I Hate the Wrinkles Under and Around my Eyes. What Are My Options? (photo)

I hate the wrinkles under and around my eyes. I am faithful retin-a user but it's just not enough. I have tried laser (fraxel repair) but no improvement. Any recommendations for treatment? Bleth? Filler? Botox? I'm considering a pinch bleth but would be interested in something less aggressive and cost effective. Please advise

Doctor Answers 4

I like to use a combination of Botox or Dysport and EndyMed Fractional radiofrequency resurfacing.

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I like to use a combination of Botox or Dysport and EndyMed Fractional radiofrequency resurfacing.  This combination with help fine lines caused by skin laxity and eyelid muscle contractions.  Laser resurfacing is used in more severe cases with great results.

Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Improve skin quality

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Lines inevitably occur when you have expression. You may want to consider a more aggressive laser than Fraxel such as the fractional CO2 laser as well Pelleve'. The goal is to improve your skin quality so the lines are less prominent. I've also experienced good results with PRP or "platelet rich plasma".

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Volumizers, Fillers, & Dysport Work Well For Nonsurgically Rejuvenating the Eyes

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Unfortunately,  I have not been impressed with any of the so-called "energy-based" modalities, such as fraxel lasers and radiofrequency devices. Often these require a series of treatments, spaced several weeks apart, and in the end the results are at best subtle, as in this case.

Fortunately, we do have a number of nonsurgical techniques that I have personally found to yield consistently gratifying results for rejuvenating the eyes. 

Dark Circles and hollows under the eyes, tear trough deformities, wrinkles and crinkles of the lower lids, deflated brows, and crow's feet lines all contribute to a more tired and aged appearance. Each of these problems can be treated nonsurgically in a matter of minutes, and for the most part, with "Wow!" results that can be seen in the mirror immediately following treatment.

Volumizing fillers, such as Perlane L or Juvederm UltraPlus XC, work well for eliminating the hollows under the eyes. When placed in the upper inner cheek or in the mid-facial region, they can lend needed to support and repositioning to lower lids to eliminate hollows. They may also be used under the outer third of the eyebrows to restore the desirable, youthful upward flare and to secondarily lift the fallen brow off the underlying, true upper eyelid. 

Fillers, such as Juvederm Ultra, mixed with a very tiny amount of Radiesse (which is white in color) injected under the dark circles can lighten them significantly and treat tear trough problems. When directly instilled in a multiple microdroplet fashion, they can be used to eliminate the crow's feet and the glabella scowl lines.

Finally, neuromodulators, such as Botox, and more recently Dysport and Xeomin, may be injected into the outer third of the eyebrow--to produce a nonsurgical browlift; injected on the sides of the eyes--to eliminate crow's feet; and be injected directly under the eyes--to soften crinkles and crepeyness. 


Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.