Crepey under eyes and rough, textured skin. What are my options for smoothing this out? (photos)

The eye area needs significant combinations to get improvement. Lasers like erbium, co2, halo, profractional/contour, or Fraxel can all be used to build collagen long term. Plasma pen is a newer less invasive option but will take many treatments and require proper skincare. Plasma Pen is focused electrical plasma energy to tighten skin, producing small columns of energy just above the skin, allowing the skin to tighten to help improve wrinkles. This area will have 3-5 days of small “dots” that will then scab and peel, then the skin will tighter and brighter after. Numerous treatments are needed over lasers where only one or two give a bigger result, but more downtime. After plasma pen you NEED peels 2 weeks like later Cosmelan, enlighten or aerify, see emeragecosmetics (link). At home derma rolling should be started weekly even after plasma pen or lasers to further increase collagen, see emeragecosmetics AERIFY x anteagemd stem cell ampules. To properly heal you need light Stim red LED, EmerageSkin refit face, refit eye; AnteageMD serum, silagen silicone gel, jan Marini bioshield, EmerageSkin enzymatic polish, and EmerageSkin hyla b and AOX, and Sente dermal repair. Otherwise there is EXTREME risk of pigmentation issues and “dots” in the treatment area. at home peels like cosmelan, enlighten and aerify along with dermarolling (AERIFY emerageskin roller with Anteage MD ampules) should be started now regardless for antiaging, sun damage, and wrinkle prevention. There are many things you can do to treat under eye hollows and dark circles. A surgical option to remove skin and/or fat will such as eyelid blepharoplasty with or without fat pad repositioning (if doing lower eyelid surgery) will be the best long term. There are many things you can do to treat under eye hollows and dark circles without surgery. Non invasive less downtime options such as fillers, lasers, microneedling/PRP, cosmelan peels, and microneedling RF like Fractora, PiXel8 or morpheus can all help give some improvement. Accutite can often be used or stronger lasers like erbium or co2 spot treatment can tighten the skin and give very quick improvement in wrinkles and texture. I suggest you get a formal consultation to see what is best for you and your goals. Best, Dr. Emer.

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for your question and photos. You may benefit from laser resurfacing or RF microneedling to treat uneven texture under the eyes. These treatments work by boosting the body's own collagen production, strengthening and rejuvenating the skin from the inside out. I recommend scheduling an in-person consultation with an experienced, board-certified facial plastic surgeon who can assess your concerns and suggest the best treatment option for you.

A HD photo of the cheeks would be additionally helpful for evaluating this case. However, from what can be seen, the addition of an appropriately robust HA filler to the upper cheeks would help not only to crreate a more feminine oval, heart-shaped face, but can secondarily improve the under eye regions. Additionally, a series of superficial peels for the under eye region, using either high concentrations of glycolic or salicylic acid, Jessner's solution or low concentartions of TCA can be helpful for improving the crepeyness. Make sure to consult with a board certified cosmetic dermatologist. Best of luck.

I do think that your under eye area could be rejuvenated with either a chemical peel or laser resurfacing. Both of these procedures can tighten the skin and make it smoother. They can also help to even out the skin tone.

First, laser resurfacing will give the best results. You will need a stainless steel internal eye shield to be placed. There is more improvement in less sessions with full-field Erbium (Sciton 2940) than either fractional CO2 or fractional Erbium. Often with full-field Erbium, folks just do 1 session. With fractional, it’s usually a few sessions — and that can still give great results. Lasers are more precise than chemical peels, but sometimes those peels can over a series give results. Once you reach a good point, keep-up with maintenance treatments like low density fractional lasers or even Microneedling every 3-6 months (make sure it’s one of the 2 FDA cleared Microneedling pens: Crown SkinPen or Eclipse Evo Pen). If you want to do something today to help a bit, then Dysport/Botox injections plus Revision Revox Line Relaxer (available on my website online store) can help a bit.