Which procedure is the best option to correct uneven eye wrinkles when smiling? (photos)

Dear Olivegreengirl,

Thank you for your question.

You've accurately identified that wrinkles in the lower eyelid area, particularly when smiling, result from the contraction of the orbicularis muscle. To address these dynamic wrinkles, a small dose of botulinum toxin can be a potential solution. It may help soften the appearance of these wrinkles.

However, I strongly recommend consulting with an experienced and skilled injector when considering this treatment. The lower eyelid area can be challenging to address due to the potential risk of paralytic ectropion, a condition where the lower eyelid turns outward. An experienced injector will have the expertise to administer the treatment effectively and with a keen understanding of the unique anatomical considerations of the eye area.

Your safety and achieving the desired results are paramount, so seeking the guidance of a qualified practitioner is crucial. If you have any further questions or need additional information, please don't hesitate to ask.

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.

Hello, hope you are well. The photos you have provided are quite helpful. It is not uncommon to have asymmetric muscle tone in the face when making expressions, but here it's relatively noticeable. Both options you are considering have advantages and disadvantages. Botulinum toxin treatment would be a good first step. If performed properly it will relax the orbicularis muscle that appears to be bulging under the eye ('jelly roll botox') and reduce the asymmetry. The advantages are minimal risk, no scarring or 'recovery' period, and it will confirm that the problem is the with muscle itself. The disadvantage is that this is a temporary treatment lasting months (not permanent). By comparison, a subciliary lower blepharoplasty provides access to hypertrophic orbicularis muscle so that it can be partially excised, if necessary, to reduce the bulge of the muscle. But the tradeoffs are a scar under the lower eyelashes, and the potential risks of surgery like ectropion. A judgement on whether the potential benefits outweigh the risks and tradeoffs is nuanced and should be reserved for an in-person consultation. Hope this helps!
Best,Dr. Tower