What is the Best for Undereye Bags and Wrinkles. Botox or Thermage?

       I would not recommend Botox or thermage for the undereye bags.  Depending upon anatomy and goals, filler or some form of lower blepharoplasty can help the area in question.  Kenneth Hughes, MD Los Angeles, CA

Botox and/or Thermage are a waste of time and money for bags or wrinkles under the eyes.  Seek a hands on examination by an experienced surgeon to evaluate whether you are a good candidate or not for some type of blepharoplasty.  Best wishes. Knowledge is power.  Luis F. Villar MD FACS

Neither Botox nor Thermage are particularly effective in treating bags or wrinkles under the eyes. Botox can be helpfull for wrinkles in the crows feet area but would weeken the lower lid  if placed in the under eye area. Thermage has no effect on the fat that creates the under eye bags. The most effective treatment for under eye bags is removal or re- distribution of the offending orbital fat. This requires surgery. As for Wrinkles, laser or chemical peeling in lighter  skin types is likely the most effective.

Undereye bags will not respond to anything other than surgery. Thermage can tighten the skin a little but not enough to hide the fat bags and Botox will only make them more prominent.

Botox can actually weaken the orbicularis in the area of the festoon and make it look worse.  Thermage theoretically will tighten the tissues and this would help tighten the tissue that makes the festoon.  I say theoretically because many patients seem very disappointed by the results they get with thermage.  I do not offer the service personally because I do not believe that it is a good value proposition and seems to offer only very subtle results.

Under eye bags are normally caused by protruding fat under the eyes, which would not be affected by Botox or Thermage.  Usually, under eye bags need to be addressed surgically or sometimes a filler can be placed under them to even out and improve the appearance.  Wrinkles on the sides of the eyes can be helped with Botox, but normally the wrinkles under the eyes would need surgery or a laser to improve them.  I do not personally perform Thermage, so I'm not sure how effective it would be with treating under eye wrinkles.  

Hi Susan and thanks for your question

Neither Botox nor Thermage will help. Bags are due to excess fat and skin that is made prominent by the shrinking of the facial bones immediately under the bulge. A lower lid blepharoplasty with fat redistribution will give you the result you are after. 

Generally bags under the eyes are caused by issues deeper than the skin.  Thermage is designed primarily to treat skin laxity, and while it may cause some improvement in the fine lines and crepey texture of the skin of the eyelids, I don't think it will really address the problem causing the bags, so I wouldn't be real enthusiastic about Thermage in this setting.  The bags form when the tissue layer holding the fat pads around the eyeballs becomes loose, allowing the fat to protrude and fall forward.  This creates a contour similar to a "beer belly" which hangs over a belt line.  In this instance the only strategies worth considering are those to tighten up that layer holding the fat or even remove some of the excess fat (which is a whole other topic, probably best left for another thread!), or to camouflage the contour differences between the protruding fat pads and the cheek.  Botox, being a neurotoxin, has only one function:  to relax muscle, thereby either relaxing wrinkles or moving structures like the brow.  Thus, I really don't see it as having any role in the treatment of eye bags per se.  Injection of a filler like Perlane would be appropriate to camouflage or blend the contour irregularity.  The only other treatment that I could recommend for this would be a surgical blepharoplasty to tighten the orbital septum/eyelid muscle and address the fat protrusion.

The only option to remove undereye bags is surgery - lower blepharoplasty. Lower eyelid bags can also be temporarily camouflaged with dermal filler treatments performed by a highly experienced injector. These treatments typically last up to 12 months and need to be repeated if you're happy with the result. Botox will help with Crow's feet but will not improve lower eyelid bags. Thermage will not help with this issue. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery