How can I treat my under eye creases? (Photo)

Question

I have these creases under my eyes that are bothering me a lot. Not really sure what to do.

Anna Chacon, MD, FAAD · Answer

Under-eye creases are very common, and the right treatment depends on whether they're caused by skin quality, volume loss, muscle movement, or a combination of these factors. From your photo, it appears that the creases are most noticeable in the thin skin beneath the eyes, which often becomes more prominent with age as collagen and elasticity decrease.

There are several options that may help:

Skin quality treatments: If the creases are primarily due to thin, crepey skin, treatments such as fractional laser resurfacing, RF microneedling (performed conservatively around the eye), or platelet-rich fibrin (PRF) may help stimulate collagen and improve texture over time.
Hyaluronic acid filler: If there is accompanying volume loss or a tear trough hollow that is making the creases more noticeable, a small amount of filler can soften the transition. This should be done carefully, as the under-eye area is delicate and not everyone is a good candidate.
Neuromodulators (Botox): If the lines become much deeper when you smile or squint, tiny amounts of Botox in selected areas may help reduce dynamic wrinkling. It won't correct skin laxity or deeper static creases.
Medical-grade skincare: Daily sunscreen, a gentle retinoid (if tolerated), and products containing peptides or hyaluronic acid can help improve skin quality over time, although results are gradual.

I would avoid assuming filler is the answer for every under-eye concern. In some patients, adding volume can actually make the area appear puffier if the main issue is skin laxity rather than hollowness.

The under-eye area often benefits most from a combination approach rather than a single treatment. Improving skin quality while addressing any underlying volume loss, if present, typically produces the most natural-looking and long-lasting results.

Giancarlo Zuliani, MD · Answer

Under eye creases can be treated with multiple modalities.  Looking at your photos it looks like you have lost some volume in your anterior cheek, this hollowness also creates hollowing in the under eyes as well. Using PRF GEL or fillers can help to give volume which can help the appearance of the creases. Also, I would consider using laser to resurface the skin this will help with the fine lines.

Nelson Lee Novick, MD · Answer

There appears to be very significant volume deficit in the cheeks, which is responsible for both the appearance of the sunken cheeks and the significant under-eye Hollows and tear Troughs. An appropriately robust HA volumizing filler injected with the proper technique in the cheeks can address both these issues, In experienced hands, treatment should take about ten minutes, yield immediate results and engender little to no significant downtime. You would be wise to make sure to consult with a board certified cosmetic dermatologist filler expert and best of luck.

David M. Creech, MD · Answer

The crease, I believe you are referring to, is due primarily to the sagging upper cheek pulling the lower eyelid down past the bony orbital rim.  If that is the question I like the lower blepharoplasty with a cheek lift.  The cheek component lifts the entire cheek back up to the orbital rim diminishing or at least allowing for a fat transfer or a filler to be injected into cheek soft tissues. This diminishes the risk of the fat or filler injection getting into the lower eyelid subcutaneous space.

How can I treat my under eye creases? (Photo)

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