What procedure will get rid of under eye wrinkles and flatness under tear trough? (Photo)

There are many ways to treat dark circles, as well as under eye wrinkles and bags. It is important to note however, that the majority of times the cause for discoloration is genetic and due to the viability of the blood vessels below the skin. A combination approach is always needed to get the best results in this area and this includes: topical skin care, laser and/or radiofrequency treatments, and fillers if placed appropriately. All my patients are on topical lightening agents, typically a vitamin C serum product in the AM and a brightening agent and/or a vitamin A based product in the PM. Sun protection is essential.Resurfacing and tightening are essential. My patients get offered a menu of options, for which a combination gives the best results. Light salicylic acid peels help give textural and pigment improvement; nonablative lasers (Fraxel or Clear + Brilliant) can be used to tighten and improve fine lines/wrinkles and crepe skin; fractional radiofrequency devices (Sublative, Viva) are cutting edge and improve texture, tone, and wrinkles with very little downtime; radiofrequency with pulsed electromagnetic fields (Venus) are amazing for puffiness and bags, in patients who do not want eyelid surgery; appropriately placed fillers can replace lost volume, cover up the vessels and fat pads below improving the appearance -- patients should pick a well experienced practitioner to prevent complications such as Tyndall (blue discoloration) and irregularities, one that uses a cannula for injection will help give results with little bruising or swelling; microsecond Nd:YAG laser treatments (Laser genesis) has produced dramatic improvement in discoloration in some of my patients and is safe in dark skin types, similar to the radiofrequency devices. For lifting, ablative laser resurfacing such as co2 laser combined with monopoloar radiofrequency deep heating (thermage) give amazing results. The key is for a patient to see a cosmetic dermatologist with experience in all the latest devices and techniques so the persons goals can be met by a combination approach of individualized treatments and skin care. In some cases, those who smile and have crepe skin or under eye wrinkles, a small amount of neurotoxin (botox, dysport, xeomin) strategically placed in the lower eyelid skin can improve wrinkles dramatically and give the eye a more "open" appearance.

yes this plastma and fat will  regenerate the collagen to fill the wrinkles  about a couple of  months later but in a normal and  healthy way nad  lasts more than 6 to7 years the positive efect of  refilling

Your lower eyelid skin would be smoother with a fraxel laser treatment or a chemical peel.  The prominent tear trough area would benefit from a filler such as Restylane or Juvederm.  These treatments can all be done in the office with minimal downtime.

You are an excellent candidate for Fraxel CO2 laser to the lower eyelids. This will completely smooth out the skin under your eyes and because there is no fat bulging, there is absolutely no indication for surgical intervention here. In my office you would have a numbing cream placed on your lower eyelids, and 30 minutes later you would have a quick light fraxel lasering of the lower eyelids. This would be completely painless and very easy to do. You would have mild redness for 5-7 days but be able to go back to work in 1-2 days. The result would last years.  I also do a lot of surgical eyelid work however in your case the laser would get a much better and faster result