No Botox - Alternate treatments to use under the eyes for moderate smile lines?

Question

hi, I'm a 54 yo female who has been getting botox for several years. I recently found out i have narrow angle w/o glaucoma. 100% health minus occ migraines. I'm now reading that botox can "cause" this condition. What would be some alternate "procedures/fillers" to use under the eyes for moderate smile lines. Recently started RF Matrix x2trmts

Michael A. Persky, MD · Answer

Hello A,
Using your own blood, processing it to form Platelet Rich Fibrin (prf) and injecting it around your eyes is a great alternative treatment for your moderate smiles lines.  The process is 100% natural with nothing added but your own blood.  It is called EZ Gel.  Some have used micro-needling with salmon dna or exosomes to improve moderate lines on the face.  Happy to answer any further questions that you may have regarding these treatments.  Good luck and be well.
Michael Persky, MD
Encino, CA

Kally Papantoniou, MD, FAAD · Answer

When Botox is no longer an option, there are still effective ways to address moderate smile lines and crepiness around the eyes. Treatments that focus on improving skin quality and collagen support can make a visible difference.

Microneedling RF is a great start. It works by delivering controlled heat and micro-injuries to stimulate collagen and tighten the skin over time. Another highly effective option is fractional CO2 laser resurfacing, which renews the surface layer of the skin while encouraging deeper collagen remodeling for a smoother, firmer appearance.

In cases where volume loss contributes to wrinkles, a hyaluronic-acid filler can restore subtle support and improve the overall contour.

Your dermatologist can help design a plan that focuses on skin quality and structure to restore collagen and reduce fine lines.

Nick Slenkovich, MD · Answer

Hi, I’m Lauren, the aesthetic injector here at Colorado Plastic Surgery Center.
When considering alternatives to Botox, it’s important to understand the range of effective options available. Two great non-invasive treatments to consider are CO2 laser resurfacing and microneedling.
CO2 laser resurfacing is a highly advanced treatment that offers impressive results for a variety of skin concerns. It’s commonly used to reduce fine lines and wrinkles, improve the appearance of scars (including acne, surgical, and stretch marks), enhance skin texture and tone, and address pigmentation concerns, such as sun spots and age spots. Microneedling is a medical-grade skin rejuvenation treatment that activates the body’s natural healing response. By creating controlled micro-injuries in the skin, it stimulates collagen and elastin production, helping to reduce the appearance of fine lines, wrinkles, scarring, stretch marks, and skin laxity. Always, the best next step is to meet with a skilled provider who can evaluate your goals to design a personalized treatment plan just for you.

Ella Fedonenko, MD · Answer

Using small amounts of blended Voluma or Volbella will definitely help soften the smile lines. It will also stimulate collagen production in the area of injections and as a result the results will last longer.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. If you're looking to treat moderate smile lines under the eyes without Botox, CO2 resurfacing laser could be a fantastic option. This laser treatment uses fractional CO2 technology to deliver controlled energy to the skin, which stimulates collagen production and promotes skin regeneration. By resurfacing the skin, the CO2 laser helps to smooth out fine lines and wrinkles, including those around the eyes, while also improving overall skin texture and tone. The treatment works by removing the damaged outer layers of skin, allowing fresher, more youthful skin to emerge and tightening the underlying layers. This is especially beneficial for delicate under-eye skin, as it targets the wrinkles caused by repeated facial expressions, like smiling, without the need for injections. While there is some downtime associated with CO2 resurfacing (typically a few days to a week), the results are often long-lasting, leaving you with smoother, more even skin around the eyes. I hope this helps and best of luck!

Dallas Buchanan, MD · Answer

Thank you for your question! Sorry to hear about this. Although there is nothing quite like Botox for addressing those lines around the eyes, there might be some other options which might be helpful. I think the best at tackling peri-ocular wrinkles is laser resurfacing (we use Contour TRL). Other invasive skin treatment options like chemical peels and/or radiofrequency microneedling can also help with skin texture and tone. 
Hope this helps!
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Nelson Lee Novick, MD · Answer

Happily there are several alternative treatments for under-eye wrinkles. 
These include the use of robust HA volumizing fillers, if volume deficit in the cheeks is at the root cause of the problem. The use of a cohesive, malleable, low viscosity HA filler can be helpful if under-eye hollows and tear troughs are the issue. 
Alternatively, professionally performed manual microneedling (no need for the added expense and risks of RF Microneedling) may also be helpful, as can a series of superficial peels employing high concentrations of glycolic acid or salicylic acid, Jessner's Solution or low concentrations of TCA. 
You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist and best of luck.

Anna Chacon, MD, FAAD · Answer

For individuals who are looking for alternatives to Botox for treating moderate smile lines under the eyes, there are several options to consider, especially given your recent concerns with narrow angles. Here are a few treatments that might be suitable:

Dermal Fillers: Hyaluronic acid-based fillers, such as Restylane or Juvederm, can be used to add volume and smooth out lines. These fillers are typically safe and effective for treating under-eye areas and can provide natural-looking results.

Microneedling: This procedure involves using fine needles to create micro-injuries in the skin, stimulating collagen production. It can help improve skin texture and reduce the appearance of fine lines.

Chemical Peels: Mild to moderate chemical peels can help improve skin texture and reduce fine lines. These peels exfoliate the skin, promoting the growth of new, smoother skin.

Laser Treatments: Non-ablative lasers, such as Fraxel, can stimulate collagen production and improve skin texture without significant downtime. These treatments can be effective for reducing fine lines around the eyes.

Radiofrequency (RF) Treatments: Since you mentioned you have started RF Matrix treatments, continuing with these might be beneficial. Radiofrequency can help tighten skin and stimulate collagen production, reducing the appearance of lines.

Topical Retinoids: Prescription-strength retinoids or over-the-counter retinol creams can help increase cell turnover and improve the appearance of fine lines over time.

It's important to consult with a dermatologist or a qualified cosmetic specialist to discuss these options and determine the best treatment plan tailored to your specific needs and medical history.

Camille Cash, MD · Answer

There are several skin treatments you can use to treat smile lines.  Lasers are one option.  Morpheus8 is another.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.  I've included a video on Morpheus8 that I hope you find helpful.

Stefan Weiss, MD · Answer

Other than a wrinkle relaxer like Botox, collagen stimulators can be used including non-ablative laser resurfacing.

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