What's the best and effective under eye treatment, please advise? (photo)

i am 45 years old and i think i have a deep hallow eyes which create wrinkles when i smile .i've seen 3 doctors and they have different opinions and i'm confused which one to believe. friends told me just to see an oculoplastic for any eye problems , is that true?

Doctor Answers 10

Options for non-surgical wrinkle treatments from an oculoplastic surgeon - doctors' style and treatment always differ

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There are many ways to enhance the appearance of the under eye area which relates to the vision the doctor and the patient share. Certainly, there is no refuting that oculoplastic surgeons are more experienced with eyes because that is the focus of oculoplastic surgery. However, even among oculoplastic surgeons, there’s going to be some variability. In my case as an oculoplastic surgeon, my practice is focused more on cosmetic procedures which give me a different perspective in terms of aesthetics and style in doing surgery. In addition, I also perform facial and body procedures like breast, body and extremity surgery.

I wrote a book called “The Fine Art of Looking Younger” where I explained that facial aging is a combination of volume loss and descent. For some people, the solution for facial volume loss and hollowing is cheek enhancement whether it is the use of fillers such as Radiesse or Sculptra or the use of facial implants such as sub-malar or combined implants.

In my practice, I approach the facial area in a different way. I evaluate the face and assess the wrinkles in the relaxed state known as static wrinkles and expressive state known as dynamic wrinkles. I often recommend a combination procedure to improve the appearance of wrinkles. For dynamic wrinkles or I use Botox or Dysport to reduce muscle activity that causes wrinkles. For static wrinkles, I use a material called platelet-rich plasma which is drawn from the patient’s own blood to improve the skin quality. I would also use fractional CO2 laser, or medical microneedling for people who have pigmentation because a thermal device may not be ideal for them. And lastly, to address hollowing in the under eye, I would typically use a filler such as Restylane. I hope that was helpful to you, and thank you for your question.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

Best treatments for your under eyes

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As you can see, there are various options given to you from excellent plastic surgeons on this thread.  It is great that you received consultations from several plastic surgeons so you know the options that are available.  Non surgical options (ie combination of Botox to crows feet, hyaluronic acid fillers to the lower lid/cheek areas, and/or skin resurfacing agents such as chemical peels)  are certainly reasonable and may be the best place to start.  Surgery may be indicated if you are not happy with non surgical options as mentioned above.  It is important to seek someone that performs alot of eyelid procedures, whether they are trained oculoplastic surgeons or not.  Good luck.  

What to do for your lower lids when everyone has a different opinion...

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Think about what your goals are and see which will best at helping you achieve that goal.  Do you want permanent solutions or would you be content with temporizing measures?  Does the skin need any attention or just the contours?  If a doctor is truly comprehensive, you should have received several options from which you can choose.  If you only get one recommendation and no other options, I would be concerned that that surgeon only has one tool in the tool box and would suggest you avoid them.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

What's the best and effective under eye treatment, please advise?

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             I would probably recommend Botox to the crow's feet area and a little Restylane to the tear troughs.  I would probably hold off on surgery given your picture.  I may feel differently after an exam.                                                                                                                             Kenneth Hughes, MD                                                                                                                                        Los Angeles, CA

Lower eyelid rejuvenation

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We no longer perform conventional blepharoplasty, involving removal of fat and skin at the corner of the eye, in any patient.  There is simply too much potential for the eye to round, or for the corner of the eye to pull down.

Rather, an ultrashort incision cheeklift is used to elevate the cheek tissues, to reduce the hollowness underneath the lower eyelid, and then remove skin that was elevated.

This results in less 'surgical appearance' of the lower eyelid.

We often combine that with an upper lid fat-sparing blepharoplasty and lateral hair-sparing brow lift, to complete rejuvenation of the eye and periorbital region.

We originally published this procedure and have written several articles and chapters on it since that time.

Many oculoplastic surgeons are fine surgeons; however, it is the individual surgeon, their expertise, experience and results that should guide your decision.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Under Eye Rejuvenation

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 Dear Julie

It can be quite confusing when speaking with different surgeons about options for your eyes. General, facial, or oculo plastic  surgeons are all well trained in understanding the complicated anatomy and function of the lower eyelid. I think the important consideration would be to find a surgeon with solid experience in treating eyes, and someone in whom you feel trust and rappor. Cosmetic procedures are an emotional experience. Having a good relationship with your surgeon is of paramount importance. 

Looking at your photo, I dont think surgery such as blepharoplasty is the right answer. You have some loss of volume in the lower lid area with extremely overactive muscles causing the wrinkles when you smile. There are also lines near your nose known as "bunny lines". It would appear that your upper brow is dropped and immobile, creating an imbalance between your upper face and eye area.   This imbalance accentuates the wrinkles around the eyes. 

You have quite stunning eyes and I would recommend non surgical rejuvenation using a combination of a hyaluronic acid filler such as Restalyne or Expression with Botox. The filler would restore the lost volume and the Botox would relax the wrinkles that occur when you smile. 

I hope you find this helpful. Best of Luck

Dr S

Travis L. Shaw, MD
Richmond Facial Plastic Surgeon
4.8 out of 5 stars 22 reviews

Blepharoplasty treatment for lower lids

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 The primary goal of lower blepharoplasty is  to remove the 3 fatty deposits creating puffiness underneath the lower lids. The secondary, or minor goal is to remove excess wrinkles at rest, not  while smiling.  Eyelid surgeons have to be very careful and conservative on  the amount of skin  that is removed from  the lower lids, because we do not want to change the shape of the lower eyelid. Excess skin is removed by a pinch technique through a lash line incision and closed with tissue glue. Fractionated laser is another alternative to help with lower lid wrinkles.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 158 reviews

Wrinkles when you smile

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Wrinkles when you smile generally are dynamic, meaning they occur because of muscle movement.  A quick fix could be botox in conjunction with a fractional CO2 laser. This hopefully would address the dynamic (moving) wrinkles and the static ( always there) wrinkles.

Louis Potyondy, MD
Tacoma Plastic Surgeon

Under eye treatments

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Oculoplastic surgeons specialize in cosmetic and reconstructive surgery of the eyelids and surrounding areas. It is difficult from your photo to assess the exact problem since you are smiling. Usual options range from botox and laser to fillers to lower blepharoplasty.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

I am an oculoplastic surgeon in Beverly Hills.

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Let me offer you some advice.

There are some essential things in thinking about your best options.  First, it is very hard to understand what the surgeons are offering you.  This makes weighing advice very difficult.  As surgeons, we generally like to propose surgical solutions to things.  There is and there is not a big difference between general and facial plastic surgeons and oculoplastic surgeons who offer eyelid surgery.  The difference is that the oculoplastic surgeon has much more depth of training in eyelid surgery compared to general or facial plastic surgeons.  The rub is that, depending on the particular surgeon, this difference may not   translate into a better surgical outcome.  Good people are where you find them.

Looking at this single photograph what I see is an eye strip with vigorous activation of the smile musculature.  You demontrate heaped lower eyelid lines that ride up into the crows feet area.  There are bunny lines on the side of the nose from corrugation of the nasal muscles.  Your upper eyelids are mildly ptotic or droopy in these pictures.  There is almost no activity of the forehead and the brows appear to crowd into the eyelid space and this is consistent with too much botox to the forehead suggesting that you may have had this area treated in the past 6 weeks.

Before deciding what needs to be done, it is essential to understand that this expression is, yes, one that gets captured in photographs.  It is how you scrunch up your face in the privacy of a bathroom (the place where so many decisions about getting cosmetic surgery are made).  However, this is not the face that your friends see.  They see this face in milliseconds when you flash a smile in conversation.  Those lines tell them that your smile is genuine (Duchenne smile).  The fact that you have gotten divergent opinions as to what should be done, suggests that you should perhaps do very little.  What I would stongly recommend against is lower eyelid skin muscle flap (transcutaneous lower blepharoplasty), midface surgery, upper blepharoplasty, or fat transfer.  Mind you, this is without the benefit of a personal consultation so I reserve the right to change my mind.

Given your overall youthful appearance, I think you might do great to avoid eyelid surgery at this time.  I think judicious use of lower eyelid fillers would make a profound difference for your under eye hollow that does not show in this photograph.  Your forehead appears to be flattened by botox.  I would ditch that type of forehead treatment and advise you to consider microdroplet botox which essentially creates a forehead lift effect while preserving forehead movement.  I am attaching a link below with more information on this method.

It is very important to understand that surgery is great if it makes you look better.  It is not great if it destroys natural resources that help you to look as youthful as possible.



Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.