How can I get rid of wrinkles under eyes without Botox? Should I try Fraxel Laser or a Peel? (photo)

I have crinkles under my eye when I smile, it is my cheeks that are pushing into the eye area and cause the crinkles to form. I have botox every 6 months for crows feet although it seems that these are getting worse too as time goes on. One expert recommended fraxel which did nothing for the crinkles for a friend of mine. Should I try a peel. I have heard that fillers might help. It makes me look older and I feel very self conscious about it. Any suggestions would be appreciated thanks!

Doctor Answers 6

Botox under eye alternatives

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Thank you for your question and for sharing your photo. Botox may help to soften the wrinkles under the eyes. It does require a very small amount and it will help to soften the lines. It will not necessarily reduce all the wrinkles like you might see in the forehead or crows feet region. You will notice a soft relaxation of the dynamic lines under the eyes, and you may notice a slight opening of the eyes. I would start with 1-2 units under the eyes on each side. If you like the effects, then it is very easy to incorporate this into your future treatments.

Dermal fillers such as Restylane can be used to fill in shadows under the eye and achieves a more rested look. You can combine the two treatments but it would require a thoughtful approach and careful analysis of your concerns to ensure that treatment options will help you achieve your goals.

I would recommend visiting with a board certified plastic surgeon in your area to address your concern as it is an advanced area to treat. In addition, a plastic surgeon will be able to discuss surgical alternatives.

Under eye wrinkles

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I think the first approach should be trying a chemical peel. It would be the least invasive and potentially have great results. If that doesnt meet your needs, then I would consider something like a fraxel laser or a sublative laser. Sublative lasers dont have the downtime of fraxel and can be just as beneficial. I would talk to a dermatologist and see what their recommendation for your particular skin would be.

Under eye wrinkles does great with a combination of procedures.

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The under eye creases often need a combination of botox, filler and/or several chemical peels/laser treatments. Usually when you do eye peels you often  do 3-5 peels at 30-35%TCA 2-4 weeks apart at a cost of roughly $350 each. Dysport or regular botox works 50% of the time under the eyes and is very helpful when it works. Sometimes you need a filler such as belotero to smooth out creases. And last but not least, a lower bleph where the skin is excised works well. Sincerely, David Hansen,MD

David Hansen, MD
Beverly Hills Dermatologic Surgeon
4.7 out of 5 stars 46 reviews

How can I get rid of wrinkles under eyes without Botox? Should I try Fraxel Laser or a Peel?

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It is very hard to make specific recommendations based on a single photo. However, Botox can be very helpful in this area. If you do have excessive crêpe paper skin the lower eyelid then you might be a candidate for ablative laser resurfacing of the eye area or a skin pinch lower blepharoplasty. In my experience, neither Fraxel not the typical facial peel are aggressive enough to achieve the results that you are looking for. For more specific answers, please seek a consultation to determine what the best option will be to achieve your goals. I hope this information is helpful for you.

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Laser resurfacing can improve eyelid wrinkles that appear at rest

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Laser resurfacing can improve what we call "static" wrinkles that is wrinkles that we see in the skin when her eyelids are at rest and not smiling or squinting.

However eyelid wrinkles that appear 1 smiling or squinting are called "dynamic" lines because they're caused by the contraction of muscles.  Botox not laser resurfacing is the best treatment for dynamic wrinkles of the eyelid.

My guess is that you require higher doses of Botox to reduce the wrinkles or wrinkles that you seek 1 smiling or squinting.  However be aware that she can only treat the crows foot area and may be the outer third of the eyelid.

If you have loose eyelid skin which exaggerates the wrinkles by causing folds of skin then a skin only blepharoplasty may help.

Botox, Dysport, Xeomin, Laser or Fractional Radiofrequency resurfacing can help.

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If the lines are present only when you have facial expression, Botox, Dysport or Xeomin can help if there is a squint component to the lines. You may benefit from a small amount of Botox in the middle of the lower eyelid immediately below the eyelashes to relax the muscle bands immediately below the eyelashes. 

If the lines only appear when you smile, as is true in almost everyone, I do not recommend Botox in the lower facial smile muscles as a means to stop the wrinkling under the eyes when you do smile. This can give your a weird expressionless face.   If the lines are still present when you are not smiling, ablative or non ablative laser resurfacing would be helpful.   Ablative Erbium or CO2 lasers work the best.   Fillers are only helpful if you have hollow tear troughs without lower eyelid bags.  

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

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.