Wrinkles under eyes only when smiling. Should I get eyelid surgery? (Photo)

Question

Hi! I'm 33 yo. The creases in my undereye area when I smile age me a lot. I have no wrinkles when my face is relaxed, they only appear when smiling. I've always had proeminent eye bags when smiling, but the skin would bunch up in a single crease. Now, there are many tiny wrinkles. The change happened sudden, 3 years ago, during a stressful period. I've tried CO2 laser, but it didn't improve the creases and left me with darkened patches. Would you recommend eye lid surgery?

Richard Zienowicz, MD · Answer

Please be reassured that is very normal to have these creases with animation (when moving/making expressions). I would only recommend Botox injections to the area around the eye to help decrease, but not eliminate, these creases that happen when you smile.

Selcuk Inanli, MD · Answer

Hello! Thank you for your question.If you can provide photos with better lighting, from the side of your face and 1 meter away I would be able to make a proper evaluation. Anyway, from this photo I can tell you that you have extra skin under your eye are. For a better and smooth look I recommend you lower eyelid surgery. Best Regards!

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.

Harold J. Kaplan, MD · Answer

Hello Camelie.  Yes, surgery, dermal fillers and laser resurfacing are all options for under eye wrinkles.  Because laser resurfacing and dermal fillers have a lower cost and usually less downtime, we often suggest them first.  But both procedures are very technique dependent and just because you had a poor result with CO2 laser with one practitioner does not mean it is not a good option (see links below).  The key for a surgical intervention would be how much loose skin you have when you are not smiling.  If you have loose skin that can be "pinched" and holds it's pinched form, then you may be a good candidate for a lower eyelid surgery.  This is usually determined with an in person evaluation.  Best of luck.

Soon-Dong Kim, MD · Answer

For wrinkles when you are smiling, it's because of the muscle movements. I recommend to get Botox for undereyes and crow's feet. Also better to get SKIN BOOSTER injection such as Rejuran healer, Exosome.. etc to maintain youthful face.

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

No.  There is no eyelid surgical procedure that can remove wrinkles from the lower eyelids.  This is because the wrinkles are caused by contraction of the eyelid muscle which is attached to the skin and when the muscle contracts it causes the folds are wrinkles that you see.

These muscles cannot be removed.

Botox can be placed in the crows foot area which will reduce the wrinkles in the crows foot and approximately the outer one fourth of the lower eyelid.

At this is the best and only effective method to reduce eyelid wrinkling.

Wrinkles under eyes only when smiling. Should I get eyelid surgery? (Photo)

Answers (6)

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