Thank you for your question.
You submitted a single photo of your left eye showing an active appearance of under
eye wrinkles and wrinkles around the eye as well.
And you state in your question how do you treat fine lines and wrinkles around your
eyes?
And say, that based on different lighting, these lines can be prominent.
Now you go to a PA for Botox® and you say that the PA did not recommend Botox® for
this area but rather recommending lasers and creams.
And now you’re looking for an answer about whether or not this is correct.
Well, I can certainly give you some guidance even this is limited to a single photo but
I think that there’s an understandable reason for confusion and I’ll explain further.
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.
Our practice, as what you probably can conclude, has basically everything you would need to
help rejuvenate the areas around the eyes, everything from skin products to lasers, to
radiofrequency devices, to injectables and of course surgery.
So how I help my patients understand the different solutions is first by defining what the issues
are.
So when you talk about the area around the eyes specifically, you’re basically, when
you’re concerned about lines, you’re looking at asking the following: are the lines present
when you’re eyes are at rest when there’s no expression?
Those lines are referred to as static lines.
Are the lines present when your eyes are activated in terms of the muscles of the eyes?
Those are dynamic lines.
Those are lines that are accentuated when there’s action of those muscles.
Now in addition, I would say that when you look at the under eye area, an area that is
often confusing for patients is essentially an effect from the cheek moving upward like
an accordion compressing the skin and causing pleats under the eyes and that’s a separate
issue in itself.
So to begin with, when it comes to addressing static lines, fine lines and wrinkles present
at rest, generally, solutions are to try to improve texture, quality, improve the collagen
in the skin, resurface some of the skin.
So that’s where lasers, whether it’s resurfacing lasers like fractional CO2, Erbium laser.
Or you can think about non-ablative lasers as well as thermal energy devices such as
radiofrequency devices like Pelleve.
The goal is to improve skin quality and texture.
In addition, we also employ something called platelet-rich plasma (PRP).
Platelet-rich plasma (PRP) stimulates collagen through injecting a concentration of the wound
healing factors that are necessary when you have a cut.
So it stimulates collagen and blood supply and this is derived from your own blood.
Now that being said, we then move on to dynamic wrinkles.
Dynamic wrinkles are of course the domain of a neurotoxin such as Botox®, Dysport®,
Xeomin®.
The limit is of course how much you can place without compromising the functionality of
the eyelid.
So you can treat the crow’s feet area, you can treat a little bit the area right under
the eyelashes often referred to the eyelid roll but there is an upper limit because you
want to of course maintain tone.
Now, last but not least, in terms of creams, creams under the eyes can certainly play a
role in terms of moisturizing, sun protection as well as for cell turnover and possibly
even the delivery of some active ingredients like vitamin C. Basically helping, through
topical application, some of those variables that essentially protect moisturize and have
some therapeutic value but is probably the least effective when compared to other modalities
but certainly has an important role in terms of long-term maintenance.
In order to really ascertain what is right for you, you have to have a proper discussion
about this with whoever is providing you with your skin care or dealing with the eye area
and to understand this distinction.
Very often people will go to ancillary or support service doctors in busy practices
like a dermatology practice where PAs or nursing practitioners are there to help provide services
that the doctor is too busy to provide.
And I’m not saying that’s necessarily in your situation and certainly not in any
way to offend nurse practitioners or PAs but it’s very important to have a proper understanding
of the physiology and the issues that are relevant to your situation and to have a proper
treatment plan.
In the modern world, we are seeing a lot of solutions being thrown at potential consumers
and competition and messaging that is completely missing the necessary understanding of what
is an individual’s best interest as opposed to selling certain various types of devices,
injectables, etc.
So it can certainly be very confusing and I can understand the origin of why this question
is coming up.
So again, I would say, meet with a physician, a dermatologist, cosmetic surgeon, oculoplastic
surgeon, plastic surgeon, just someone who has a lot of experience in helping people
in the eye area and learn about these options and understand what the realistic outcomes
will be.
A lot of times, people get sold a procedure or something and then are disappointed because
they didn’t know exactly in what range their outcome would be and that of course creates
unnecessary bad feelings.
So I hope that was helpful, I wish you the best of luck and thank you for your question.