4 Eye Area Treatments and Problems

I am age 62. Post Botox injection more than a year ago I experienced a lower eyelid bubble. I waited six months then had Resurf Fx treatment. The area looks smooth when waking, however, it becomes wrinkled looking as the day progresses. What is my best option to correct this problem? Thank you for your assistance in advance. Sincerely, Linda

Hi Linda – great question because this area is complex and there are so many treatments now. Here are some things to think about. Fresh eyes for the new year are a good goal, especially with these masks still covering the lower part of our face.

  1. Fluid accumulation/puffy eyes. Most of us wake up a little puffy in the morning and then, as the day progresses, we get better. You’re having the opposite problem. You feel like you look good in the morning and then it gets progressively wrinkly as the day goes on. One possibility is to correct this with a filler because it will fill the area underneath and help hold the contour during the day. We use Restylane in our clinic, but your dermatologist can advise you. If you’re having the puffy eye problem, try the Madison MD Eye Rescue; it helps with puffy eyes. For you though, an eye cream like the Pevonia in our shop may help with the wrinkles late in the day as well.
  2. Botox/Dysport lower eyelid “bubble”.  People mean different things when they use this lay term (not a medical one). But most seem to mean a puffy area under the eye after Botox/Dysport.  This is often due to poor lymphatic drainage caused by the reduced muscle action. Usually it will go away after a week or two. Gentle 5-10 seconds of lymphatic massage under the eyes may help. If it doesn’t go away, the injections may need to be kept higher, above the lateral canthus.
  3. Excess upper or lower eyelid skin. These wrinkles are caused by excess lax skin that occurs slowly over time. The skin is so thin around the eyes and has very few oil glands. Using an eye cream both morning and night will help, but it doesn’t solve it usually. Non surgical options include the FDA approved eyelid Thermage (you may need multiple treatments), and resurfacing lasers like the CO2. The Fraxel eye tip (FDA approved) may also be helpful if the problem isn’t too far along. Large bags and a lot of hooding may need surgery.
  4. Eyes look smaller. This occurs to some extent with natural aging.  But check to make sure your cheeks, especially the mid cheek, haven’t been over filled which creates a odd looking shelf like effect and creates a smaller looking eye. Also, too much Botox can drop the brows too much having a similar effect.
  5. Prominent treat troughs. Fillers to fill the trough may be your best option. Experts only please FDA off-label. And anything that builds collagen over time will help.

Hope this helps,


Dr. Brandith

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