CO2, fillers or Botox for under eye wrinkles when smiling? (Photo)

this needs a combination of lasers, peels, skin care and fillers.    Please see an expert.  Best, Dr. Emer.

It's a pleasure to answer this question. 
You will need a combination of treatments for the best results. This might include Botox or Dysport, Lasers, Peels, Dermal fillers, and other treatments. I like to start patients off with effective, but rapid healing procedures first.
See an expert. Best wishes. Dr. ALDO

Hi there and thanks for your question! There are a few options for your under eye problem.  Botox is a good treatment for dynamic fine lines such as the crows feet on either side of the eyes.  Fillers work well in the tear trough area to add some volume.  If you have some downtime, lasers such as CO2 and J-plasma work well for resurfacing the skin and stimulating collagen.  I recommend speaking to a plastic surgeon for more information. Best of luck! 

There are many reasons for under-eye lines and most of these reasons have to do with the quality of the skin (collagen and elestin issues). To correct these, techniques to generate collagen need to be used. One of them is SkinBoosters but other treatments can also be of significant benefit.Please make sure that you see an experienced doctor for a thorough consultation and assessment prior to undergoing any treatments.Best regards and I hope this helps, Dr. Sapijaszko.

It is difficult to assess completely because the only photo is with a smile, making it challenging to determine if there is volume loss, and the degree of resting rhytids/wrinkles. For small volume loss a filler will help with contour and wrinkling. The quality of your undereye skin can be improved with several sessions with a device such as the Exilis elite, this works with radiofrequency to induce collagen production making your skin smoother and firmer, with no downtime. For true creases at rest a CO2 laser can help, and will help with tightening, but has the longest downtime.Good luck, Dr. Papantoniou. 

Generally speaking, when wrinkles are accentuated with annimation (smiling) using a neurotoxin such as Botox or Dysport is considered the best option.  For the lower eyelids in your case, I would also consider using some laser resurfacing to smooth out and firm up the skin which will also improve the appearance.

There are a few options for treating this area which include topical creams/serums to optimize under-eye hydration, as well as low-dose Botox (especially when the wrinkles present mainly with movement and not much at rest), and fillers (when wrinkles or hollowness present at rest). Laser resurfacing, microneedling +/- PRP can also be helpful. Much more important than the choice of treatment is the choice of an expert physician such as a dermatologist to optimize safety and to give the best, natural looking and symmetric results possible and who offers all the different modalities so you receive only that which would benefit you most.

I would start with a filler for volume loss, Botox/Dysport for dynamic lines and wrinkles, and a good at home eyecream. Resurfacing procedures like fractionated lasers, microneedling, and chemical peels will help as well. 

There are many reasons for these type of lines. Poor local and systemic hydration adds always to the problem so make sure your skin is well hydrated and you doing optimal amount of liquids.The skin laxity in your case is aggravated by the volume loss in the upper face including upper and lower eyelids. First, there is not a single treatment that will eliminate all of these lines. I always suggest as permanent solution as possible, so filler would not be on the top of my list. Laser resurfacing or aggressive micro-needling would be my first choice. Small doses of Botox prior to resurfacing could be of great help for many reasons. Some use very successfully a deep chemical peel but the downtime could be much longer. Once either resurfacing or micro needling are done, filler could be very helpful but the choice is very limited in that area. Therefore, the best option for volume expansion would be either fat transfer or fat-derived filler - Allofill. Discuss the options with your physician and ask questions about each option. The more you know the better decision you will be able to make. Good luck!

When people have excessive lines in the lower eyelid area, it is usually because they're lacking volume as the face is getting thinner or the skin quality has significantly changed. It would serve you best to have an in-person consultation with a plastic surgeon. You might either need some fat grafting or some form of resurfacing. Good luck from New York City