What would best help the skin around my eyes? (Photo)

Question

I am 29 years old and over the past year, I've noticed the skin above and below my eyes has become quite loose. I try to moisturize, I use a collagen-based eye cream, I try to stay hydrated...not sure what else to do. My eyes are already pretty asymmetrical but I feel like the looseness makes it more noticeable. I almost feel self conscious smiling because it looks so bad. What can I do? I haven't lost weight or anything so not sure why this happened to begin with.

Jordan Kaplan, MD · Answer

Thank you for this question and for providing photographs. It appears the extra skin on your upper eyelids would be best addressed with a blepharoplasty. This skin is removed through a well hidden incision in your natural lid crease that would be invisible after it heals. I regularly perform these under local anesthesia in the office with minimal downtime required. 
You are young and likely do not need skin removed from you lower lids. We each have natural fat pads that can become visible and when this occurs the fat can be removed from inside the eyelid leaving no visible scar. I expect your young skin to contract beautifully afterwards. This too can be done awake in the office under local anesthesia with minimal downtime. 
I hope this helps!

Jason Emer, MD · Answer

There are many things you can do to treat the saginess around your eyes . Non invasive less downtime options such as fillers (Belotero, Juvederm Volbella​), lasers (Moxi/Halo/Fraxel/CO2​) 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. A surgical option to remove skin and/or fat might be the best solution long-term. Plasma pe is also a great alternative. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Emmanuel Mallol Cotes, MD · Answer

Thank you for your question.

Some individuals may have a genetic predisposition to certain eyelid characteristics, such as excess skin or prominent fat pads, that can be present from a young age.

Based on your photos you appear to be a good candidate for Upper and Lower blepharoplasty to remove excess skin and improve the overall contour of the eyes 
Kind regards, Dr. Emmanuel Mallol Cotes.

Eric M. Joseph, MD · Answer

Your photos are a bit difficult to examine, however, since you are only 29 years old and are concerned by the appearance of loose skin around your eyes, Morpheus 8 treatments are a non-invasive and safe method for achieving Skin tightening. Hope this helps! Sincerely, Dr Joseph

Dana Goldberg, MD · Answer

Hi. There are multiple options to address this area, but the first two that come to mind are Botox and laser. Botox can minimize muscle contraction at the corners of the eyes and give a subtle lift to the corner of the eyebrow. This can minimize wrinkling in the area. Most patients like the effect, but some patients do not like the change in expression. The only way to know if it will work for you is to try it. If you like it, you can maintain the results with treatments every 3-5 months. If you hate it, you simply wait for it to wear off (unfortunately it can't be reversed).

The other option is laser resurfacing. CO2 laser is a fairly aggressive laser (meaning you will look burned and have significant skin peeling in the first 5-10 days after the procedure). Over the next 4-6 months, the body will build collagen in the area, smoothing the lines and tightening the skin. Results are fairly permanent, but your skin will continue to age, so we have some patients who do CO2 laser every few years to maintain their results.

Nelson Lee Novick, MD · Answer

No surprise that the collagen creams, hydration, and moisturizers haven't worked, since these approaches relate to the "fabric" of the skin. The problem here appears to be related mostly to when there is underlying muscular movement (i.e. when smiling). So, if this is indeed the case, then Botox, which works to quiet down muscular activity, would appear to be a logical treatment option. A few microdroplets of Botox injected properly along the muscle can help this kind of "jelly roll" issue. I have been routinely treating this kind of problem in this way for the past three decades. You would be wise to explore this further with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Anil R. Shah, MD · Answer

Hello, My name is Ranen and I work for Dr. Shah as his medical aesthetician and aesthetic nurse.  Thank you for your question and photos. As we age our undereyes may need a little bit more attention.  This area in particular may appear more lax due to the loss of volume( normal as we age). Treatement options would be perhaps botox or laser resurfacing to help with the collagen.

Tanya T. Khan, MD · Answer

Hello, from your photos it looks like there is some volume loss that is contributing to the looser skin. Your upper eyelids have a bit of hollowing and may benefit from hyaluronic acid filler injected into the superior sulcus space to give fuller upper eyelid space. The lines along your lower eyelids are somewhat animational, meaning that they are emphasized when you smile. You can make this a bit weaker with botox injections. I would consider doing some resurfacing treatments, either laser or chemical peels, to improve the skin texture. And do have a good eye cream that you will commit to using daily or 2x daily. Please see an experienced oculoplastic surgeon for best results with your eyelids.

Camille Cash, MD · Answer

You may be a candidate for a blepharoplasty which would remove excess skin and further contour the eyes.  Other options include Morpheus8 treatments.  We always recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.  I've included a video I hope you find helpful.

Benjamin Barankin, MD, FRCPC · Answer

I would start with topicals, gently rotating a mild retinol, and lower concentration vitamin C, and taking a break the 3rd day. There are also creams like TNS with growth factors that can be useful. Ofcourse sunglasses/sunscreen protection is critical as well. Best to see local dermatologist for optimal skincare advice.

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