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What do you recommend for the wrinkles and crepiness under my eyes when I smile?
My dermatologist recommended erbium laser and I am concerned if it will not be enough.
I am curious about laser, injectables, fat injections, or surgery. I currently have Botox
around my eyes.
Thank you for your question!
You're asking about recommendations about what to do about wrinkles and crepiness under
your eyes when you smile. You mentioned that your dermatologist recommended erbium laser
and you are concerned that it might not be adequate. You submitted a photo of one eye
at rest and one eye when you smile. This is a good starting point for you to understand
very important concepts.
Let's first start by defining wrinkles. They are basically two types of wrinkles that we
think about in the aesthetic field. One is called static wrinkles. These are the wrinkles
on your eyes at rest. That means that with the photo you submitted with your face relaxed,
you can appreciate the fine line that are there when you are relaxed. Then there are
dynamic wrinkles. Those are the wrinkles that occur when there's an activation of a muscle.
You mentioned that you were treated with botox but it's very important to understand that
the dynamic activity will still cause wrinkling on the skin. A strategy and understanding
of how to execute that strategy and what kinds of results you would expect is very important.
When I look at a patient who comes to with this type of concern, we start first by evaluating
the overall aesthetics. A lot of times when we look at ourselves, we look at ourselves
very critically. We notice things that we don't really like. But when people look at
us, they look at the big picture. They look at the whole face. So, when I evaluate someone,
I start at the basics of what the impression does the eyes make when someone looks at them.
I noticed that at rest, there is some puffiness under your eyes. This is something that you
also must consider as you make a plan for your ultimate treatment. The puffiness under
your eye is probably due to lower eyelid fat prolapse. From my experience, puffiness under
the eyes has so much more of an overall impact on the perception of the individual. Because
when you have puffiness under your eyes, people think you're tired or older or lacking energy.
It's something that dominates.
You can see many people who have lines under their eyes whether they are actors or models
and you can see that they are still attractive people. At the same time, when you look at
younger people who have lines under their eyes, they don't look bad. It's not just about
being smooth. Unfortunately, a lot of people pursue this holy grail of smooth, tight, flawless
skin to the point that they got laser and their skin got tighter but it also got very
thin. They looked tighter but they didn't look younger.
These are the things that I discussed in my book I wrote years ago called "The Fine Art
of Looking Younger" and so I would share with you that is whether you relax those muscles
from the botox or if you physically move the cheek upward, those lines can still form because
there is an effect when other parts of your face move. So the cheeks move up and the lines
will form even if you have botox. The perception of crepiness is very important to understand.
I'll share with you what our philosophy is in our practice. When you think about crepiness,
you think about thinning of the skin and what happens as we get older. So what we have been
doing is focusing on regeneration rather than looking do some type of heat stimulation.
I have pretty much any kind of laser you need to do work in this area however I have modified
my approach for years. What I have been doing is something called platelet-rich plasma.
It is basically your own blood that is spun down and the active healing factors called
platelets and the serum which have growth factors are very important healing factors.
These are manipulated and injected in a very specific way under the eyes to help improve
skin quality. We find that there is a lot of benefit in helping people restore quality
and volume. If you think about aging skin, there is loss of collagen and loss of vascularity.
With platelet-rich plasma, we are able to accomplish that. It doesn't mean it reduces
the wrinkle per se but skin quality improves significantly and a lot of those wrinkles
do improve.
From the top part of the skin, we employ fractional CO2 laser. We do microneedling. Certainly
there is a role for combination. But understanding that all of these procedures really help the
static lines, the lines that are there when the face is at rest. And I would argue that
it is really difficult to make a significant change in the amount of line when you smile.
They may look a little improved but the activity is still something that can be best addressed
with the neurotoxins such as botox and dysport.
I think that you can certainly explore different strategies but understand what you're desired
result is and what kind of result you will see with whatever modality you choose. So
I think that taking a step back and looking at the big picture, looking at the puffiness
under your eyes, look at wrinkles at rest or at activity and get the general understanding
of what part of each of those factors play in your overall appearance. Very often, it
is better to get opinions from your friends and family to get a sense of another idea
or perspective. When we look at ourselves, we tend look very critically and tend to magnify
what you see. So I hope that was helpful, I wish you the best of luck and thank you
for your question!