Treatment for Horizontal Line Under the Eyes?

Question

I have a deep horizontal line under both my eyes. They are there when I smile. And because they are getting deeper, they stay when I don't smile too. Is it my cheeks that are causing this problem? What are my options?

Rod J. Rohrich, MD · Answer

This area can be managed
either with Botox or, if the wrinkles are deep, you can do laser skin resurfacing.

Tanveer Janjua, MD · Answer

It seems that you are noticing either 'tear trough' line or festoons of the lower eyelids.
Either case you have the option of either getting a filler to fill up the groove or injecting a small amount of Botox to relax the hyperactive lower eyelid muscle causing the line.
Surgical options will work well by removing any excess fat from the lower eyelid.
Regards

William Portuese, MD · Answer

The horizontal wrinkles underneath the eyelids can be addressed through a pinch technique on the lower blepharoplasty. This is usually done in conjunction at the same time as the fat removal from the lower lids. The incision for the lower lids is made after a lash line and is nearly invisible within a month after the procedure. This usually gets rid of lines close to the lash line, but if the wrinkle is more than a quarter of an inch below the lash line it may not be able to be removed.

Christopher L. Hess, MD · Answer

The deep line that you're describing sounds to me like your lid/cheek junction. This occurs at the lower orbital rim. It is accentuated by pseudoherniation of fat in the lower lids (bags) and descent of the cheek fat. Smiling will make it worse. Fixes can be temporary such as with fillers-Radiesse is good for this. Fat can be useful as well. But likely you are headed toward lower lid surgery and/or surgery for cheek elevation.

Robin T.W. Yuan, MD · Answer

Is the line a contour problem or a crease in the actual skin? Irish skin, due to its fairness, can exhibit premature aging with wrinkling and thinning. If the line is cause by loss of elasticity, a peel of sorts, chemical or laser, might be just what the doctor ordered.

Peter A. Aldea, MD · Answer

Hi Billabonggirl777,
As we age and our cheeks begin descending, the lower margin of the eye socket is exposed along a line called the tear trough or the nasojugal line.
The choices involve either lifting the cheek surgically and covering the area as it was in your youth or putting a filler just over the bone margin to cover and blend in joining the convexities of the lower lid to that of the cheek.
We all have favorite filler for this area ; you cannot go wrong with either Juvederm or Restylane placed by an experienced Plastic Surgeon.
Good Luck.

Brooke R. Seckel, MD, FACS (retired) · Answer

Many people with active orbicularis oculi muscles have an exagerated line beneath the eyelid when smiling--Botox can help but not eliminate this line.
If you simply have a skin crease accentuated by aging, fractional laser resurfacing may help.
Many people have a deep depression beneath the lower eyelid which they refer to as dark circles under the eyes. This is caused by protrusion of the eyelid above the line caused by aging, the dropping of the cheek fat pad beneath the eyelid (tear trough deformity) and by the attachment of the arcus marginalis beneath the lower eyelid skin.
I call this the arcus deformity and correct it by releasing the arcus margunalis through a laser incision on the inside of the eyelid and grafting fat beneath the line to plump the line.
See before and after photos of arcus release and fat grafting.

Treatment for Horizontal Line Under the Eyes?

Answers (7)

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