Surgery for under eye wrinkles (photo)

Question

Im 31 years old and I have so much loose skin/wrinkles when I smile. What can be done to fix it? Is it a lower blepharoplasty case?

Anshu Gupta, MD · Answer

Based on your photos, this does not look like you're dealing with true under-eye bags. What you're likely seeing is dynamic wrinkling from muscle movement when you smile. In cases like this, Botox (or a similar neuromodulator) can be very effective. It works by softening the contraction of the orbicularis oculi muscle around the eyes, which in turn reduces the appearance of those smile lines or “crow’s feet.” This approach can significantly improve the skin’s appearance without the need for surgery like lower blepharoplasty.

Chet Mays, MD · Answer

Thank you for your inquiry! By your photos, it looks like you would be a great candidate for a lower bleph procedure as that procedure will remove excess skin to your lower eyelids. I recommend scheduling a consult appointment with a board certified plastic surgeon like myself so we can assess your eyes, listen to your goals, and create a surgical plan that is best for you and your goals!

Kyle Kimura, MD · Answer

Great question and thank you for providing photos! 
I generally like for patients to start with more conservative measures such as botox to the lower eyelids to see if this helps with some of the wrinkles when you smile (likely secondary to exess muscle contraction) before considering surgery. As far as the surgical options, in my opinion I think the two best options for you particularly would be either laser resurfacing or lower blepharoplasty with skin excision. 
Hope this helps! Kyle Kimura, MDFacial Plastic and Reconstructive Surgeon

Earl Stephenson, Jr., MD, DDS, MBA · Answer

Dear Nadinelement

Thank you for your pictures. In my opinion, the lower lid blepharoplasty will not solve your problem. You have a very active  eyelid muscle when you are animated.  BOTOX can help the active wrinkles you have toward the outer corner of your eyes. There's no consistent/safe procedure surgical or non-surgical they can help the remainder of your wrinkles.

Best wishes,

Earl Stephenson, Jr, MD, DDS, MBA,

ESJ Aesthetics.

Jeffrey M. Darrow, MD · Answer

Thank you for your photos. You have no excess fat of your lower eyelids and it appears you only have skin laxity. You are an ideal candidate for what is known as a pinch lower blephroplasty. This is performed under local anesthesia.  The skin of the lower eyelid is gently and repeatedly pinched, just under the eyelashes until there is a standing ridge of excess eyelid skin and the rest of the skin of the lower eyelid is smoother.  This standing ridge of excess eyelid skin is then excised and the incision closed. This results in a smoother lower eyelid with an incision line hidden just barely beneath the eyelashes.  Bruising is minimal and recovery is fast. Speak to your plastic surgeon about this option.

Lexie Wang, MD · Answer

i would try some non-surgicals first such as botoxing to relax the muscle from crinkling so much when you do smile, as well as mega increasing your skincare to this area (possible laser/peels in addition to regular day to day routine) as these tend to be the most common culprits for why the undereye area skin gets so crepey. However, if these aren't enough, then yes removing some skin can be helpful for you because you are young and you probably have good eyelid tone, but long term you have to be careful about how much skin is removed and you will need to be working on botox/skincare in this area anyway to maintain your results so you might as well get started

Kenneth D. Steinsapir, MD · Answer

You do appear to have lower eyelid wrinkles. It is likely that these would benefit from lower eyelid surgery. A detailed in person assessment would determine if other issues are present that might also be addressed with surgery, fillers, or chemical peeling. I recommend being weary of zoom consultations. There really is no substitute for meeting a potential surgeon in person and having a detailed consultation that would included a careful history, examinations, and unhurried discussion of your best options based on your concerns and goals.

Zoran Potparic, MD · Answer

It appears that a combination of lower blepharoplasty and chemical peel would be a good solution for your under the eye wrinkles. In person consultation with a board certified plastic surgeon familiar with these procedures would help. Good luck.

Mats Hagstrom, MD (license on probation) · Answer

There is no great procedure for treating premature wrinkles of the lower eyelid associated with smiling.
You might get partial improvements from certain procedures, but none of them will eliminate the problem.
Treatments that may be recommended can include Botox treatment, CO2 laser, ablative treatment.
Personally, I do not recommend removing skin from the lower eyelid and so I would not recommend a lower eyelid blepharoplasty. Doing so increases the chance of developing a premature atropine which is an undesirable appearance.
It also doesn’t stop the wrinkles from forming.
If you’re not wearing daily sunscreen and avoiding excessive sun exposure, then start that immediately.
Well, done Botox is probably your best option at this point but different providers may have different opinions.
Best,
Mats Hagstrom MD

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