Is filler the best option to minimize the appearance of crepey skin in the under eyes? (photo)

Question

Hi, I’m 32 years old and the skin under my eyes has become significantly more wrinkled and ‘crepey’ over the last 2 years. It’s especially noticeable when I smile. Is filler the best way to minimize these lines? I’ve tried Botox under my eyes and while it does help, the results last a month at most. I’ve also seen micro needling mentioned as a treatment option - looking for any suggestions! Thanks!

Nelson Lee Novick, MD · Answer

A series of  superficial peels can be a very simple approach to diminishing under-eye crepeyness. Superficial peeling agents can include high concentrations of glycolic or saliciylic acid; Jessner's Solution or low concentrations of TCA. Usually three to four treatment sessions are required to achieve the necessary smoothing and tightening. Glycolic and salicylic acid typically engender little to no significant post-treatment downtime and were often referred to as "lunchtime beauty fixes."  In more resistant cases, professionally performed manual (no need for the expense or risks of added RF) microneedling prior to the application of a low strength TCA may be tried. Finally, if still necessary, a low viscosity, cohesive, malleable HA filler can be judiciously used to further smooth the area. Make sure to consult with an experienced board certified cosmetic dermatologist and best of luck.

Randal Haworth, MD, FACS · Answer

Based on your photo, it look like you would be a great candidate for a lower blepharoplasty.

The procedure aims to remove excess skin and, where necessary, pockets of fat under the eyes due to aging. The incision follows the lower lash line where it heals invisibly. There is also an incision behind the lower eyelid through which the surgeon can remove any excess fat. About 30 % of patients will need to get the fat “bags” reduced. Fat can be carefully transferred to the “hollows” below the eye to produce a smooth transition from the lower eyelid onto the upper cheek.

Of course, an “in person” exam is necessary.

I hope this helps,
best of luck !

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jonathan Kulbersh, MD · Answer

Thank you for your question and photos. Treatment options like RF microneedling and laser resurfacing can smooth the skin below your eyes. RF microneedling increases your body’s collagen production and improves your skin’s elasticity, quality, and texture. Laser resurfacing can also treat skin laxity and uneven texture to promote a more youthful appearance.

I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to assess your concern and determine the best treatment option to help you achieve your aesthetic goals.

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Vibha Gambhir, MD · Answer

Hello, and thank you for your question! Platelet Rich Plasma is a procedure that can be done under the eyes to help with the fine lines and textural concerns. Your blood will be drawn and spun down in a centrifuge and the golden rich fluid at the top (the plasma) will be extracted and injected under your eyes. This procedure produces collagen production.  Good luck on your journey!

Camille Cash, MD · Answer

There are  few treatment options to correct the under eye area.  Fillers can be used disguise eye bags and improve hollow areas.  Morpheus8 and lasers can be used to improve skin tone and texture.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Paul Munsanje, MD · Answer

Consider a combination of 4 treatments for this area.
Keep using Botox underneath the eyes and make sure that you are not using too much at the side of the eyes and causing rebound increase in traction by the muscles under the eyes.
A skin booster like Sunekos can improve texture and color underneath the eyes.
Your picture doesn’t show a lot of volume loss but it’s not the best picture so I can’t be sure that you wouldn’t benefit from a small bit of a thin filler under eye filler like for example, Juvéderm, Volbella.
Finally, most medical skin care ranges include an under eye cream with a small amount of retinol.

Is filler the best option to minimize the appearance of crepey skin in the under eyes? (photo)

Answers (8)

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