38 & need advice on what to do with these under eye wrinkles? (Photo)

It appears that treatment of the fine skin wrinkles by means of chemical peel would improve your skin condition. Concavity of the upper cheeks due to loss of fat tissue should be treated with fat grafting which will also contribute to your skin quality. In person or teleconference consultation with a board certified plastic surgeon with expertise in periorbital fat grafting is recommended. Good luck.

Hello; These wrinkles on your lower eyelid; are caused by volume loss, in the middle cheek area and infraorbital skin laxity. Surgically, with lower blepharoplasty; the problem can be solved; without surgery; for skin tightening; Thermage implementation and for volume; a serious improvement can be achieved with a high lifting affect; which is Dermal Filler application to the bone level.

Hello, you have some thin crepe-like texture skin along the lower eyelid, which is very common. It is the thinnest skin in the body and now that the fat has been removed from the lower blepharoplasty you had, the skin needs to be tightened. This can be accomplished with chemical or laser or device resurfacing. Please visit an experienced oculoplastic surgeon for best results.

You have fine skin - this should be correctable with a combination of the right skin care products and possibly light laser resurfacing. That can be done right in the office. Also we should look at what kind of blepharoplasty was done as some can actually make the problem worse.
Overall, all of this should be addressable in the office.

Hello Rational. very sorry to hear about how this issue is affecting you. There are a couple solutions available. Although you had a blepharoplasty 18 months ago, revision surgery may be an option. That would be hard to gauge without an in person evaluation.

Alternatively, you still have three other options. A small amount of Dysport (Botox) can be injected into the upper roll of skin below the eyelashes. The amount has to be small and the results will be small, but the results are present when smiling. Dermal filler may be an option as you have some hollowing under the eyes. We also use Erbium laser resurfacing (photo link below) to tighten the skin under the eyes.

You may benefit from a mid facelift to pull the skin taunt. You may also benefit from excision of the excess skin of the lower eyelids.

Best Wishes,

Gary Horndeski, M.D.

Hi.For under-eye wrinkles that appear when you smile, here are some options to consider:1. Laser Resurfacing (CO2 or Erbium) - Helps tighten skin and reduce wrinkles by stimulating collagen.2. Radiofrequency (Thermage or Morpheus8) - Non-invasive treatments to tighten skin and smooth wrinkles.3. Microneedling with PRP - Promotes collagen production for smoother skin texture and wrinkle reduction.4. Tear Trough Fillers - Hyaluronic acid fillers can plump and smooth under-eye areas, reducing wrinkles.5. Revisional Lower Blepharoplasty - A surgical option to further tighten and smooth the area.6. Botox for Under-Eye Wrinkles - Small doses can target dynamic wrinkles under the eyes.7. Skincare (Retinoids) - Topical treatments to improve skin texture and prevent wrinkles from worsening.
A combination of treatments is often recommended for best results. Consulting with a specialist can help tailor a plan for your specific concerns.

Like you, so many patients I've seen in consultation think that a blepharoplasty will fix undereye wrinkles. This surgery does fix the issue of protruding lower-eyelid fat pads, whereas lasers and RF-microneedling treatments address wrinkles. The best thing you can do to substantially make these wrinkles less visible is to have a treatment with the Sciton pixelated erbium laser. I see this in my practice many times per week with great success. Because the skin of the lower eyelids is very thin, it shows the wrinkles in a more pronounced way. RF microneedling can help as well, and possibly some PRP injections depending on your skin quality.

It is an easy issue to address in many patients but can be stubborn to correct. You have to commit to follow up treatments. What you have is muscle and skin issues. Botox is needed once every 4 months to relax the muscle tone that is causing the muscle to be in mild spasm. A Co2 Laser resurfacing with Fraxel repair can be of great help. It is one procedure done at the office with a very short down time.

If your lower lid blepharoplasty didn't involve skin removal and was carried out via a transconjunctival approach, you could benefit from a skin pinch blepharoplasty.
Ablative laser treatment could also tighten the skin in this area if you want to avoid further surgery.