Sometimes 2-3 units of Botox is used in the lower eyelid to treat hypertrophy of the orbicularis muscle. In essence, the orbiculris muscles of the lower eyelid cause "crinkling lines" and are responsible for holding the lower eyelid against the eye. When you smile, your cheeks are raised and crinkle the skin under the eyelid. I hope this explains why this occurs.The key is to use a judiciously small amount of Botox to relax the orbicularis muscle but not weaken it - weakening this muscle will result in sagging of the lower eyelid margin. You would not like that effect either.The alternatives are laser resurfacing or Ultherapy as one can treat the area under the eye but not right up to the lower lid with the new 1.5 mm Ultherapy transducers. The treatment needs to be kept outside of the orbit of the eye. The full effect will take 3-6 months from the time of treatment. Read the Ultherapy book provided on the link below under the ebooks section.Consider Ultherapy and thank you for providing a picture.

Stacey Whitehead, MD · Answer

Hello!  Even if you are not able to use neurotoxins, there are several good treatment options for rejuvenating the eye area without resorting to surgical blepharoplasty/eye lid lifts.  Depending on the downtime and discomfort you want to work with, you can consider non invasive and no downtime options like thermiSmooth 250, minor downtime/discomfort with microneedling plus PRP topically and/or injected, or a bit more downtime and mild to moderate discomfort with laser options like profractional.  Generally, a short series may be needed to get more complete results and support with Elastiderm Eye treatment products with twice daily use is highly recommended.

Benjamin Barankin, MD, FRCPC · Answer

Many of your wrinkles around your eyes are "dynamic wrinkles" and would respond very well to Botox. Chemical peels and laser resurfacing are also options to consider after your dermatologist does a thorough assessment of your skin.

Sheryl D. Clark, MD, FAAD · Answer

At first look, it appears you have hyperdynamic periorbital muscles, thinned skin, and laxity.  Dysport is a botulinum toxin-A that provides wonderful, soft relaxation of the muscle that causes smile lines.  For the thin, loose skin, you should begin a regimen of topical rejuvenators such as retinol, green tea, glycolic acid, and TGF-beta creams, and considering treatment with one of the tightening or resurfacing devices such as Pellevé or fractionated laser. Pellevé is very effective, is not painful and does not require downtime.I do hope this is helpful to you.  All tye best, Dr. Clark

Davin Lim, MBBS, FACD - Account Suspended · Answer

Texture, tone and volume. This is what we want to achieve. The use of laser resurfacing will tighten your skin, and without doubt stimulate collagen. This will lessen your wrinkles and refresh the surface of your skin. My next suggestion is to build the lower lid cheek junction and the treat trough area with a tiny bit of filler such as Volbella. Done well, the combination of lasers and fillers will give you an outstanding result. Have a look at my before and after pics for a more detail explanation on techniques dermatologists and plastic surgeons employ to solve this problem.CheersDr Davin LimLaser Dermatologist

Michael E. Jones, MD - Account Suspended · Answer

Hello, there are some phenomenal laser resurfacing treatments available on the market right now. My office uses the Sciton Joule Laser system and has seen fantastic results in patients seeking to reduce wrinkles, crow's feet and improve crepey skin. I recommend that you research a plastic surgeon that offers a laser like this and schedule a consultation to determine if you're the right candidate. Best of luck.

I have wrinkly crow's feet & crepey sagging under my eyes. I'm Botox/Xenomen intolerant. Any suggestions? (photo)

Answers (11)

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