Awkward texture under eye, tried many solutions and nothing really helps. What can I explore to improve this texture? (photo)

Question

Please share thoughts on how this can be improved. I use Retin_A .1%, did TCA 30% peels twice, and Erbium Yag laser once. All well over a year ago. There is nominal improvement. My left looks great. It's very upsetting and I want it to look better. I'm 47. Some days it looks a little better than others. What is it?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

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.

Georges Kaado, MD · Answer

Hello, I would recommend a radio frequency treatment, or fillers under the eyes.  We have used Pelleve' in our office and find it a great success.   I have also used fillers and also have great success.  Retina under the eyes and be too much on a day to day basis, try using it less and adding more of a Hyaluronic Acid serum.  Environ makes a great serum that helps with the eyes along with a nightime roller.

Adam Scheiner, MD · Answer

Dear Krystal,
It seems from your photos that you have developed loose skin from likely prior sun damage. This resulted in the festoon that is appearing in your lower eyelid region. 
To improve this condition, you need to injure the skin enough to cause it create new collagen that would tighten the skin in that area. 
I've had success using lasers to help festoons and malar mounds.
I'll include some links below.
I hope this was helpful.

Fereydoon S. Mahjouri, MD · Answer

Hi Krystal73!Thank you for your question. It looks like you have normal aging under your eyes. For your age, it is not abnormal. To help improve this area, I would suggest doing a series of microneedling treatments. With this treatment, it is easy to treat right under the eye up to the lash line. It will stimulate your body's collagen production, causing the skin to become thicker with collagen. I would also add in a great eye cream and use that twice a day. Something like iS Clinical's Youth Eye Complex would be perfect. It is loaded with antioxidants and growth factor's to also promote collagen production. Best of luck to you!

Katherine Dee, MD · Answer

1. Jan Marini Luminate eye gel
2. Infini RF or Exilis Ultra for skin tightening
3. As always sun block every day

Awkward texture under eye, tried many solutions and nothing really helps. What can I explore to improve this texture? (photo)

Answers (6)

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