What recommendations other than Botox/Dysport can you recommend to eliminate these eye wrinkles and crepey skin? (photo)

There are several other modalities that could help with the skin in this area, radiofrequency can help with crepiness and tighten skin.   We have seen promising results using our Morpheus 8 for this treatment.  Also sometimes correcting volume in the cheek can smooth out the skin around the eyes. Lastly using PLLA smooth threads can stimulate collagen and create a smoother result.   Consultation in office is recommended to further discuss options and see concerns in real time.  KH

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 be the best long term. However, non invasive less downtime options such as fillers, lasers, (Plasma pen) microneedling/(RF/)PRP, cosmelan peels and stem cells can all help give some improvement. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

The harder you chase these lines, the worse they are going to get. Laser resurfacing and chemical peel will harm the gliding planes close to the skin and actually make these fine lines thicker and more bothersome. Hyaluronic acid filler to provide some volume to this area can be very helpful but this service is fussy and who does the treatment makes an enormous difference. The botulinum toxins here are good to help the crows feet line but unless everything is frozen, you will have some lines.

Based on your anatomy, I think adding volume to the lateral cheek would help reduce the appearance of crows feet from the lower lid. This could be achieved with filler, PRP (platelet rich plasma), or micronized fat transfer. These procedures have minimal downtime. 

MM2525I appreciate your desire to find another option other than Botox and the necessary treatment every four months, however it is still the best option. The fact that CO2 laser resurfacing failed to resolve your issue demonstrates the fact that animation of the muscles around your eye are causing your areas of concern. Botox is by far the best option.Best of luck

Thank you for sharing your question and photograph.  As these appear to be created with subtle squinting, the best treatment would be Botox/Dysport.  These medications are designed to limit the creasing that comes from dynamic muscle activation as seen in your picture.

Thanks for the photo. You are asking for treatment recommendations to eliminate the eye wrinkles and crepey skin. I would suggest a more achievable goal would be to diminish them. As you know, neurotoxin for the lateral crows feet is very effective. Combined with an appropriate hyaluronic acid filler for the under eye and cheekbone areas, you will get a nice improvement. We have had good skin tightening results with Tempsure Envi but if you have not responded in this area to C02 laser then i doubt this RF treatment will help significantly. PRP combined with microneedling would be worth trying. I would suggest a review of your skin care regimen to ensure it includes growth serums, SkinMedica TNS Illuminating eye cream is a nice choice for this area. Best, Dr. Tkatch

Hello there,
      Procedures like you mentioned, build over time, so it is important to maintain treatments to avoid worsening. I also would recommend either Ultherapy or Exilis Ultra to target the deep collagen and elastin. This may further soften this area by strengthening the tissue and restoring it. Filler is not typically done in this area unless it is used in the cheek (which may inadvertently soften the look of this area). It is unrealistic to expect removal of crows' feet without using neurotoxin, but continued maintenance and commitment to skin health should start to soften this area over time. Hope this helps.
Sarah RN BSN 

Thank you for posting your photos with your interesting question. Most of facial aging is due to the loss and remodeling of facial bones and the earliest is the boney orbital bones around the eyes. As a result the muscles and tissues around the eyes begin to sag a couple of millimeters in a very predictable way. This can be corrected with some micro droplets of Botox or Dysport to relax the musles and with hyaluronic acid fillers like Restylane to restore the lost volume. Very little filler is required to restore the lost lower eyelid volume and usually lasts up to a year. It does not have to be overdone. I recommend that you have a consultation with a Board Certified Plastic Surgeon who is highly experienced with fillers and under eye correction. It is not a beginner injection technique. This can be done with a little topical numbing cream in the office. Please bring a photo of yourself from a few years ago to show your doctor. Best wishes, Richard Wellington Swift, M.D., F.A.C.S.

If you're somewhat apprehensive to receive neurotoxins like Botox and Dysport, radio frequency devices like Tempsure Envi and Candela Sublime can help tighten the skin to reduce the appearance of wrinkles and lax skin. Radio frequency skin tightening is a treatment that needs to be kept up with fairly regularly, about once a month for three to six months to see the result that you're likely envisioning. There are devices that combine radio frequency with microneedling to create profound tightening of the skin; these often give results more quickly than radio frequency skin tightening and don't need to be kept up with as frequently. Hope this helps!