What is the best treatment for under eye wrinkles/fine lines under the eyes? (photos)

Question

I am 29 y/o and have had fine lines/wrinkles under my eyes since my early 20s. These lines have increased and deepened over the last couple years and are really starting to bother me as they make me look much older than I am. I use SPF daily and have been getting regular Botox since I was 24. I've tried it under my eyes but haven't noticed much improvement. What is the best way to significantly improve these lines? If it's laser resurfacing, which laser is best (plz be specific!) Does skin pen work?

Laurie A. Casas, MD, FACS · Answer

Hello,It is important that you receive an in person consultation with a board certified plastic surgeon.  However, based on your photos it looks like you would be a great candidate for 1540 non-ablative fraxel resurfacing laser.  The advantage to this laser is that you will have less downtime compared to the CO2 resurfacing lasers.  I recommend 4-5 treatments spaced 3 weeks apart and then a treatment every 6 months as maintenance.  
  
Skin care and sun protection is also critical in this area of fine, delicate skin.  I recommend you use a medical grade skin care product with a growth factor like Regeneration booster from Jan Marini twice daily and zinc based SPF >30 every day. It is difficult to assess from your photos but lower lid wrinkles may be due to volume loss in the midface and/or tear trough area which can be corrected with hyaluronic acid fillers.  I prefer to use Voluma or Restylane Lyft in the midface and Belotero for the tear troughs.   Good Luck.

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

William Groff, DO · Answer

The delicate skin under the eyes requires a customized approach for effective rejuvenation without damaging the skin and tissue. Your choices might include a collagen induction therapy like fractionated laser or RF microneedling. These procedures create micro-channels in the skin that trigger the body to produce more collagen. As collagen levels increase, the skin becomes thicker, smoother, and firmer. Another option would be tear trough fillers, which would add subtle volume under the eyes and smooth away the wrinkles. I recommend scheduling a consultation with an experienced, board-certified dermatologist who can evaluate you in person and create a customized treatment plan just for you.

Ross A. Clevens, MD, FACS · Answer

Thank you for your question. Laser skin resurfacing can remove facial wrinkles, including deep lines around the mouth and eyes, and any facial scars. I suggest that you move forward and consult with your board certified facial plastic surgeon to determine which lasers, or other surgical/non-surgical procedure is right for you.
Best wishes,

Cameron Chesnut, MD, FAAD, FACMS · Answer

Loose, wrinkly, and crepey skin under the eyes is a really common issue talked about in consultation, as everybody gets some aspect of this as they age. There are numerous nonsurgical and surgical options for this, from a lower lid blepharoplasty to skin tightening via devices like laser resurfacing (fractional CO2 being the god standard).  In your case, it looks like there is a significant amount of skin redundancy paired with a slight amount of volume loss exacerbating it all. Botox can work for prevention of this, but needs to be very precisely placed precisely on your lower eyelid, where most beginner or even strong intermediate injectors do not inject. 
What is going to be the best option for you will be dependent on your individual goals, needs an anatomy. With an examination and conversation, the best options for you will become quite clear!
To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these "core four" cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.
Cameron Chesnut
#realself500 Physician

Raymond E. Lee, MD · Answer

Thanks for sharing.  At your age to treat the fine wrinkling at rest, a fractional CO2 laser would be ideal.  Another option would be a surgical "skin pinch."   Finally botox to treat dynamic wrinkles would help the lateral crows feet.

Elisa A. Burgess, MD · Answer

In more recent years I have been favoring non surgical options for lower lids for a natural look.  We believe in layering of treatments. The easiest option is ThermiEyes. This is a series of treatments of radiofrequency that feels like a warm massage around your eyes and brows. The second option is the Madonna lift. This is a series of three treatments on a very light setting of a fractional CO2 laser, like Smartskin.  We put eye contacts in for the pt and then laser right on the eyelids.  This helps with the crepey appearance. However, if there is a lot of lower lid skin or fat bulges, then I favor a blepharoplasty. Even when I do a blepharoplasty, this mostly removes skin but does not treat the skin that is left behind. So I still may favor a Madonna lift or ThermiEyes for further improvement or maintenance. A good medical grade eye cream can also maintain.Best of luck to you.

Sam Naficy, MD, FACS · Answer

Based on your photos you would be a great candidate for laser resurfacing.  There are a number of options that we offer based on how much improvement you wish to have and how much down-time you are willing to have.  Here are the choices1. Fraxel Dual2. Erbium resurfacing3. CO2 resurfacing

Jason Emer, MD · Answer

A combination approach will give the most improvement. Fillers, lasers (Fraxel, Co2), and microneedling/PRP can improve under the eyes. My patients try to get non surgical treatments to avoid surgery. We use PRP and stem cells there often. I suggest consulting with an expert to develop a treatment plan best suited for your short and long term goals. Best, Dr. Emer

John J. Martin, Jr., MD · Answer

You would do best with some laser resurfacing  to the lower lids.  This will help to improve the collagen in the skin and decrease the wrinkles.  Either CO2 or erbium can be used.  Some filler may also help by adding some volume - expanding the tissue.

What is the best treatment for under eye wrinkles/fine lines under the eyes? (photos)

Answers (20)

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