What’s the best option for under eye lines? (photos)

Question

What can I do to help with under eye lines? I constantly look tired when I’m not. I have been trying to stay hydrated drinking plenty of water and have been using a salicylic acid face wash and hyaluronic acid serum with lotion on my face daily. My cheek skin does seem to be puffy causing my nasolabial folds and under eye lines seem more prominent. Would filler or some type of skin peel be best? Skin tightening seems to help when I use my fingers on my face. Possibly micro needle help? Thanks !

Nima Shemirani, MD · Answer

Hi @Helpful710695! You would be a great candidate for mid-face and tear trough filler. As we age, we tend to experience volume loss. The upper cheek is a major support for the under eyes. So when there is volume loss there, not only do the cheeks reflect this, but the under eye can as well with the development of tear trough and under eye hollows. Addressing the volume deficit in the cheeks with the use of a  volumizing hyaluronic acid filler would be a reasonable place to begin.  I would then consider addressing the volume loss in the tear trough.

In addition, I highly recommend Morpheus 8.  Morpheus8 is a non-surgical treatment for full body skin resurfacing, skin tightening, and fat reduction of stubborn areas. It uses minimally invasive fractional radiofrequency energy (RF) to penetrate the skin deeper than other microneedling devices, triggering the skin’s natural healing response to promote skin tightening and lifting.

Jonathan Kulbersh, MD · Answer

Thank you for your question and photo. Dermal filler is an excellent option to add volume to this area and reduce the appearance of the lines you’re referring to. RF microneedling is also ideal for increasing the body’s collagen and hyaluronic acid production while restoring the skin’s elasticity. Dermal filler injections can last for up to a year or more, depending on the formula used, while the results from RF microneedling can last for over five years. I recommend scheduling an in-person consultation with an experienced, board-certified injector who can assess your concerns and suggest the best course of action 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.

Marc Polacco, MD · Answer

Thank you for your question. This is often the first area where patients start to show signs of aging. Based on the photo, a combination treatment to restore volume and improve skin tone and texture will work best. For volume, either fillers or fat transfer are nice options. For skin and fine lines there are a few options including microneedling, chemical peel, or laser resurfacing, each with their own risk and recovery profiles. I hope that helps, and I wish you all the best.
-Dr. P

David M. Kowalczyk, MD, MBA, FACS · Answer

Good Morning! Thanks for your questions. For fine lines on the lower eyelids, Botox can work well and there are certain tightening creams as well. Some will even use CO2 laser with nice results. For the tear trough area, volumization works best by using fillers. There are many options some being Volbella and Belotero. The longevity is about 8-10 months for most of those fillers. The results can be natural if done well. Microneedling along the cheek area does work to tone collagen and soften fine wrinkles. Hope this helps!

Camille Cash, MD · Answer

You will probably have the best outcome from a combination of treatments.  Fillers can be used to help improve contours and replace lost volume.  AccuTite uses RF technology to tighten skin up to 40%.  Results are enhanced with Morpheus8 treatments which improve overall skin tone and texture.  We also recommend using medical grade skincare products, such as Transform MD, and wearing sunscreen every day.

Richard E. Buckley, MD · Answer

This is a great question. It is important to first understand what a patient means by under eye lines. One would think that it should be obvious enough but it often is not. For example starting with the lower eyelid lashes and looking below them we can in most of us see some lines and wrinkles. Those are indeed under eye lines but may not be what you mean. That skin I just described is very thin, gets thinner with age and wrinkles easily. The orbicularis oculi muscle is under the skin and our fat pads below that. There is for example no “floor” there and so no fillers can be put there. Putting fillers there would just make for swelling and migration. That skin that I just described, which is immediately below the eyelashes, is often tightened with RF such as Thermage or ThermiSmooth or various lasers both ablative and non-ablative. And the fat pads which bulge forward can be reduced from the inside of the eyelid in an office procedure called a transconjunctival blepharoplasty which requires on stiches. Sometimes we also remove a little pinch of skin starting from below the eyelashes and this is called a pinch blepharoplasty. Or, do you mean that bit of skin that appears darker, a little depressed and is “U” shaped like a hammock? People often point that area out and say they look tired and they have dark circles under their eyes. If so, we are now talking about the ORL a.k.a. the orbital retaining ligament. The darkness due to the shadowing of the ORL is usually improved by reducing the fat pads, as described above, which are bulging the skin that is above the orbital rim outward. It can also be helpful to support the ORL by placing some filler just below it deep in the naso-jugal groove area. Doing that can lift it a bit and help to smooth out that valley above. If there is volume loss as part of aging or being an athlete, etc. than a consideration can be made to do some form of filling and tightening in other areas of the face. It is helpful to see what is happening to the entire face rather than simply focusing on the “eye” area. A physician very familiar with facial aging can help you figure out what the best treatment plan would be. Often the plan is best when it is multifactorial. Best of luck!

What’s the best option for under eye lines? (photos)

Answers (7)

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