Can You Trust These Eye Wrinkle Treatments?

by Nancy Monson Health Writer

A telltale sign of aging is crepey skin under the eyes, which affects men and women alike. The problem is dryness and a loss of the proteins collagen and elastin in the eye area that cause skin to sag, bag, hollow, and wrinkle.

The good news is that dermatologists and plastic surgeons are offering some effective nonsurgical solutions for undereye wrinkles, though they are not covered by health insurance and can be costly. Here are the risks and benefits of three popular new procedures.

1. Cosmetic filler injections

Injectable gel fillers are made from substances such as hyaluronic acid or calcium hydroxylapatite. They fill in lines and wrinkles (unlike Botox, which relaxes facial muscles).

Most popular now is hyaluronic acid (such as Restylane and Juvederm), which is naturally present in the skin and in other tissue. It breaks down harmlessly in the body after six months to a year and is less likely to cause allergic reactions than other fillers.

“These injections work as spot treatments for crepey skin under the eyes to fill in depressions and soften lines,” says Michael R. Burgdorf, M.D., M.P.H., a board-certified plastic surgeon in Nashville, Tenn. They can also pad and plump up the area around the eye, he says, creating a less hollow, more youthful look. If you don’t like the results, Burgdorf says an enzyme called hyaluronidase can be injected to break down the hyaluronic acid.

Although considered safe and well-tolerated, the practice of injecting a filler is a medical procedure, and there can sometimes be side effects. It’s critical that a dermatologist, a plastic surgeon, or a facial plastic surgeon trained in using fillers and familiar with the products performs the procedure to avoid bad outcomes.

If you’re receiving injections, your skin should be makeup-free. Your doctor should first clean your skin with an antiseptic, preferably one with an antibacterial effect.

HealthCentral asked Burgdorf for more details about cosmetic filler injections for undereye wrinkles.

Q: How many treatments are needed?

A: One to two.

Q: How long do the results last?

A: Six months to a year, and then the hyaluronic acid gets absorbed into the body.

Q: Do the injections hurt?

A: They can be mildly uncomfortable.

Q: What do they cost?

A: $750 to $1,500, depending on how much you need.

Q: What are the risks?

A: If the filler is injected too superficially, you might see a bluish hue beneath the skin. Or if too much is injected, you can have swelling. A poorly trained doctor can also inject into a blood vessel or cause bleeding around the eye.

Q: How do you look afterward?

A: You might be slightly red or bruised from the injections, but you’ll see immediate improvements in the skin.

2. Microneedling

Microneedling uses an instrument that has many small needles to make tiny punctures in the skin. “It looks like a marker with 12 needles in it,” Burgdorf says. “You can vary the depth of treatment, and around the eyes we don’t have to go as deep as other parts of the face.”

As the wounds heal, they are supposed to stimulate the production of new collagen and elastin to make skin elastic and plump.

Does microneedling work? A review of the current evidence on microneedling, published in June 2017 in the Journal of Plastic Reconstructive & Aesthetic Surgery, found it to be a safe and effective therapeutic option for the treatment of scars and wrinkles.

The journal reported that microneedling “showed noteworthy results” and when compared with other treatments, “it showed similar results but was preferred due to minimal side effects and shorter downtime.”

HealthCentral asked Burgdorf for more details on microneedling for undereye wrinkles.

Q: How many treatments are needed?

A: Three to five.

Q: How long do the results last?

A: Improvements may appear in about a week and accumulate over time, especially if you continue with maintenance treatments.

Q: Does it hurt?

A: A numbing cream is applied to the face first, so the discomfort is minimal.

Q: What does it cost?

A: About $250 to $395 per treatment, but $500 to $800 more if you opt for administration of hyaluronic acid, botulinum toxin, or platelet-rich plasma (your own blood) along with microneedling.

Q: What are the risks?

A: Skin infections and cold sores in people who are prone to them.

Q: How do you look afterward?

A: Your skin will be red, hot, and tight, but that will usually go away in a day.

3. Laser therapy

Lasers work by producing an intense beam of bright light that travels to the skin. Laser resurfacing treatments generally fall into one of two categories: ablative lasers and nonablative lasers, according to the American Academy of Dermatology.

Ablative lasers, which tend to be more invasive and require more recovery time, vaporize the outer layers of the skin. Fractional nonablative lasers, such as the Fraxel DUAL, are now considered the standard treatment for tightening the delicate skin around the eyes. Those nonablative lasers heat up the targeted tissue without actually destroying it, but cause an injury that prompts the production of new collagen and elastin.

There are a wide variety of lasers that can be used but, according to Lisa M. Donofrio, M.D., associate clinical professor of dermatology at Yale University School of Medicine in Connecticut, “It’s not the laser that matters, but the person operating it.” Donofrio says you should seek out a doctor who has a lot of experience with lasers. Otherwise, your skin could be damaged permanently.

The American Academy of Dermatology says fractional lasers use the same amount of energy as older models but that energy is broken up into smaller doses, offering safer, more effective treatment. In addition, improvements in laser technology have allowed dermatologists to treat people of color safely and effectively.

HealthCentral talked to Donofrio for more details on laser therapy for undereye wrinkles.

Q: How many treatments are needed?

A: Four to six.

Q: How long do the results last?

A: For years, if you have the appropriate number of treatments.

Q: Does it hurt?

A: Yes, which is why a numbing cream will be applied first, along with ibuprofen or acetaminophen. Some doctors also use a device that blasts cool air onto the face during the treatment.

Q: What do laser treatments cost?

A: $400 to $800 and up.

Q: What are the risks?

A: Dark skin can become lighter or darker, and lasers can exacerbate acne and rosacea, or cause scars or cold sores if you’re prone to them.

Q: How do you look afterward?

A: Your face will be red and hot for a few hours and then tight, swollen, and dry for a few days or longer, depending on the laser used and the depth of the treatment.

Nancy Monson
Meet Our Writer
Nancy Monson

Nancy Monson is a freelance writer and certified health coach. Her articles have been published in over 30 national magazines and newsletters, including AARP The Magazine, Family Circle, Shape, USA Today, Weight Watchers Magazine, and Woman’s Day. She is also the author of three books, including Craft to Heal: Soothing Your Soul with Sewing, Painting, and Other Crafts, which links creativity to well-being. Read more of her work on her website,, and follow her on Instagram and Twitter @nancymonson.