Thank you for your question.
You’re 29-years-old and you submitted two photos of close-ups of your eyes, one at rest
and one at expression.
And you stated in your question that you’ve been doing Botox® since you were about 24-years-old.
And you’re asking about what’s the best way to improve the lines under your eyes.
If it’s a laser then you’re asking for a specific answer and you’re also asking
about a commercial microneedling device.
Well, I can certainly share with you my approach to developing a treatment plan for patients
like yourself in my practice.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
And helping people improve the appearance wrinkles around the eyes is something we do
all day long in our practice every day.
So in the absence of both a more in depth history and a physical examination, I would
start by first inquiring.
When I see someone who is young like yourself as to what are some of the potential causes
of this degree of wrinkling which is from my experience, greater than what I would expect
from someone who is young.
And usually or often, there is history of excess sun exposure, maybe a history of the
use of tanning beds consistently and extensively as well as smoking history.
And of course, I’d also ask about medical history and other issues as well as the genetics
of these types of wrinkle issues in the family in terms of ethnic background.
People who tend to have lighter skin tend to have fine lines and wrinkles at an early
age as opposed to people who have darker skin types.
Now that being said, I also look into other medical issues whether it has to do with diet
with medications and other factors that could be contributing.
Also allergies, I’d look into whether a person has extensive seasonal allergies and
other issues that can cause an issue with eye swelling and eye rubbing.
Now that being said, the point of asking those questions about history, if there are variables
that I can do something about in terms of guidance and what to do or what not to do,
that also helps.
Prevention is very important and certainly you’ve been doing that by doing Botox®
to try to minimize the muscle activity that’s causing the fine lines and wrinkles to occur.
Now to share with you my general approach, again, looking at someone who’s young and
with the tools that we currently have, the point of your question as far as technology
is concerned is what do the technologies do to help improve wrinkles.
Well, when you think about wrinkles, you’re thinking about essentially one major issue
which is loss of support in the skin and the support in the skin is generally focused on
one major protein called collagen.
Now collagen is important and all of the devices that are very openly and aggressively marketed
whether it’s laser, thermal energy device or microneedling device are all focused on
induction of collagen.
Well, I would also say that one of the things that we have to be mindful of is degree of
trauma and the consequences of that trauma not only short-term but long-term.
You see, doing this for over 20 years, I have gotten to see the results of very aggressive
treatments on patients as they age and I would say that when a treatment is very aggressive,
the skin can actually become thinner and that is something that I would caution you about.
A lot of times people believe that a more powerful laser, a more aggressive microneedling
procedure or a very aggressive thermal energy device such as a focused radiofrequency ultrasound
is a good thing because it would induce maximal collagen.
But there is a balance there and sometimes, you actually cross the line and you actually
accelerate collagen breakdown.
So I would tell you that in my practice, what was always been essentially the gold standard
to help with under eye wrinkles for lighter skinned individuals has been some kind of
laser whether it was an Erbium laser or whether it’s a CO2 laser.
At the current time, in a situations like yours, probably again without the benefit
of a history and a physical examination, I would consider doing something like a fractional
CO2 laser so I could get the benefit of collagen induction as well as some thermal contraction.
Now that’s different from microneedling where microneedling is causing collagen induction,
however, the thermal element of that is not there.
But I would also suggest the use of something called PRP.
Now PRP is platelet-rich plasma.
Now this is derived from your own blood and it is a concentration of the wound healing
growth factors and elements that help stimulate collagen.
And the reason why I use it a lot and I’ve been doing this for many years now is that
with that goal in mind of stimulating collagen and understanding that there is a line and
limit when it comes to different devices, when you’re talking about PRP, you can inject
PRP under the skin and do it with regularity with no fear of a negative consequence related
to a device where skin is being heated.
In other words, you’re looking at the foundation of the skin being improved and we can constantly
do that.
You can’t keep doing lasers over and over.
You can’t keep doing microneedling beyond a certain level, the same thing with radiofrequency.
Basically those treatments are essentially to treat then wait and see how your body responds.
Well, we’ve learned a lot in our practice in the art of balance where you can use a
thermal energy device like a CO2 fractional laser to resurface some of the skin as well
as induce collagen induction, I should say, and at the same time, minimize and narrow
the risk so that you don’t have to be overly aggressive because then PRP complements the
process in inducing collagen and then we can do that with consistency.
The thing about this strategy and any strategy in cosmetic dermatology is that you have to
have a little bit of understanding of the concept of observation.
You treat and you observe and then you further make decisions based on the skin’s response.
A lot of times whether it’s non-physicians or medispas, people get locked into a treatment
schedule, a protocol, a process, something that doesn’t involve a lot of thinking.
But I would argue that if a physician who understands this and is thinking about this
critically with a greater depth of knowledge and experience, you can actually have a more
customized approach.
Now of course the Botox® would also play a very important role in terms of the ongoing
maintenance.
So I recommend that you meet with qualified, experienced doctors who do this type of work
a lot and learn about the strategy of using a device that stimulates collagen in conjunction
with PRP.
I think that from my perspective, that would probably be a good strategy for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question.