How Under Eye Wrinkles That Appear When Smiling can be Helped with Non-Surgical Treatment

A woman complains about her inner eyelid corners that look puffy and the appearance of extra skin folds when she smiles. She wants to know recommendations to fix her problem.

Dr. Amiya Prasad, an oculofacial cosmetic surgeon, observed from her photos that there appears to be some puffiness in her lower eyelids. It's not a lot of puffiness but it must be evaluated to know what must have caused this. He also observed that she has some sagging and pulling down of the left lower eyelid which is called lid retraction. This is usually the case of some of his patients who have had previous eyelid surgeries wherein their surgeon removed too much skin resulting in eyelids being pulled down.

There are two aspects in the dynamic activity of the muscle actions when someone smiles. One aspect is wrinkling related to the activity of the muscle called orbicularis oculi muscle. This is the muscle that surrounds the eye which is responsible for supporting the eyelid and allowing one to blink. The wrinkles that form under the eyes can be helped a little bit with neurotoxins such as Botox and Dysport. Another aspect is the recruitment of skin when the cheek moves up and pushes the skin against the eyelid and causes wrinkles.

One must understand that there is a difference between how they looked when they were 40-years-old compared to how they look when they are 60 or 70 years old. Dr. Prasad wrote a book a few years ago called, "The Fine Art of Looking Younger" where he explained that aging is caused by many factors. including changes in skin quality and thinning of skin as people get older. Unfortunately, many patients look too much at the details and forget about the big picture. There is no way to completely eliminate those wrinkles but there are strategies to help improve the skin quality.

Dr. Prasad has been practicing for 20 years and has helped a lot of his patients over the course of time with problems with their eyes to sagging of the jowls. Basically, he has become their lifetime beauty doctor. His overall philosophy has always been critical strategic solutions that are minimally invasive and allow for a natural appearance.

Dr. Prasad suggests having some fillers such as Botox or Dysport in the depressor anguli oris muscle to have some volume enhancement. This will also lift the lips and can also help the area around the mouth to improve the overall appearance of the face. As far as the wrinkles under the eye that are concerned, he typically injects something called platelet-rich plasma. This is from the patient's own blood that is spun down. Basically, the blood contains platelets that are involved in healing. Platelet-rich plasma also has vascular endothelial growth factor that contributes to the healing process and helps improve skin quality. Platelet-rich plasma is not only used in the eyes but also in other parts of the body such as the face to improve the skin texture, quality and overall appearance.


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