Periorbital Wrinkles (Below Eyes) Treatment Options: Fraxel, Chemical Peels/TCA, Botox, Other?

I'm a male, 31, who suddenly developed folds - perhaps due to increased sleeping on my stomach. I’ve included pics of both eyes, w/ & w/o smiling. What treatment is most advisable for me? How long does each work?

My lines are still present when not smiling, so would Botox help, and would my smile look unnatural? Fraxel, chemical, & TCA peels - Which would be most effective, and which least risky? I’m very concerned about damage. What order is advised if I needed different treatments?

Doctor Answers 3

Eyelid lines and folds

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A combination of treatments works best.  Botox will help smile lines, Thermage for eyes can tighten and lift the skin, and a fractional laser can help the texture of the skin.  Treatment should be in that order.  You should try to sleep on your back with your head elevated on 2 pillows.

Toronto Dermatologist

Lower eyelid lines and folds

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If your folds are only due to sleeping on your stomach, then positiional changes should improve your eyelids! If it is related to a hypertrophic or enlarged eyelid muscle, it is doubtful that it would suddenly be noticed by you as it is a gradual or life long situation, but one or two units in the lower eyelid can help this. Fraxel would only be expected to help resurface damaged skin that looks damaged at rest, and not a result of muscle motion. Certainly, though, Fraxel would be more helpful than a chemical peel. Fraxel restore is very safe; the risks of complications with Fraxel Restore, although existent, as in any procedure, are very, very low.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

A combination of treatments works best

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A combination of treatments works best.  BOTOX will not only relax the muscle to decrease the smile lines while you are smiling, but over time smiling will not be as intense causing fewer lines to evolve.  Even the superficial lines in the skin will improve with BOTOX.  And if it’s administered in low doses, your smile will not be distorted.  The superficial treatments such as TCA peels and Fraxel are all safe if done by an experienced provider.  With TCA peels, usually 30% TCA is used.  But laser treatments are generally the most predictable.  We often recommend superficial fraxelated lasers.  In your case, being young, usually a combination of a neuromodulator (such as BOTOX) to relax the muscle and possibly in combination with an injecatble filler is going to give you the best result.  At 31 you usually don’t need deep skin treatments. The folds that are developing are related to sleeping on one side and to the changes in the soft tissue and the bone.

Joseph A. Eviatar, MD, FACS
New York Oculoplastic Surgeon
4.7 out of 5 stars 68 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.