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

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.

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.

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.