What are my options for thin and crepey skin under my eyes? (photos)

I received Botox last summer for my crow's feet and started using Tretinoin cream. I'm not sure why, but my the area under my eyes formed horrible wrinkles. I'm assuming it was because the botox froze certain muscles forcing other muscles under my eyes to contract more? Maybe the Tretinoin thinned out my skin causing the wrinkles? Please help.

Doctor Answers 4

Crepeness under the Eyes

I can just about assure you that both your assumptions are wrong. Both the things you have done are excellent in preventing or correcting what you have. The tretinoin, however, must be used correctly and for some time (several years) to get the desired effect. Instead of thinning the skin, it actually thickens it by building the collagen in the support layer. People get the idea that it thins the skin because it reduces the abnormal thickened outer covering layer of the skin. This is something you want to do and what alpha hydroxyls, microdermabrasion and micro-peels do. The Botox reduces the contribution to the wrinkling by the muscles. It appears that you really need it around the lateral orbit. The obvious next non-surgical step, as long as you are getting an effect from the Retin-A is a leveling peel or laser to the area to further stimulate collagen production to tighten the skin. See a plastic surgeon experienced in both surgical and non-surgical eye rejuvenation.

Highlands Plastic Surgeon
5.0 out of 5 stars 5 reviews

Fine creases under eyelids

Dear Brandtferg,

i do see this shift with Botox now and again, however since the creases are very fine and subtle CO2 laser can act as a very good adjunct! 
Jawed Tahery
Consultant ENT /Facial Plastic Surgeon

Jawed Tahery, FRCS
Manchester Facial Plastic Surgeon
4.8 out of 5 stars 77 reviews

Dark Circles, Eyelid Wrinkles/Bags Treatment -- Restylane or Belotero with Cannulas, Clear+Brilliant, Eclipse Micropen, Viva

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately.
All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.

Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 158 reviews

Crepey skin treatment

My suggestion is to continue the use of the Retin-A and getting Botox injections. The next steps are to either receive a laser treatment using an ablative/non-ablative head or have a blepharoplasty combined with fillers for volume loss. Visit a board certified dermatologist or plastic surgeon who can direct you in you surgical or non-surgical path.

Thank you for your question and for sharing your picture!

Kate Ross, MD

Kate Ross, MD
Bradenton Dermatologic Surgeon

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.