Treatment for under eye cross hatch wrinkles?

Question

I’m 60 and familiar with fillers and even PBP for under eyes, but nothing specific to this concern. A fine series of wrinkles appear when I look down i.e. reading. The lines are almost vertical and disappear by raising head but while my head is not completely “ straight “ they are there and age defining. Likewise, after sleeping or supine for any time, the wrinkles are more aggressive, stay longer and there is a cross-hatching appearance to them. Any skin concealing product really brings them

Anna Chacon, MD, FAAD · Answer

Under-eye cross-hatch wrinkles can be a challenging aesthetic concern, especially as they become more pronounced with age. Given your familiarity with fillers and Platelet-Rich Plasma (PRP) treatments, here are some additional approaches and considerations that might help address this specific issue:

### 1. **Topical Treatments**
- **Retinoids (Prescription strength or Retinol):** These can help stimulate collagen production and improve skin texture over time. However, they can be irritating, so it’s important to start with a lower concentration and gradually increase as tolerated.
- **Peptides and Growth Factors:** These can support skin repair and collagen synthesis. Look for products containing these ingredients.
- **Hyaluronic Acid:** A good hydrating serum can help plump the skin and reduce the appearance of fine lines temporarily.

### 2. **Microneedling**
- **Microneedling with PRP:** Enhances the effects of traditional microneedling by using your body's own growth factors to stimulate collagen production. This can help improve skin texture and reduce the appearance of fine lines and wrinkles over time.

### 3. **Laser Treatments**
- **Fractional CO2 Laser or Erbium Laser:** These can resurface the skin and stimulate collagen production, improving skin texture and reducing the appearance of wrinkles.
- **Non-ablative Lasers (like Fraxel):** These can also help with collagen stimulation with less downtime compared to ablative lasers.

### 4. **Radiofrequency (RF) Treatments**
- **Microneedling RF (e.g., Morpheus8, Profound RF):** Combines microneedling with radiofrequency to stimulate deeper layers of the skin, promoting collagen and elastin production.

### 5. **Botox or Dysport**
- **Micro-Botox:** Small amounts of botulinum toxin injected superficially into the skin can help reduce the appearance of fine lines by relaxing the underlying muscles.

### 6. **Chemical Peels**
- **Mild to Moderate Chemical Peels:** Such as glycolic acid or TCA peels, can help improve skin texture and reduce fine lines. However, the under-eye area is delicate, so these should be done cautiously and by a professional.

### 7. **Lifestyle and Home Care**
- **Hydration:** Ensure you are well-hydrated, as dehydration can make wrinkles appear more pronounced.
- **Sleep Position:** Try using a silk pillowcase and sleeping on your back to reduce pressure and creasing on the face.
- **Sun Protection:** Always use a broad-spectrum sunscreen to prevent further damage and collagen breakdown from UV exposure.

### 8. **Concealing Products**
- **Hydrating Concealers:** Choose a concealer that is specifically formulated for mature skin and has hydrating properties. Avoid heavy, matte formulas that can settle into fine lines.
- **Primers:** Use an eye primer to create a smooth base for makeup application, which can help prevent products from settling into lines.

### 9. **Professional Consultation**
- **Dermatologist or Cosmetic Surgeon:** Given the complexity of your concern, a consultation with a dermatologist or cosmetic surgeon who specializes in aging skin would be valuable. They can provide personalized recommendations and possibly combine several treatments for optimal results.

It’s important to have realistic expectations and understand that while these treatments can significantly improve the appearance of under-eye wrinkles, they may not completely eliminate them. Combining various approaches often yields the best results.

Nelson Lee Novick, MD · Answer

Your problem is quite common and I have achieved very gratifying results employing a combination of at-home daily Rx topical medications containing alpha and/or beta hydroxy acids and retinoids to complement a series of in-office superficial peels containing full strength glycolic or salicylic acids, Jessner's Solution, or low concentrations of TCA. 
The use of fillers under the eyes for such relatively minor issues is likely to cause more problems than it treats and the proven benefits in aesthetic treatments of PRP and PRF lags well behind the heavy marketing hype and social media buzz that surrounds these expensive treatments. 
You would be wise to consult with a board certified cosmetic dermatologist. And don't go into any consultation asking for some treatment(s)--be they expensive fraxel laser or other energy-based "bells and whistles" gizmos that you picked up on Dr. Google or Dr. TikTok because to your later financial loss, frustration and disappointment, you are very likely to get exactly what you ask for. Hope this helps and best of luck.

Camille Cash, MD · Answer

From your description you may find improvement from Morpheus8.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  It is safe for all skin types and the under eye area.  Chemical peels and Retin A may also be helpful. See my website or a provider near you to learn more.

Treatment for under eye cross hatch wrinkles?

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