What is The Best Way To Treat These Wrinkles Under My Eyes When Smiling? (photo)

I'm 40. After the last 2 times I got botox (1st time I ever went to this particular nurse) I noticed bunching under my eyes when I smile. I have never had this before. I waited till the botox wore off & the bunching toned down a bit. But then I just had my botox redone (inner corner of eye + crows feet) and the bunching just looks so awful when I smile again. I'm confused about whether it's the botox, or just plain old aging. Therefore, is it time for something more serious like blepharoplasty?

Doctor Answers 2

A Treatment Plan for Smiling Wrinkles of the Lower Eyelid

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I agree that if BOTOX is used beneath the eye it can relax some of the muscle fibers and not relax others. This can result in noticable animated folds when smiling.  In reviewing your photos I would not recommend surgery at this time.  I would recommend the following:

  1. Profractional laser 2 to 3 times per year. With a microlaser peal done during one of the sessions.
  2. I would also recommend Peleve'
  3. I also use a strong Tri-Peptide, Stem Cell Wrinkle reducing topical and have seen great results.

What ever you decide: avoid the BOTOX immediately beneath the eyelid.  Good Luck


Eau Claire Plastic Surgeon
4.7 out of 5 stars 22 reviews

Combination treatment

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Botox or Dysport relaxes the muscles. In your situation, I believe it's a combination of having light skin and loss of some muscle tone which makes the lines look more prominent. procedures such as fractional CO2 laser and Pelleve' can help improve the skin tightness. In my practice, I have also been using platelet rich plasma (PRP) to improve skin quality under the eyes.

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

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