What's the best treatment for under-eye thinning/crepiness and fine lines?

Question

I'm developing under-eye crepeyness and lines which I assume is due to thinning of the skin, it's also slightly hollow. I use tretinoin and have botox but this doesn't help. What is the most effective treatment? I've been looking at Fraxel, Intracel, Smartxide and/or fillers but i'd like to know what's the most effective.

Jason Emer, MD · Answer

I find great results with many lasers or RF devices (sublative, Fraxel, Clear and Brilliant, Thermage, CO2) in combination with topical creams and/or microneedling.  I suggest finding a physician with experience to address your concerns and who specializes in facial rejuvenation.  Best, Dr. Emer.

Richard W. Westreich, MD · Answer

Hi cmbb,While the cause of your under eye issues may be due to multiple factors, the essential issue for most people with skin creepiness and vertical lines is skin laxity. While lasers, creams, and peels may help with this issue, I would generally suggest a skin only lower eyelid procedure called a skin pinch. There is almost no bruising associated with this procedure and very little downtime in terms of incisional puffiness or redness. Some patients can do this on a Friday and be very functional by Monday. General anesthesia is not required and most patients will have twilight or local only. It takes about 30-45 minutes to perform and addresses the problem directly and precisely.

Nelson Lee Novick, MD · Answer

I have successfully been using fillers for treating the under eye area for nearly thirty years, since the days of the original Zyderm I collagen filler for filling tear troughs. Today, we have much more sophisticated injectables for this purpose composed of hyaluronic acid. These include Belotero Balance, which I use in my Upper East Side Manhattan practice and Teosyal Redensity II, which I use in my Israel satellite facility where a far greater number of regulatory agency approved fillers are available. Both possess little to no tendency to elicit the unwanted bluish Tyndall Effect when injected superficially within the delicate tissues of the under eye area.The adjunctive use of tretinoin to maintain the benefits achieved with the treatments discussed above is reasonable. Alpha hydroxyacid creams containing glycolic acid are another possible maintenance at-home topical therapy that may be used alone or in combination with tretinoin. Other topical agents have less science behind them, and so I am less inclined to recommend these. And, unfortunately, the results of lasers, including fraxels, have to date  been disappointing in my experience and have so far proven to be far more device manufacturer supported marketing hype than hard science.

David C. Yao, MD, FACS · Answer

Thank you for asking. There are many options for the lower eyelids both surgical and non-surgical. This really depends on a good consultation and the amount of skin and anatomic factors. A provider who has comprehensive surgical and non-surgery options will best fit. Having said that, if skin excess is there laser, topical peels, or surgical skin (maybe fat) removal are all effective. The pros/cons need tooth your body and needs. Hope that helps. Best wishes

Joseph A. Eviatar, MD, FACS · Answer

Treatment around the eyes is highly individualized so it is not possible to generalize regarding a "best" treatment for you.  The choice of filler vs laser or device treatment vs Botulinum toxin depends on the reason for the laxity.  In most patients, it is a combination of volume loss and loss of collagen in the skin so combination therapy works best.  If there is a lot off loose skin, I'll often tighten the skin first with ThermiRF smooth (which is like an advanced type of Thermage ) and then add volume under the skin and muscle with a product such as Restylane (off label).  If you do the ThermiRF first, you can melt the Restlyane.   If we are treating fine lines and volume loss I'll treat the volume loss first and then possibly treat with laser, which won't affect the volume below.  Seek out an oculo-plastic surgeon who is also a board certified injection specialist to review the options.  This is a delicate area to treat and many physicians won't treat this area if they are not experienced.  Skin tightening devices are particularly helpful and long lasting and combination therapy is usually the best and can provide improvement that lasts 2 or more years.I hope that helps and best of luck!

Benjamin Barankin, MD, FRCPC · Answer

There is no "best treatment" for treating under the eyes. Often combination therapy is advised, and properly determining by your dermatologist the cause of the problem (e.g. age, genetics, sunlight, eczema, volume loss) is critical to determining the right treatment plan. Topical therapy with retinol or retin-a, or topical vitamin C can be helpful, as can glycolic acid, but with all these agents you must start low and slow, otherwise there will be irritation. Other products containing collagen, elastin, peptides and/or growth factors can also be used, but its important to use medical-grade products if you want to see real results. Sometimes a little botox or fillers can be helpful, while in other situations a resurfacing laser (e.g. ProFractional) can be quite helpful.

Kevin Tehrani, MD, FACS · Answer

Thank you for your question. It is difficult to give you proper advice without at least pictures. In general, you maybe candidate for skin tightening using nonsurgical methods like Thermismooth or Fraxel, TCA peel in combination with volumization using Restylane or Belotero.

Michele S. Green, MD · Answer

There are several ways to tighten the skin around the eyes. Non-surgical skin tightening with Thermage works very well. If there is sun damage and hollows than a combination of Fraxel and Dermal fillers such as Belotero may be best. Please consult a board certified dermatologist with extensive experience in all of these lasers and injections for the best cosmetic results.

William B. Rosenblatt, MD · Answer

One of the oldest most tried and true way using standard therapy is a TCA peel. This can be done under no anesthesia, there is minimal down time and can give an excellent result. It can also be repeated over time if the lines come back.

Naveen Somia, MBBS, PhD, FRACS · Answer

Laser resurfacing, needling, and injection of Platelet Rich Plasma can induce collagen production andimprove the appearance of eyelid skin. This should be maintained with regular topical medical grade skin creams.Hollows respond well to Dermal Fillers. If you have excess skin then a eyelid lift/blepharoplasty is the best choice

What's the best treatment for under-eye thinning/crepiness and fine lines?

Answers (17)

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