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? – The younger the patient the more springy and elastic the skin and the easier it is 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

 

under eye lines after anti-wrinkle treatment

 

Can anti-wrinkle injections treat under eye lines?

Yes, but the side effects are likely to be worse than the aesthetic gains. Anti-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 work by reducing the contraction of muscle and if we reduce muscle contraction around the eye we may reduce lymphatic drainage which could cause bags / fluid buildup under the eyes

  • 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.

 

where to treat under eye lines

 

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.

tear trough treatment

 

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.

Laser treatments can be used with care under the eyes to reduce the appearance of lines under the eyes. Fraxel and CO2 lasers have been used in this area but, like any treatment around the eyes, you have to be extremely careful. Results from laser around the eye are subtle.

 

Summary

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

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