I am 47 years old and I'm noticing substantial wrinkling and skin folding under my eyes when I smile. This is such a bummer to me ~ I'm actually finding myself smiling less because I feel like it makes me look old. I had an upper and lower bleph at age 42, and I get Botox about twice a year around my eyes and forehead. I would greatly appreciate any advice on how I might improve this issue. I really want to get back to smiling freely again!
December 1, 2023
Answer: Lines Hi! You have such a pretty smile, you should not try to hide this!! Your main workhorse is going to be botox. You want to make sure you are getting as heavy of a dose as you can tolerate around the eyes, including carrying the dosage into the inferior orbicularis oculi. I also expect that you will need it more than twice a year as generally it tends to last ~3mo. The goal is to essentially get the muscle here to the point where it can never work hard enough to cause lines there. Once you have that achieved, your next step is going to be on working on building the skin in this area, bc stronger skin can bounce back from wrinkles faster. This means making sure you are absolutely on medical grade skincare including some kind of retinol product and looking into some more aggressive options for skin tightening such as radiofreq microneedling and/or laser.
Helpful
December 1, 2023
Answer: Lines Hi! You have such a pretty smile, you should not try to hide this!! Your main workhorse is going to be botox. You want to make sure you are getting as heavy of a dose as you can tolerate around the eyes, including carrying the dosage into the inferior orbicularis oculi. I also expect that you will need it more than twice a year as generally it tends to last ~3mo. The goal is to essentially get the muscle here to the point where it can never work hard enough to cause lines there. Once you have that achieved, your next step is going to be on working on building the skin in this area, bc stronger skin can bounce back from wrinkles faster. This means making sure you are absolutely on medical grade skincare including some kind of retinol product and looking into some more aggressive options for skin tightening such as radiofreq microneedling and/or laser.
Helpful
November 30, 2023
Answer: Lower eyelid folds Hello. This is actually a very common issue. I have seen patients ask to treat this with botox, but unless you paralyze the zygomaticus muscle (smiling muscle) it will not help. The reason for the issues is two fold. There is some skin laxity in the area and the skin itself is very thin, with decreased amounts of collagen. When we smile, the cheek raises up and the skin wrinkles as it bunches up. The more conservative treatments would be things like lasers (CO2, fraxel), microneedling (with RF), and nanofat, which can improve the quality of the skin itself, so that the skin itself is tighter and thicker, thus less prone to bunching. These can lead to some very nice improvements, but take time and sometimes multiple treatments. Surgically, you have to be very careful. You cannot simply excise this extra skin and stretch it as that will lead to pulling on the lower eyelid and a complication called ectropion. A lower lid surgery approach would be focused more on elevating the muscle and skin together out toward the corner of the eye. This gets anchored to the boney lining for support and allows for a conservative excision of skin laterally (toward the side). So you have some options and can even try both methods as they address slightly different issues. Hope this is helpful! Good luck!
Helpful
November 30, 2023
Answer: Lower eyelid folds Hello. This is actually a very common issue. I have seen patients ask to treat this with botox, but unless you paralyze the zygomaticus muscle (smiling muscle) it will not help. The reason for the issues is two fold. There is some skin laxity in the area and the skin itself is very thin, with decreased amounts of collagen. When we smile, the cheek raises up and the skin wrinkles as it bunches up. The more conservative treatments would be things like lasers (CO2, fraxel), microneedling (with RF), and nanofat, which can improve the quality of the skin itself, so that the skin itself is tighter and thicker, thus less prone to bunching. These can lead to some very nice improvements, but take time and sometimes multiple treatments. Surgically, you have to be very careful. You cannot simply excise this extra skin and stretch it as that will lead to pulling on the lower eyelid and a complication called ectropion. A lower lid surgery approach would be focused more on elevating the muscle and skin together out toward the corner of the eye. This gets anchored to the boney lining for support and allows for a conservative excision of skin laterally (toward the side). So you have some options and can even try both methods as they address slightly different issues. Hope this is helpful! Good luck!
Helpful
