What Can I Do to Improve Undereye Wrinkles when Smiling? Kind of Like an Accordion Under my Eyes when I Smile?

Applying Botox would help relax the muscles and soften fine lines around the eyes, you may need a filler like Belotero for deep creases. For a long term result you may want to consider having a lower blephorplasty. Seek a reputable medical provider who can ensure a result you want to achieve.

The upper inner cheek region, i.e. that inner area immediately under the eye and extending diagonally upward and inward toward the inner angle of the eye, plays an important role in supporting the lower lid. Loss of fat and downward displacement of the remnant of the upper cheek fad pad with age contribute to wrinkling and tear trough formation (and even dark circles) under the eyes.


Revolumizing that region nonsurgically with the use of injectable volumizing fillers, such as Radiesse and Perlane L (or a combination of these agents) can go far to reestablishing the buttressing to the lower lid and diminishing wrinkles and crinkles. In experienced hands, the procedure takes about five minutes per eye. If necessary, tiny droplets of Restylane L or Belotero Balance may be layered above this region to further smoothe the undereye area and diminish the crepeyness. If there is drooping of the brow over the upper lid and falling of the outer third of the eyebrow, a volumizing filler may be injected to restore the outward projection to the outer third of the eyebrow and to lift the brow off the upper lid. 


When there is accompanying hypertrophy of the thin muscles under the eyes, the additional injection of a microdroplets of a neuromodulator, such as Botox, Dysport or Xeomin, can diminish this effect and further improve the lid area immediately under the eye. Likewise, if there are significant crow's feet wrinkles, these can be easily dealt with by very superficial instillation of any of these neuromodulators. When needed, an additional lift to the lateral third of the eyebrows can be achieved with a drop of neuromodulator placed right into the tails of the eyebrows. 


Nonsurgically rejuvenating the periorbital region should only be performed by a board certified aesthetic physician with extensive experience in treating these areas. Because of the profound cosmetic impact that can result from treating the eye region, be sure to insist upon seeing the befores and afters of any physician that you consider.

Botox or equivalent will help with the line around your eyes. You also have some loose skin that may not improve with the botox injections. If this is the case then you would need a skin tightening procedure such as a laser resurfacing or lower lid blepharoplasty. I would start with the botox to see how you do and then go from there based upon results.

Good Luck,

Dr T

Dear Amaxy,


It depends on the location of the wrinkles, along the outer edge of the eye, Dysport or Botox works well

If you get wrinkles when you smile and it is because the cheek pushes up on the skin, you can try a resurfacing procedure like a chemical peel or mild laser


Best regards,

Nima Shemirani

Botox is appropriate for the under eye area, but first you should be assessed by a well-trained and experienced injector, to be sure you are a good candidiate. Many different factors come in to play when treating the eyes.

 Wrinkles like these are not that simple to tackle with nowe type of treatment but a good combination can give you good results. I would use Dysport  or Botox to relax the wrinkles and stop those that occur from movement. I would then use a filler such as Restylane or Belatero to add some volume to the area to decrease the folding

There are several treatments that address different aspects of your problem. Some of your wrinkles are dynamic, meaning they worsen with movements and some are due to the looseness of your skin around your eyes.    Neurotoxins such as Botox or Dysport work by weakening part of the circular muscle that surrounds your eye.  Partially weakening this muscle will reduce the "crows feet" wrinkles that form when you smile.  You also have laxity in the skin under the eyes that appears more noticeable when you smile and bunch it up. Either a chemical peel or laser resurfacing can be performed to improve the wrinkles that are present even when you are not smiling by tightening the skin and improving the overall texture. 

If you are relatively young and the wrinkles disappear when you aren't squinting or smiling , the lines are caused by muscular contraction and can be treated with a neuromodulator like Dysport or Botox.  If the wrinkles don't disappear with relaxation and there are minimal lines, fillers can be used to restore volume to the area.  If the skin has significant wrinkles with creepy skin, the skin needs to be tightened to reduce the crepiness and or redundant skin.  You would need to be seen in consultation to determine which procedure would be best for you.  Normally, CO2 laser resurfacing (either full CO2 or fractionated CO2 resurfacing) or excision of the excessive skin (lower eyelid blepharoplasty) is required.  

Basically there is aging of the Periorbita (eyelids and tissues surrounding the eyes including the mid-face)

I would look at the smiling and non smiling appearance to determine the options and priorities.

For a non surgical choice, Botox to the squint/smile lines and a small amount to the muscle below the lashes may get you to your goal. If there is still a sunken area between the cheek skin and the lower lid then a filler would offer additional help. If there are still wrinkles and crepe loose, skin laser resurfacing is another choice.   

I'd have to have a good look to discuss your best options, but generally Botox or laser resurfacing can be considered. Sometimes a topical retinol or vitamin C, or a collagen and elastin based product can help to some degree. Best to speak with your dermatologist about the best option for you.