Getting rid of under eye wrinkles is one of the most difficult cosmetic problems that patients ask us at Cityskin and sometimes the solution is a surgical one rather than injectable. Factors that help with our decision making when treating under eye lines include:

  • How old is the patient?– In younger patients, the skin is more elastic, making it easier to treat under eye lines.
  • How much loose skin is there under the eyes?– Can you pinch and lift the skin under the eyes? If so – we may find it very difficult to treat the lines.
  • Are the lines under the eyes established– The longer the lines have been there the more difficult they will be to treat (see image below.)
  • How deep are the lines?– Very fine lines are easier to treat than strong, deep lines.

Can anti-wrinkle injections treat under eye lines?

Yes, but the side effects are likely to be worse than the aesthetic gainsAnti-wrinkle injections could be used to treat under eye lines but the side effects are likely to be worse than the cosmetic outcome of reducing lines. Problems that we might cause by using anti-wrinkle injections under the eyes include:

  • Bags / swelling under the eyes– The muscle around the eye is a circular (concentric) muscle known as ‘orbicularis oculi’. All day long we are moving our eyes and blinking which contracts the muscle. This muscle contraction helps with lymphatic drainage (drainage of fluid that occurs all over the body). Anti-wrinkle injections reduce muscle contraction, which can potentially affect lymphatic drainage and lead to under-eye bags or fluid build-up.
  • Ectropion– An ectropion is the eyelid equivalent of the lip flip. Using anti-wrinkle treatment around the mouth can cause the lip to turn out slightly and in the same way – using anti-wrinkle injections close to the eyelids can cause them to turn out slightly. This is known in medicine as an ectropion and can cause redness of the eyelids and eye.

In most cases the risks of treating under eye lines outweighs the benefit. The image below gives an indication of areas that we can treat and areas that we should leave alone. Most injectors will not treat in the ‘no-go’ zone directly under the eye. We can treat in the ‘caution’ zone, but we have to be careful not to over-treat this area (see our article on common mistakes made by novice injectors) as it can cause a ‘chipmunk’ cheek effect.

Can dermal fillers treat under eye lines?

Dermal fillers replace volume loss that occurs to all of us as part of the natural ageing process. The closest area to under eye lines that we treat is the ‘tear-trough’ – the area shown in the image below. Treating the tear trough is complicated and should be treated by experienced injectors only. Oculoplastic surgeons may treat the immediate under eye area with dermal fillers, but this is an expert procedure and not something that we perform at Cityskin.

What are the alternatives to dermal fillers and anti-wrinkle injections under the eyes?

Now that we have established that under eye lines are very difficult to treat, what are the options for patients wanting to reduce these lines? If you are over 40 then under eye lines are likely to be due to a combination of skin laxity and sun damage. If you have skin laxity under the eyes you may benefit from a surgical procedure such as a lower blepharoplasty to reduce lax skin. This is best performed by a plastic surgeon; however, this procedure requires a week of downtime and is costly.

Laser treatments can be used with care under the eyes to reduce the appearance of lines under the eyes. Fraxel and CO2 laser can work well to reduce the under-eye lines. Laser treatment is riskier in the area around the eye, but it can achieve an effective and subtle look. However, CO2 laser is a service that we don’t offer at Cityskin.

If you have lots of loose skin under the eye the best treatment is probably surgery. However, that requires a week of downtime and considerable cost.


Under eye lines are common and very difficult to treat. We can treat the lower crow’s feet, but most injectors won’t treat in the ‘no-go’ zone under the eyes. If skin laxity is the concern, then treatment of the lines might be best addressed with a lower blepharoplasty (surgical removal of loose skin).

Suggested reading:

Common anti-wrinkle problems and how to fix them – our comprehensive guide to common issues after anti-wrinkle injections and how to correct them.

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