What are my treatment/surgery options for undereyes? (Photo)

Question

Hello! I'm a 45 year old non-smoking, non-drinking healthy female. I sleep well, manage stress, eat well and have no allergies. I’ve had 'lines' (nasojugal grooves?) since childhood. This combined with my undereyes becoming darker/wrinklier/hollow, I am looking for treatments as my work involves being on TV and stages and lord knows media and stage lights are far from favourable at the best of times. With thanks in advance for your suggestions and assistance.  Elise

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.

Nelson Lee Novick, MD · Answer

I had a long career in appearing in the media myself, and I know just how those bright lights can emphasize every defect. Happily, the experienced use of HA fillers can help to establish a smoother transition between the upper cheek and the lower lid region, which in turn would create more even light reflectivity.  It can also improve the direct under eye region. An inperson examination that allows for palpation and manipulation of the skin would be the best way to determine the exact injection technique and the appropriate filler(s) to use to get the job done. You would be wise to consult a board certified cosmetic dermatologist and best of luck in this and in your media career.

Brooke R. Seckel, MD, FACS (retired) · Answer

Thank you for your question. You are very well informed-even some Plastic Surgeons are unaware of the Nasojugal grooves!

First, avoid filler injections-they disappoint and can cause serious complications.

The only effective procedure is called a Transconjunctival Lower Eyelid Blepharoplasty with Arcus marginalis release and fat grafting (NOT Fat repositioning).

Not many do this procedure so do your searching and be specific.

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