Which laser for under eyes? Or other treatments for excess skin and wrinkles? (photo)

Question

I just turned 50 and I suddenly seem to have excess skin under my eyes. I used to get botox for my crows feet but I haven't had it since September 2020. I do have a little bump under my eye and I was told that was a fat pocket that has pushed through. I was told to fix that would be over 10k and I can't afford that. But I would like to know what I can do for the wrinkles and excess skin under my eyes. Botox isn't working. I am interested in lasers but unsure which one would be the best.

C. Blake Perry, MD · Answer

You do have some excess skin and fat under your eyes. This can be addressed with CO2 laser and lower lid blepharoplasty. The CO2 laser will help tighten the thin skin under your eyes. The blepharoplasty removes and transposes fat to give you a smooth transition from your eyelid to cheek. Botox would continue to be a useful adjunct for your crows feet.
Best to see an eyelid expert.

Jason Emer, MD · Answer

lasers and plasma pen under the eyes can help in the office. peels and dermarolling should be started at home.

at home peels like cosmelan, enlighten and aerify along with dermarolling (EmerageSkin roller with anteage AERIFY MD ampules weekly, see link) should be started now to prevent further aging.

For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Kian Karimi, MD, FACS · Answer

You would be a great candidate for a surgical lower lid skin pinch which involves trimming the extra eyelid skin to address the bunching and wrinkled appearance. If you are concerned with surgery, a resurfacing laser such as a periocular TRL laser, could tighten the crepey skin in the undereye region but would be less effective as you do have quite a bit of excess skin.

You are also a good candidate for an upper blepharoplasty which is a procedure that involves removing the excess skin on your upper eyelids that is creating the hooded appearance. The procedure involves measuring the amount of extra skin needed to be excised to ensure symmetry. These procedures can be done together or separately if cost or uncertainty is a concern. Going forward, I would recommend you to complete multiple in office consultations with board certified experts to discuss your ideal outcome. This way, they can assess your goals in person and determine the best treatment for you best.

Best of luck! 
Kian Karimi MD, FACS

A.J. Amadi, MD · Answer

Unfortunately, its not possible to evaluate your anatomy solely based on the photo of your smiling. Wrinkles are ALWAYS worse when smiling. We need to see your eyes without smiling to see if laser resurfacing or a chemical peel would be a good option for you.

Camille Cash, MD · Answer

From your photos it appears you would benefit from lower blepharoplasty.  This procedure would remove the excess skin and smooth the under eye.  Another option to consider is FaceTite/AccuTite which can tighten skin up to 40%.  This procedure is done in the office with no general anesthesia required.  See a board certified plastic surgeon near you to learn more.

Which laser for under eyes? Or other treatments for excess skin and wrinkles? (photo)

Answers (5)

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