Despite having both Botox and fillers, I still have bad under eye wrinkles when I smile. What else is there? (Photos)

Properly placed Botox injections can usually at least soften the types of wrinkles seen in the attached photographs. Many injectors do not know where to place these injections, or do not feel comfortable doing so. Any other treatments like lasers, peels, RF, etc are likely to help only with static wrinkles (at rest) in this area.Be sure to see an expert who specializes in facial aesthetic procedures to review all of the options in detail.All the best,

A combination approach will give the most improvement. Botox and fillers combined with lasers and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

You can use a little more under eye filler to correct the hollowness and a tiny amount of Botox directly below the lash line. I also recommend Thermismooth and/or Microneedling with PRP to improve the skin quality in that area. Good luck!

There are many different treatments to address under eye wrinkles. Start with an eye cream, from a medical grade line of skin care, good at- home skin care is very important.  A low dose Neuromodulator, such as Botox just under the eye can also help with these fine lines. There are also multiple treatments that will assist in collagen stimulation to decrease the lines under your eyes, such as Fraxel, Thermismooth, Microneedling, PRP (platelet rich plasma) injections, Miconeedling with radiofrequency (such as Vivace) and Ultherapy, which uses ultrasound to generate heat and tighten skin under the eyes (and the entire face). I hope this helps!

Thank you because yours is a common question.  It looks like there is still a slight volume loss so PRP injected in the tear trough area can add some volume.  In addition consider a few radiofrequency resurfacing procedures to tighten skin laxity  with topical or injected PRP or microneedling and topical or injected PRP.  For injections pretreat with arnica plus vitamin K cream to reduce bruising with your skin type.

A combined approach tailored to your specific needs will give you the most improvements for your around the eye wrinkles. Fillers and botox work well when combined with PRP micro-needling and Radio Frequency. An appropriate strength chemical peel may also help, explore these options during a doctor consultation. 
See a doctor who is willing to assess your face while considering a number of different treatments that are creatively utilized and layered. If fillers and botox were going to work alone, they would have already. 
Regards, Dr. Bector 

Hello KHarris95,
At our office we use the patients prp to inject underneath the eyes to fill in the hollowness, correct dark circles, helps with puffy bags and fine lines and wrinkles. This treatment is very cost friendly and can last much longer than fillers because it is your own platelets it can last years compared to the less then a year with fillers. Some patients need a single treatment to correct the under eye issues but others could need more depending on their concerns. I hope this helps KHarris95!

In addition to the treatments you mentioned, I recommend RF Microneedling for periorbital (around the eye) wrinkles. In my clinic, we utilize the Vivace device and our patients have been seeing excellent results, particularly in this area of the face. Dermal fillers will increase volume in the deeper layers of the skin and toxin will affect dynamic wrinkles, but often times adjunctive treatments to improve skin texture, fine lines, wrinkles etc. are needed. Lasers and light devices are another option, but the results we have been seeing with Vivace in this area would likely make it my preferred treatment if you were my patient. You can check out some of our Vivace before and after photos for this area in my profile to give you an idea of the kind of results we have been seeing in my clinic. Good luck!

Hi KHarris95:I could be wrong, but I don’t believe you have had Botox just under the eyelid margin. Try 2 units just under each eye. If that doesn’t work, I have found ThermiSmooth to be the best treatment for under eye lines, by far.Dr. Clark

Hello! 
Botox and fillers in the tear trough area can help decrease the wrinkles and fine lines, however they may not fully eliminate them. Another treatment we use in our office is Exilis by BTL Aesthetics which is a radio-frequency ultrasound used for skin tightening to help further eliminate wrinkles by tightening the skin. The combination of all of these treatments has given our patients optimal, longer lasting results. Hope this information helps!! 
Nikki Stoker, PA-C, MPAS