What will help improve my under eye area-Restylane, Botox, or a lower blepharoplasty/skin pinch? No lasers please. (photos)

It is making you look old and haggard rather than beautiful and wonderful.  Don't talk yourself into more funky service and ill conceived surgery.  That will wreck you.  I recommend seeing a cosmetic surgeon who really understands these issues and have them take out all the volume that is filling up your face and making you look older.  You probably also need the poorly done under eye fillers removed as well.  Once this is done, judicious use of filler will help restore the heart shaped face. You forehead botox is also freezing the face and making it look inauthentic. I also think you have upper eyelid ptosis and this is some thing that will benefit from being addressed.

Thank you for sharing your question and photos. You appear to be an excellent candidate for full field laser resurfacing to your periocular (eye) area. I have had excellent success using this treatment to reduce the appearance of “crepey” skin around the eyes and improve overall texture and laxity. While there is some downtime associated with this procedure, the treatment offers long lasting results that will restore youthful skin. I would also recommend a resurfacing laser treatment called Halo for the rest of your face to improve the appearance of fine lines, brown spots, and pore size. This treatment also reverses sun damage and will improve your overall skin health. Both the Halo and periocular resurfacing can be done at the same time. After your skin quality has improved, you may benefit from a combination of Botox and fillers. For more information about which procedures are right for you, I recommend consulting with a board-certified specialist. 

Swelling and exacerbation of wrinkles of the lower lid can happen if attention is not paid to the volume changes around the eye.  By filling the cheeks, there is upward pressure on the lid an accentuation of the orbital hollows.  From your pictures, you would be best served by placing some filler on the lateral portion of the orbit with small amounts of botox on the lid itself.  Some filler in the mid cheek may need to be dissolved in order to create a more natural look.   Seek out an expert in facial injectables.  When in doubt get multiple opinions.  Best of luck.

 Hi There,Restylane under your eyes will improve the appearance significantly.  I understand from your question that you are not interested in Fraxel, however, this will help to resurface your skin as well.  Finally, you should be using a top notch sunscreen such as Total Defense & Repair from Skin Medica everyday all over your face with re-application including under your eyes.  Good luck, Dr. Downie

This is a commonly reported problem. Crepiness under the eyes, worse with animation. I would recommend treatments that safely tighten the skin.  These include: Fraxel laser, microneedling, microneedling with radiofreq combo (Intensif, Infini), or a TCA-25% peel.  Downtime for these treatments varies from 1 week (Fraxel) to 48 hours (microneedling).  You mention that you do not want lasers which would exclude Fraxel, although you are a good candidate for that.  I would also recommend that you discuss with your injector the possibility of reversing some of the Voluma that is seen immediately below that crepey skin.  Be well! 

Fillers can cause local swelling. Botox in my opinion would not help this.  I would allow the fillers to resorb and do nothing at this point or inject hyaluronidase to dissolve the product ( but you may get more initial swelling).  I would then re-evaluate it in 6 months.

Thank you for your question. In your case, it seems as though with animation (smiling), the skin under the eye gathers - to a certain extent, this may have been exacerbated by volumizing your cheek area. With more fullness in the cheeks, it's natural to have more skin gather when smiling or squinting. I am not sure about your hesitation with lasers - you would be a great candidate for an Erbium or CO2 under eye skin resurfacing to tighten the skin in this area. A medium depth peel may also help to tighten the skin under the eye. These techniques do have some downtime, and you can be persistently red or pink for 3-6 weeks, depending. You are also a great candidate for a simple pinch blepharoplasty. The incision can be concealed just under the lash line, and sometimes a little bit of fat transfer can also help to give a more natural transition between the eyes and cheeks and eliminate hollows.  This obviously has downtime and risks, and can be made more complicated if you have any history of dry eyes, or other ocular problems. Based on your photos, I don't feel like more volume (i.e. Restylane) in your tear troughs (left eye seems to have more of a hollow than the right) would really solve the problem with excess skin with animation. I would suggest having another discussion with your oculoplastic surgeon, and really show him what bothers you. Regardless, you may want to wait a couple months for the last round of botox to wear off so he can start with a relatively fresh palette and give you the best option.