What can be done about my genetic under eye creases? (Photos)

Hi Brooke.  You are correct that the horizontal creases directly under the lash lines are not easy to improve.  These are genetic and because of their location do not respond really well to fillers.  You do have some darkening in the tear trough area that would improve with filler, but these lines would probably not.  In our patients that have similar concerns we have used fractional resurfacing to improve these lines.  Although not a perfect solution, it does improve them. 

Hi Brooke, there are certainly treatments that might work for you. For instance, we use Renuvion helium plasma radiofrequency energy to achieve incredible results around the eye. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Eyelid Lift.' The focused heating tightens and peels the upper layers of skin with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing. I suggest getting a formal consultation with a cosmetic dermatologist to determine the best solution and develop a treatment plan that works for you. Best, Dr. Emer

You should not need to jump into surgical treatments or fillers at your age to achieve a more refreshed look. The best treatment will depend on the severity and cause of the lines. In order to thicken the dermis of the skin to avoid folding or fine lines, chemical peels, microneedling, and topical retin-A cream, are all techniques that can be used to reduce the fine lines. If the wrinkling is more profound due to a very active eyelid muscle, then it can be be made less dramatic by a tiny amount of botox placed conservatively in the area. Less is more in the area around the eyes as too much botox or overly severe peels or treatments can cause damage or change the appearance of your eyes. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!
Johnson C. Lee, MD
Board-Certified Plastic Surgeon

Hello Brookedusek,
You appear to be a great candidate for a dermal filler. An experienced injector can safely add filler to the delicate undereye area giving you the volume back, resulting in a more youthful appearance.
Best to you,

Your under-eye area is not too deep for fillers.  They should do a good job in brightening the under eye with less shadowing.  You may need 1-2 syringes to complete the job.  I recommend not putting in more than one at a time to mitigate against swelling of the product.

The tear trough itself could be treated using a hyaluronic acid based filler like Restylane. Botox or Dysport would help with dynamic lines around the eyes (crow's feet). Good skincare and possibly microneedling or nonablative laser could improve the quality of the skin around the eyes and help with any superficial lines/wrinkles. 

Autologous fat grafting will fill out the hollowness in your lower eyelids and cheeks and in the process of increasing the volume the creases will disappear or markedly improve. Fat grafting provides natural and near permanent results. Good luck from New York City