Restylane, Other Fillers or Canthopexy for Dynamic Eye Wrinkles?

I have wrinkles under eyes and got some helpful answers from three doctors here on RealSelf. Thanks for the replies! I am going to research a good doctor in my area for a canthopexy surgery and a Sciton Erbium ProFractional... But I saw on RealSelf that some patients did fine with Restylane under their eyes. Would I be a candidate for that? Or would I be a better candidate for other types of fillers? I have included a photo of my wrinkles relaxed and not smiling for review. Thanks.

Doctor Answers 10

Yes, Restylane will be fantastic for dynamic eye wrinkles

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Dear Beach

I am in complete agreement with Dr. Waldman concerning the phenol 89% peel. Conservatively done, this is far better than any laser procedure for helping the lower eyelid. In particular you have an extra line that is called a malar festoon. Lower eyelid surgery is not going to help the festoon. The factional laser procedures will also not get the job done. However, my expereince is that many patients are not quite ready for the surgical procedures and are very happy to get a lot of help with the injectable fillers. I think the best of these for this area is Restylane. In particular you will benefit from a material that can be adjusted so in my mind this rules out fat or a product like Radiesse which can not be adjusted after treatment. If you came to my practice I would assess the quality of your lower eyelid skin and based on this make the recommendation of lower eyelid chemical peel versus filler.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lower Eyelid Enhancement - Restylane, ProFractional and Restylane

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Restylane WILL nicely fill the Tear Trough and rejuvenate the lower lid - cheek junction. But - it will do nothing to the thin, crinkled skin. That is where the ProFractional (fractionated Erbium by Sciton) would do a fantastic job of rejuvenating and tightening this skin. (As a Floridian you may want to check Dr. Jason Pozner in Boca Raton).

You MUST have it done by an experienced plastic surgeon who would make sure the lower lid is not lax (in which case, without a prior lid tightening, any lower lid procedure may cause a downward pulling (ectropion) of the lower lid).

Dr. P. Aldea

Peter A. Aldea, MD
Memphis Plastic Surgeon

Watch out for canthopexy: read below.

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I agree with the multi-faceted approach the doctors are recommending here. I do agree that a small amount of filler well placed in the orbital rim area (near the bony edge) can help fill in a bit of a hollow, but I caution you against getting canthopexy surgery if your lids have normal tightness and are healthy. Some people do it anyway, but be aware it can change the natural shape of your eye and give you a lifted, cat-eye look that you may later regret because you will look different. I'm not saying that will always be the case, but be very cautious with that decision. Resurfacing the fine lines (cautiously--too much pulling can ruin the function of eyelid closure and lead to chronic dry eye problems) is a good option if done with the right laser in very well-experienced hands.

Jessica J. Krant, MD, MPH
New York Dermatologic Surgeon
4.7 out of 5 stars 41 reviews

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Solutions for dynamic eye wrinkles

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We do not recommend fillers around the eyes for dynamic eye wrinkles. Excess wrinkles on the lower lids can be addressed through a pinch technique where excess skin on the lower lids is removed at the lash line. A canthopexy is only used to bring up a lax lower lid such as a retracted lid from a hound dog look. Crows feet are best treated with Botox.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Fillers do work for some types of lower eyelid wrinkling

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Aging of the face involves loss and or shifting of facial fat as well as changes in the skin. All of these processes can contribute to changes in the appearance of the lower eyelid and that area where the lid joins the cheek. As such, soft tissue fillers may be very useful in rejuvenating this area. Make sure that the surgeon you are seeing has the ability to treat skin, and soft tissue with both a variety of surgical and injectable options. That way, you will know you are getting the full range of recommendations. Showing your photos to a variety of specialists may give you a general idea of how to proceed, but is no substitute for a consultation with a board certified eye or plastic surgeon.

Elizabeth Slass Lee, MD
Bay Area Plastic Surgeon
4.8 out of 5 stars 56 reviews

Fillers for lower eyelids

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ON your photograph, the right lower eyelid shows either a fluid swelling or a fatty prominence. If the later is bulging forward a blepharoplasty would be beneficial to reposition this fat. I think you will get a better result by seeing a plastic surgeon to have this evaluated. Many patients undergo laser resurfacing after eyelid surgery. FIllers don't work very well, at least in my hands, on the skn of the lower eyelid within a half inch below the lashes. Here the filler can't be placed behind the muscle wall, and superficial filler is often noticable because the skin in that location is so thin.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

Options for lower eyelid tightening

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I am glad to hear that you are planning to schedule a consultation with someone who can examine you personally since that is the only way to get definitive advice. Fillers such as Restylane will not improve the fine lines if that is an issue, but the shadow where the eyelid meets the cheek can be helped a lot. For tightening with peels, there are many options out there and no clear winners; they will all do the job. Fractional lasers have a slightly faster healing time but don't do as much as traditional lasers, and chemical peels vary quite a bit in terms of concentration and depth of peel so judgment and technique are important.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 59 reviews

Preference of Phenol Peels under the eyes

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Personally I use both traditional and fractional CO2 laser resurfacing for full face treatements. But my preference under the eyes continues to be 88% Phenol applied in a very conservative fashion. In fact it is the rare Lower Lid Belpharoplasty that I do that is not followed 2-3 months later by a Phenol Peel. Having stated this dynamic lines are always minimized with BOTOX injections as well so we prefer combining procedures as needed.

S. Randolph Waldman, MD
Lexington Facial Plastic Surgeon
4.6 out of 5 stars 19 reviews

Restylane for tear trough

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I would agree with Dr. Aldea's statements. Although I do not have personal experience with the Sciton, I believe you would alos benefit from some sort of resurfacing procedure for management of the very fine wrinkles.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 86 reviews

Are you kidding me?

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Restylane, lasers, Fillers or Canthopexy for Dynamic Eye Wrinkles?
first of all that is one crappy picture.  lasers promise much and deliver little. peels may work but I wouldn't use 1980's technology in my car or phone and I'm surely not doing it in my plastic  surgery.   the only helpful answer based on this photo is: see a doctor and get a professional opinion. so, see a good surgeon and see what they think after examining you.

Rafael C. Cabrera, MD
Boca Raton Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.