Would eyelid surgery help minimize the appearance of my under eye wrinkles? 30 y/o female (photos)

Question

Hello, i am a 30 year old female who has bad under eye wrinkles since i was a young girl. I dont know if it has a name. They just look like bags or wrinkles. It gets worse when i smile. I hate it! No one in my family has this problem my sister and brother all have beautiful eyes. Im not sure what happened to me lol. Ive tried fiberblast (6 times) chemical peels (5 times) ive tried microneesling (6 times) nothing will take it awaym ive also tried ubder eyw filler but it made it worse

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.As far as I can see from your photos you have extra saggy skin under your area. That is the cause of the wrinkles. For get rid of the extra skin and gain more elegant, fresh look I recommend lower eyelid blepharoplasty. If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation.Best Regadrs!

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. It is possible that a combination of Botox injections and laser resurfacing can improve your under-eye appearance. Since you mentioned that smiling makes your concern more noticeable, it’s likely that repetitive facial movements have deepened the creases over time. Botox injections can target the muscles causing the creases and reduce their activity. Laser resurfacing is also a favorable option for reducing lines and wrinkles and improving the skin’s elasticity. During this treatment, a laser is used to remove the outer layer of the skin and reveal the new, healthy skin below. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon or injector. They will be able to review your cosmetic treatment history and determine the best approach to help you achieve your aesthetic goals.

C. Blake Perry, MD · Answer

The under eye wrinkles in your pictures are caused from your orbicularis oculi muscle. This muscle is responsible for closing your eyes and blinking. The wrinkles can be reduced with neurotoxin. However, this is a trickle place to give neurotoxin because if you give too much you will get lower lid retraction and fat prolapse. Best to see an eyelid expert.

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.

Camille Cash, MD · Answer

It appears you may have a better result from a combination of fillers and Botox.  If you are looking for a more permanent solution you can consider lower blepharoplasty.  The next step is to visit with a board certified plastic surgeon near you for a consultation.

Derek Fletcher, MD · Answer

I suspect you have a variation of the pre septal portion of the orbicularis oculi muscle. The muscle is thicker than average and the added thickness causes skin wrinkles because it is positioned immediately under the thin lower eyelid skin. Smiling often accentuates the wrinkles because the movement of the cheek pushes the muscle into a folded position. An in-person examination is necessary to confirm this diagnosis. The extra muscle and a small amount of skin can be removed using an incision 2 mm below the eyelashes. This is called a subciliary blepharoplasty. Hope this helps and good luck!

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