Advice on what treatment to do for lower eyes. CO2 laser? Filler? (Photo)

I am 44 years old and have always had deep creases under my eyes when I smile, they are just staying longer now! A few years ago I had some of the fat removed under my eyes (which I loved) but am not sure if that's why there is more skin now. I have these sagging bags all the time now and a ton more wrinkles when I smile. Will CO2 laser help this? Is there anything else I can do? Filler? I tried botox recently and I think it made it worse. Thanks in advance for any advice!

Doctor Answers 4

Lower eyelid lines treatment

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Hi, I just added a couple of links that might be helpful...

Hi charli71. Your photos show extra skin and bulging fat pads in the lower lids that are optimally treated with a lower eyelid lift. A CO2 laser is an effective way of tightening skin.  Smaller degrees of looseness can be treated by chemical peels, microneedling and other methods that carry less downtime than the CO2 but require multiple sessions. Some can be completed at the time of surgery.  Fillers, whether synthetic like Restylane or natural like fat, are a nice choice to smooth out the depression/tear trough at the junction of your lower eyelid to cheek. Wrinking in the lower eyelid region is a recurring issue regardless of which method you choose.  I encourage you to see a board certified Plastic surgeon who can provide you with a combination of treatments and ongoing maintenance. Good luck!

Lower eyelid wrinkles

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These lower lines are best treated with co2 laser and then followed with fillers.  For this you want to go to a very well trained physician who uses the most advanced technologies for both.  For fillers I use cannulas to this area so you dont get bruising or swelling and it is very precise.  For lasers we use PRP and microneedling along with the co2 to get the most tightening and best long term results.  I suggest a formal cosmetic consultation.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Laser vs fillers for lower lids

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Given your findings I don't think fillers are a good option. They are used for tear troughs. Co2 laser is best for fine lines. Blepharoplasty looks like your best option. You  have what appears to be festoons

Christopher Kelly, MD
Plantation Plastic Surgeon
4.0 out of 5 stars 19 reviews

Extra skin under the eyes

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From your pictures I would say you may need a blepharoplasty which is surgical removal of the excess skin under the eyes. Although CO2 laser can tighten that skin somewhat, when there is an excessive amount of skin the laser will not be able to tighten it enough for a satisfactory result.

A lower blepharoplasty is a relatively straightforward procedure as long as you have it done by a qualified experienced physician.

Filler in this area would not result in nearly enough smoothness and the amount required to fill the skin to make it smooth would make your lower lids look too puffy.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Lee P. Laris, DO
Phoenix Dermatologist
4.8 out of 5 stars 16 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.