Is surgery needed to treat under-eye wrinkles? (Photos)

Question

I am 38 and want to address my undereye wrinkles. I don't think I have many static wrinkles (see first picture), but when I smile, the area under my eyes completely hollows out and the skin is very wrinkly and crepey. What is the best method to treat this? Laser tightening/fat transfer? Or would it require surgery to see real results?

Jonathan Kulbersh, MD · Answer

Thank you for your question and for providing photos. Botox is an ideal solution for treating lines that appear around the eyes when smiling. Repetitive muscle movements, such as smiling, can cause lines that can deepen over time. 
Botox injections target the muscles causing these lines by preventing movement of the skin and allowing it to become smoother. Many patients are able to maintain their desired results with an adequate Botox schedule, undergoing touchup treatments every 3-4 months. I recommend scheduling an in-person consultation with an experienced, board-certified injector who can discuss your concern with you and help you decide on the best treatment option.

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.

Geeta Yadav, MD · Answer

Thank you for your question! Neuromodulators &mdash; like Botox, Dysport, or Xeomin &mdash; can soften these undereye lines by minimizing the movement of the muscles that are causing the wrinkles to become visible when you smile. If you are also concerned with hollowness, you might want to consider under eye filler as well. Hope this helps!

Mark T. Boschert, MD · Answer

Those muscles are caused by a tiny muscle under your eyelid called orbicularis. When you smile you actually contract those little muscles. Therefore, if you don’t want to see those wrinkles when you smile then Botox or other neurotoxin is the answer. I would try to find someone who has experience with this it is a very tiny amount and it can leave you with a little bit of droopy lower eyelid for a month or so if you are not evaluated properly. Other than that a few wrinkles under your eyelids when you smile is normal. Best of luck! Dr. Boschert Renaissance Plastic Surgery

Mats Hagstrom, MD (license on probation) · Answer

There are two groups of muscles that can cause wrinkles around the eyes especially in the lower eyelid and crows feet area.
One is a set of muscles involved with smiling which is primarily the zygomaticus muscles. There really isn’t much you can do to stop the motion of that muscle and not lose the ability to smile.
The second muscle the contributes to wrinkles in this area is The orbicularis oculi muscles. This is a flat wide muscle that contributes closing the eyelids. when that muscle contracts it often causes crow’s feet a type wrinkles and wrinkles in the lower eyelid. Weakening that part of the muscle with Botox works well.
Wrinkles begin to form with age because of sun damage and loss of skin elasticity.
Adding volume is not going to help with wrinkles particularly well unless you need volume enhancement otherwise.
Botox is the way to go and it will soften wrinkles associated with the orbicularis oculi muscle but not those associated with the zygomaticus muscle.
Best,
Mats Hagstrom MD

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