How can I improve the crepey wrinkles under my eyes? (Photo)

Question

I am 46, wear SPF religiously, and have tried so many things to improve the skin under my eyes with no luck. In the past 2 years I've done microneedling twice, CO2 laser, non-ablative laser, microtox, treninoin, peptides, topical HA serums. How can I improve the wrinkles under my eyes?

Eric M. Joseph, MD · Answer

We have been performing Morpheus 8 treatments for over a year, and the tightening of under eye skin has been the most remarkable in our experience. Treatments may be performed with local anesthetic in the office and there is little to no downtime. Typically three treatments are necessary for a desired result. Thank you for your question. Sincerely, Dr Joseph

Jon E. Mendelsohn, MD, FACS · Answer

Hi! The under eye area is a common concern. The skin in this region tends to be thinner and therefore can crease and gather easier. Microneedling is a great maintenance treatment method. Multiple CO2 ablative lasers would help to correct more with each treatment you have. Many times I’ll treat patients twice in the same year with CO2 and then yearly until we achieve the result we want in tightening the skin under the eyes. There’s also potentially an option for a Pinch Excision, where your facial plastic surgeon would locally numb the area, make a small incision just beneath the lash line and remove excess skin.

Michael P. Morrissette, DDS, FACS · Answer

This area can easily be treated with multiple devices for skin tightening. I like a CO2 laser. Another option is a medium depth chemical peel such as TCA.

Nelson Lee Novick, MD · Answer

First, let me start by saying that I am not surprised with the lack of success with the peptides and serums. In general, their use is supported far more by advertising, manufacturer marketing and social media buzz than any hard science. Tretinoin can be effective for maintenance after many months of regular use, but, again not really so good for outright wrinkles and crinkles in my experience. Microtox is sometimes helpful, but more as an add-on than a primary treatment. Micronreedling can be helpful, but generally requires between two to six treatment sessions performed at four to six week intervals--on average three or four sessions--to be effective and only two sessions were performed here. Under-eye crinkles in my experience can be helped by the use of HA skin booster treatments and the use of a robust HA filler for the cheeks (if there is volume deficit there, which cannot be determined in the photos provided) followed by a series of in-office superficial peels using high concentrations of glycolic or salicylic acid, Jessner's solution or low concentrations of TCA. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist. Hope this helps.

Camille Cash, MD · Answer

You may consider Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  Three treatment sessions are recommended for optimal results.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day (bravo to you for already doing this important step!).

Raman Mehrzad, MD, MHL, MBA · Answer

Hi!
To improve your wrinkles under your eyes, you have different options to make your eyes and eyelids look more rejuvenated. 
First, I suggest, botox as a foundation to prevent further worsening of your wrinkles. Second, You can fill the lines with some fillers, but ensure you go to a board certified plastic surgeon because under eye filler injection is associated with risks if you do not know what you're doing. Third, different types of lasers could improve your lines as well. 
Lastly, lower blepharoplasty with tightening of your skin could def help as well. 
D
Raman Mehrzad

Hilton Becker, MD · Answer

Wrinkles in the lower lid can be difficult to correct.
I find that that best approach is fat grafting below the muscle and nano fat grafting to the skin.

Anna Avaliani, MD · Answer

Thank you for your photos. How long have you been using SPF? Your under eye skin needs more resurfacing. I'm very surprised that after 2 CO2 lasers you still have it, so that leads me to believe it wants done appropriately. You need to resurface the skinned the to introduce nutrients there. You may just go for another CO2 or an aggressive peel and apply PRP to help promote remodeling faster and expedite the healing process. Keep using retinoid, but maybe don't use it every day as it may dry out your skin and make the lines look like they are there. Put a heavy moisturizer at night. Topical Vitamin C + SPF and you need to reapply SPF. I love TempSure Envi eye tightening treatment for the superficial lines that yo have as it has no downtime and is designed for that. Look up a provider in your area .

Leonard Grossman, MD · Answer

The reason you see wrinkles in the lower eyelid area is that your face, as you age slowly deflates. If you were to take a fully inflated balloon and deflate it, you’ll see folds and wrinkles in it. This is exactly exactly what’s happening to your face. I would recommend fat grafting done by an expert Plastic Surgeon in such techniques, and you will lose all these wrinkles as well as look considerably younger. Fat grafting one properly done produces natural and permanent results. I hope this helps and best of luck for New York City Plastic Surgery.

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