Which procedure would minimize wrinkles, fine lines, creases and volume loss in the under eyes? 27 y/o (photos)

Question

I am 27 and I have major loss of volume under my eyes ad vr deep creases and also lots wrinkles and fine lines. My eyes look 45 years old or over. What can I do?

Anna Chacon, MD, FAAD · Answer

I can understand why this feels very distressing, especially when the under-eye area makes you feel like you look much older than you are. The important thing to know is that at 27, what you’re seeing is usually a combination of early volume loss, skin thinning, and shadowing, not true “aging” in the severe sense.

The under-eye area is one of the first places where even small structural changes become very visible.

Step 1: Address the volume loss (most important part)

When there are deep creases and a hollow appearance, the first priority is usually restoring support—not treating the wrinkles directly.

The most common option is:

Tear trough filler (hyaluronic acid filler) – carefully placed in the deep fat pads to restore volume and reduce shadowing

When done correctly, this can significantly soften the tired appearance by improving light reflection under the eyes.

However, this has to be done conservatively. Overfilling this area can lead to puffiness or heaviness, so technique matters a lot here.

In some cases where hollowness extends into the mid-cheek, I also consider cheek support filler, because lifting the midface often improves the under-eye area indirectly.

Step 2: Improve fine lines and skin quality

Once volume is balanced, we then look at skin texture:

Fractional laser resurfacing (non-ablative or ablative depending on severity)
RF microneedling
Light chemical peels (carefully selected for under-eye safety)

These help stimulate collagen and improve fine lines and crepey texture over time.

Step 3: Biostimulation options (long-term improvement)
Certain skin boosters or collagen-stimulating treatments can improve hydration and elasticity gradually
These work well as maintenance after structural correction
What I would focus on in your case

Based on your description—deep creases + volume loss + fine lines—the most effective approach is usually:

Subtle tear trough filler (and possibly midface support)
Followed by skin tightening or resurfacing treatments

Trying to treat wrinkles alone without restoring volume usually doesn’t give a satisfying result, because the shadowing is what makes everything look more aged.

Important reassurance

At 27, what you’re seeing is very commonly a structural lighting issue + early volume changes, not true premature aging. When properly treated, the improvement can be quite significant and very natural-looking when done in stages.

The key is a conservative, layered approach—not overcorrecting the area in one treatment.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

From the photos provided, it would appear that the use of the appropriate HA filler(s) injected with the proper technique would address the under-eye tear troughs and hollows visible in the photos provided. Since the upper cheek region is a major support for the infraorbital region, the use of a robust HA volumizing filler in the upper outer cheek region would not only create a more ogee curve to the face, but would secondarily improve the under-eye tear troughs and hollows. If necessary, the additional use of a low viscosity, cohesive, malleable HA filler could be use to further refine and improve the infraorbital region. In experienced hands, the treatment can should take no more than ten or fifteen minutes to perform, yield immediate results, and engender little to no significant downtime. These are advanced injection techniques not to be left to the hands of novice injectors accustomed only to using simple Restylane or ordinary Juvederm for filling smile lines. You would be wise to consult with an experienced, board certified cosmetic dermatologist filler expert. Hope this helps and best of luck.

Camille Cash, MD · Answer

You can consider non surgical and surgical options.  Non surgical options include a combination of Botox and fillers as well as treatments such as Morpheus8 which can improve overall skin tone and texture.  Surgically you can consider a lower blepharoplasty for longer lasting results.  I've included a video I hope you find helpful.

Sheryl D. Clark, MD, FAAD · Answer

Hello tegen1:

I can understand why you might want to treat this issue. You would see the most benefit from filler placed in the tear trough. The benefits would be seen immediately, and if a filler with the appropriate rheologic characteristics is chosen, such as RHA1, you should not suffer swelling afterward.

I think you would be quite pleased with the results. If you have any additional questions, please do not hesitate to reach out.

All the best from New York City, 
Sheryl Clark MD FAAD.

Leonard Grossman, MD · Answer

There’s absolutely nothing safer than using your own fat when it comes to treating hollowness in the lower Island area. Hollow lower eyelids are generally required by heredity from the father’s side of the family. When Fat grafting is performed by an expert fat grafting plastic surgeon, the results are extremely natural and practically permanent. I hope this helps and good luck from New York City Plastic Surgery.

Kenneth R. Francis, MD, FACS · Answer

Dear tegen1,
You appear to be a good candidate for under eye fillers.  There are many options for the specific filler to be used so seek consultation with a provider skilled in under eye filling.  Good luck!

Which procedure would minimize wrinkles, fine lines, creases and volume loss in the under eyes? 27 y/o (photos)

Answers (7)

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