Under eye smile lines - what would give me the best, most natural result? (Photo)

Question

I’m wondering what tx would give me the best most natural result. I tried Botox under my eyes. it didn’t help with the lines & just made my eyes look sunken— not sure if placement was an issue. I was told I am not a candidate for filler. Did PRP injections under my eyes x1, but due to mixed reviews about the efficacy of the procedure and no change after one treatment, I only had 1. I’m willing to opt for surgical tx if necessary. I use a retinol eye cream & plan to start Tretinoin 0.025%

Jason Emer, MD · Answer

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. 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 such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Jonathan Kulbersh, MD · Answer

Thank you for submitting your question and photos. If you aren’t a candidate for fillers, you may benefit from laser resurfacing or RF microneedling to minimize the under-eye lines you’re referring to. Both treatment options can reduce the appearance of fine lines while improving skin laxity for a revitalizing result. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon. They will be able to review your treatment history, assess your concern, and determine the treatment option that may be best for you.

Nelson Lee Novick, MD · Answer

Your concern about the lack of efficacy of PRP is valid. The hard science to support its use simply lags woefully behind the social media hype to promote it. I have been injecting Botox for aesthetic reasons since 1991, and I would not recommend Botox in this case for use directly under the eyes. However, the crow's feet component to the sides of the eyes extending onto the cheeks would likely respond quite nice to a few microdroplets. Finally, a small amount of a low viscosity, cohesive, malleable HA filler can be used to smooth the under-eyes.  You would be wise to consult with an experienced, board certifgied cosmetic dermatologist injector. Best of luck.

Randal Haworth, MD, FACS · Answer

Hello !

It sounds like you have tried some non-surgical options to improve the appearance of your under-eye area, but have not seen the results you were hoping for. Botox is, in general, not recommended for treating under-eye lines, and can sometimes cause a sunken or hollowed appearance if injected improperly or in the wrong area.

Fillers can be a good option for some people, but it's possible that you were told you are not a candidate due to the specific nature of your concerns or the anatomy of your under-eye area.

PRP injections have been shown to be effective for some people in improving the appearance of under-eye bags and dark circles, but results can vary depending on individual factors such as skin quality and the severity of the issue. It's possible that you may need multiple treatments to see a significant improvement.

If you're willing to consider surgical options, there are several procedures that can be performed to improve the appearance of the under-eye area, such as lower eyelid surgery (blepharoplasty) or a mid-face lift. These procedures can be highly effective, but they also come with potential risks and downtime.

Using a retinol eye cream and starting Tretinoin 0.025% can help improve the overall health and appearance of your skin, but it's important to speak with a qualified healthcare provider before starting any new skincare regimen.

Ultimately, the best course of action would be to consult with a qualified plastic surgeon or dermatologist who can assess your individual case and provide personalized recommendations based on your unique needs and circumstances. They can also discuss the risks, benefits, and expected outcomes of each option to help you make an informed decision.

I hope this helps,
best of luck !

Under eye smile lines - what would give me the best, most natural result? (Photo)

Answers (4)

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