What can I do about dynamic wrinkles under the eyes? Filler, laser?

I can get botox for my crows feet but that doesn't stop the bunching under my eyes. What about laser (erbium, co2) followed by filler? Is this a good strategy?

Doctor Answers 4

Eye Rejuvenation

There are a few options that I can suggest to improve your condition. A retinol based eye cream is great option as a start. Options include:

-ZO® Olluminate Eye Repair

-ZO® HydrafirmT

-SkinCeuticals® AOX Eye Gel

Other options include botox injection into the lower eyelid. Dermal filler injections might be a great option as well. Surgery for excessive buldging might be an option as well. Skin resurfacing procedures (laser resurfacing with CO2 laser, Er:YAG laser, Fraxel DUAL®, PicoSure® FOCUS Lens Array or OBAGI® controlled depth chemical peel) might be an option. This is an advanced technique so be sure to get an experienced dermatologist or plastic surgeon consultation for recommendations and treatment options.

Calgary Dermatologist
4.9 out of 5 stars 14 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
4.8 out of 5 stars 190 reviews

Laser then filler.

Yes, I personally would perform CO2 as this gives more tightening that other lasers - fully ablative if you can handle the downtime, or 2-4 fractional if you want to minimise redness. Then fillers- I would use the Juvederm Volbella range, however Perlane- Restylane is also a great option. 

You can expect good results with that combination of lasers and fillers- you are absolutely correct. 


Dr Davin Lim 
Laser Dermatologist
Brisbane, Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 75 reviews

Strategy for Dynamic Wrinkles

Hi Catreal.  The strategy you proposed is exactly what we would suggest.  Fractionated laser resurfacing under the eyes followed by Restylane injections.  

To see an example for another Los Angeles patient, click on the link below.

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 reviews

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.