What can I do that will REALLY help my crepey under eye skin/ fine lines peri-orbital? (photos)

Needling and radiofrequency are probably your best bets in this area, and the combination of the two is the best, so you are doing the right thing. Sometimes there is a genetic component that is impossible to correct 100%. It does not mean that it will get worse every year, though, so don't despair! Botox or Dysport injections in the crow's feet would reduce the wrinkles that go out to the cheek. Retinols and topical moisturizers (e.g. skin medica topical hyaluronic acid) are still worth using because they will prevent more wrinkles from occurring. Even if you don't correct this 100%, you can prevent progression with the Vivace treatments, so you are not wasting your effort. I don't have any personal experience with carboxytherapy yet, but it is supposed to be useful under the eyes as well. From what I have read, carboxytherapy may take a longer series of treatments, but there is no down time.

Hi, thank you for your question.  Fine undereye lines are a common concern and they can be difficult to treat. Combining topical products (like the ones you are using from Skin Medica) with microneedling or resurfacing (such as non-ablative or ablative fractionated resurfacing) can yield the best results in the long run, but it may take several treatments. Depending on when you had the microneedling, it may be too early to see any improvement. It can several weeks or even months following microneedling and fractionated treatments before you see visible results. Also, after treatment the skin can dry out.  This may give the appearance that the lines are worse.  It's important to use gentle cleansers, moisturizers, antioxidants (and/or retinol- carefully as this can sometimes cause irritation) and daily spf (as well as sunglasses that provide UV protection). I would follow-up with your treating physician for evaluation and to discuss your concerns.