Q: Dr. Eppley, I know I want infraorbital rim implants but an additional concern is the changes in the skin under my eyes that I have noticed in the last three to four years. I have attached a PDF of some of my eye pictures. They shows the bunching up and “crepey” skin that tends to exacerbate my undereye issues and tired appearance. Even though the lower photos are the effect with an extreme smile, this tends to occur even with a mild smile, and really affects my self-esteem. I was wondering how infraorbital implants and/or fat relocation will ameliorate these folds. Though I had a series of three micro laser peels this last year, they did little to address this issue. I just would like to be realistic as possible in terms of the outcome of this procedure.
A: The smile animation ‘deformity’ around the lower eyelids (under eye wrinkles) is a tough one since it is a muscular action effect and not a structural problem. No amount of static skin resurfacing will help a dynamic movement issue. The infraorbital rim implants will make some improvement in it due to volume expansion and some diminution of muscular excursion but ultimately animation wrinkle deformities respond best to Botox injections.
Dr. Barry Eppley