What are my options for under my eyes? (photos)

I am a 32 year old female and I have noticed that the skin under my eyes has gotten 'crepe' like and quite sunken in. I really want the under eye area to be smoother and more youthful looking again. I was also wondering if raising my right eyebrow would be recommended as it is lower than the left. * please note that it was difficult for me to show the sunken in part in a photo so the picture attached is with me smiling to show the wrinkles/sunken in area.

Doctor Answers 12

Options for under eyes

Dear Jen6987,

Thank you for your clinical post and photos. If when you’re not smiling there’s some crepey skin laxity then you may be a candidate for some non-surgical or surgical maneuvers. Non-surgically, soft tissue fillers like Restylane or Belotero can be placed under the eye and a fractional carbon dioxide or fractional laser resurfacing or radio frequency thermal energy can smoothen the skin. A little bit of Botox to minimize squinting and you should anticipate a good result.

Surgical options would include a small skin pinch blepharoplasty with a scar hiding right under the eyelashes and fractional laser or radio frequency resurfacing of the skin. If there are deep blue vessels present during examination then treatment with an Nd YAG would treat dark blue vessels and finally any fat pads can be removed at the time of surgery.

Consultation with a plastic surgeon with significant experience in blepharoplasty would be warranted.
I hope this information is of some assistance and best of luck.

To find out more, please visit the link below.

R. Stephen Mulholland, M.D.
Certified Plastic Surgeon
Yorkville, Toronto

Toronto Plastic Surgeon
4.6 out of 5 stars 93 reviews

Lower eyelids

It is difficult to adequate evaluate you from one picture.  If you have minimal excess skin it can be treated with skin peels/ lasers/ or even retin-a.  For larger excesses it may involve excision of skin and surgery.  Hollowing can be treated with camouflage with fillers or excision of fat or layering of fat with surgery if there is excess fat as well.

Lawrence Rosenberg, MD
Lutherville Timonium Plastic Surgeon
4.8 out of 5 stars 18 reviews

Options for lower lids

Thank you for the question and the picture. A lower lid blepharoplasty can remove  the excess skin under your eyes.  See a board certified plastic surgeon for consultation.   Best of luck

Ivor B. Kaplan, MD
Norfolk Plastic Surgeon
5.0 out of 5 stars 2 reviews

Lower eye lid

If you have loose skin in repose without smiling, then perhaps a small amount of skin can be removed.  Lasers may also be of benefit sometimes.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Under eye crepe

Hello Toronto!

A Board Certified Cosmetic Surgeon or Board Certified Facial Plastic Surgeon could best address your concerns in a Consultation and offer you quotes for the procedures. 

Your photo does reveal lower eyelid crepe.  You could benefit from Laser Resurfacing to smooth out and tighten the excess skin.  You may or may not want filler under the eyes at a later time, you could just do the laser first and wait a couple of months for the skin to tighten completely and then decide if you want further correction.

Brow ptosis could be best corrected with Botox. 

Best of Luck!

Robert Shumway, MD
San Diego Facial Plastic Surgeon
5.0 out of 5 stars 12 reviews

Wrinkled lower lids

You do have some wrinkling of the lower lids.  Some filler into the area combined with some laser resurfacing should help to improve the appearance of the lines.  Botox not a good option for this.  You could use some Botox to drop the left brow a little for better symmetry. 

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Lower eyelid surgery and Botox for the eyebrows

 The decision to remove excess skin on the lower lids is made at rest, not upon animation. If there is any excess skin present on the lower lids, a conservative pinch technique of excess skin is performed at the lash line. In our practice we closed that incision with tissue glue. Botox is the most conservative way to approach  eyebrow asymmetry. A brow lift  can be considered once you have failed medical management with Botox

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Under eyes.

Botox can be used to help raise the brow and even out the brows. You can do a small amount of Botox under the eyes to help relax those line. I would also consider doing a Laser resurfacing (fractionated CO2)  around the eyes to help with the wrinkles you are experiencing. I would recommend you have a consult with a board certified dermatologist or plastic surgeon to go over which treatment is best for you. 

Lenore Sikorski, MD
Orange County Dermatologist
4.3 out of 5 stars 24 reviews

I do not recommend botox for this area.

Botox does smooth the muscle lines.  However, if you do not make one or two lines when you smile, things do not look right.  A Duchenne smile which is what these smile lines are called, tells people that you mean your smile.  In addition, botox in this area can make the lower eyelid slump (not pretty).  This area is much better helped with under eye fillers.   

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

One brow lower and too much skin under eyes

Thank you for asking about your lower lids.

  • Based on your photos, Botox should be all you need.
  • Botox under the lower brow should raise it.
  • Botox under the eyes - in tiny amounts should soften the pull lines, caused by the orbicularis oculi muscle.
  • If at rest, your lower lid skin is truly loose (not often the case, but possible) then surgery to remove the excess can be done.
  • Always see a Board Certified Plastic Surgeon.
Hope you find this information helpful. Best wishes

Elizabeth Morgan, MD, PhD
Atlanta Plastic Surgeon
4.6 out of 5 stars 43 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.