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