Wrinkles under and around the eyes inspire people to spend a lot of money on solutions
from miracle creams to medically based procedures.
The specific reasons for different types of wrinkles determine how the wrinkles are treated.
I’ll discuss the way I help my patients who come in concerned about wrinkles under
and around the eyes.
I’m Dr Amiya Prasad.
I’m a Board Certified Cosmetic Surgeon and Fellowship Trained Oculoplastic Surgeon.
I’ve been in practice in Manhattan and Long Island for over 20 years.
I specialize in cosmetic procedures of the eyes and eyelids, and treating the signs of
facial aging, ranging from advanced techniques such as upper and lower eyelid surgery; injectable
treatments around the eyes such as cosmetic fillers, platelet-rich plasma, and Botox;
as well as laser and radiofrequency treatments for eyelid skin.
Many people first recognize signs of aging around their eyes.
This includes wrinkles just below the eyes, to crow’s feet that appear when smiling
We face people every day with our eyes, and the eyes are the first thing we see in the
The appearance of your eyes can project an impression to another person in a fraction
of second that you’re tired (even if you’re not) or older than you really are.
So, it’s natural to want to refresh the appearance of your eyes and diminish the signs
of aging, and tired looking eyes.
There are two basic types of wrinkles around the eyes: static wrinkles which appear when
the face is at rest, or with no expression; and dynamic wrinkles that appear when smiling
or other facial expressions.
Treating these two different types of wrinkles need separate approaches
Wrinkles are one of the most noticeable aspects of an aged appearance.
While there are more significant causes of facial aging such as loss of facial volume
from bone loss and sagging as skin and underlying support gets weak, wrinkles are what most
people see when they look at themselves and conclude that they are aging.
There is a common misconception that under eye wrinkles are caused by excess eyelid skin.
Patients will sit in front of me and pull on their lower eyelid skin and believe there
In actuality, this stretchy characteristic is more the result of decrease in skin quality
and facial volume loss.
Nonetheless, well-meaning doctors often try do address under eye wrinkles during lower
eyelid surgery by removing skin.
In my opinion, this is not the best treatment for wrinkles under the eyes, as skin shortage
can make pull the eyelids down, making the eyes look rounded and hollow.
Under eye wrinkles are most commonly caused by collagen loss, not excess skin quantity,
so treatment should be about improving the eyelid skin, rather than removing it.
Lines that appear around the eyes with facial movement expression, such as those commonly
known as crow’s feet, appear due to muscle activity.
Collagen loss and breakdown as well as constant creasing of the skin make these lines appear
prominently, even at rest.
Since movement causes the these lines to deepen, limiting movement can help diminish these
Wrinkles under the eyes are treated by improving lower eyelid skin quality.
This may involve heating devices such as lasers or radiofrequency technology applied with
precision to stimulate the body’s collagen production.
The body produces collagen as a response to injury, so applying heat as well as removing
part of the upper layers of skin as in the case of ablation is a controlled injury.
Increased collagen in the lower eyelid skin makes the skin thicker, and healthier.
In addition, removal of the top layer of skin cells, allows new and fresh layers of skin
cells to emerge.
It is important that heating and ablative devices are not overused as too much heat
energy or overaggressive ablation can cause the skin to become thinner.
Collagen stimulation is not limited to the application of thermal energy and laser devices.
Collagen production and increased blood supply in the lower eyelid skin can be stimulated
with a regenerative treatment called platelet-rich plasma, or PRP.
Platelet-rich plasma is a concentration of the platelet component of the blood, which
is responsible for healing when you have a cut.
PRP is concentration of the wound healing growth factors that can also stimulate a collagen
and also stimulate more blood supply the under eye skin.
PRP can also be used to help help with skin discoloration under the eyes commonly known
as dark circles.
To reduce wrinkles around the eyes that appear with movement, the treatment approach would
be to reduce the movement that cause these wrinkles.
This movement can be reduced by limiting muscle activity with a neurotoxin such as Botox,
Dysport, or Xeomin.
Reduced movement makes the lines appear less deep.
An artistic and experienced touch with injectable neurotoxins is important so that natural movement
and facial expressions are not affected.
With time and regular treatment, lines and depressions in the skin caused by constant
muscle contraction improve.
It is important to understand that wrinkles around the eyes cannot be completely eliminated.
The goal here is to improve or to reduce the wrinkles.
As is often seen on some well known people, attempting to completely erase lines and wrinkles
could result in frozen, expressionless faces that don’t look natural.
When can you go back to work: Laser and radiofrequency may take a day to a week before returning
The healing process which going on below the surface is characterized continued collagen
production and remodeling.
PRP can be placed below the skin as well as in the upper layers of skin and can have anywhere
from no downtime to a day or two . Neurotoxins like Botox and Dysport take about 3 days for
effect and 2 weeks for full effect.
It is routine for our patients to go back to work right after treatment.
When it comes to lines and wrinkles under and around the eyes, I always discuss aspects
of lifestyle with my patients.
Simply said, anything that’s not good for your health is not good for your skin.
Poor diet, smoking and excess sun exposure of indoor tanning with ultraviolet light accelerated
loss of collagen.
I also discuss strategies for keeping the skin looking good for the long term through
regularly scheduled treatments and skin products such as sunblock and cosmeceutical products.
In the modern world, people are being constantly bombarded by irresponsible messaging from
the internet and television.
Hype for products and procedures result all too often in people having poor outcomes and
permanent skin damage.
A lot of people make the mistake of having procedures based on coupon offers to save
money or from inexperienced practitioners only to spend more money and time trying to
repair their overtreated or damaged skin.
I recommend to find a doctor who you can trust to have your best interest in mind and be
your guide to navigate through all the messaging before you undergo a procedure.
In my practice, I provide my patients with a treatment plan with an understanding of
what to expect with the procedures I’ve recommended.
I hope you found this information helpful...thank you for your question