Dear Dr. Seckel, I am only 29 and I am beginning to see eye wrinkles at the corner of my eyes. It used to happen only when I smiled but now I can see the wrinkles at the corners of my eyes even when I’m not smiling. I have tried several creams but I don’t think they help. Can the laser remove eye wrinkles? Is it safe? Thank you, Michelle, Boston, MA
Dear Michelle,
Eye wrinkles or Crow’s Feet are usually the first sign of facial skin aging to appear and often, especially in fair skinned individuals, eye wrinkles begin to appear at about your age. While Retin A can improve very fine lines after a year or two of use, most non-prescription eye creams do not work on significant eye wrinkles in my opinion.
It is important to distinguish between dynamic eye wrinkles and static eye wrinkles because the therapy is very different for the two different types of eye wrinkles. Dynamic eye wrinkles are the eye wrinkles you see when you smile or wince or grimace. The dynamic eye wrinkles are caused by the pull of the eyelid muscle, called the Orbicularis Occuli on the eyelid skin. The muscle surrounds the eye and is attached to the skin of the eyelid and when the muscle contracts during smiling or wincing, the muscle pulls on the eyelid skin and causes the dynamic eye wrinkle, also called crow’s feet in lay terms. Dynamic eye wrinkles are best treated with Botox. The Botox is injected into the muscle, weakens the muscle, the muscle contracts less, pulls on the eyelid skin less, and the dynamic eye wrinkles are reduced or disappear altogether at the corners of the eyelid on the cheeks in the crow’s feet area.
Static eye wrinkles are eye wrinkles that are seen on the eyelids when the eyelid is at rest, which is when the Orbicularis Occuli muscle is not contracting during smiling or wincing. The static eye wrinkles are caused by eyelid skin aging and by the repeated dynamic wrinkling of the eyelid skin over many years. Static eye wrinkles are permanent changes in the eyelid skin and do not respond to Botox treatment. In my experience laser skin rejuvenation treatments are the most effective treatment for static eye wrinkles.
The eyelid skin is very thin and sensitive and great care must be exercised when doing laser skin rejuvenation on the eyelid skin. Protective, laser impermeable shields must be placed over the eye so the laser does not accidentally injure the eye.
The most effective laser treatment for eye wrinkles is superficial ablative laser resurfacing of the eyelid. The eyelid must be checked for laxity and if the eyelid is lax or loose then ablative laser resurfacing cannot be used to remove the eye wrinkles. The two best laser treatments for eye wrinkles are the Erbium Microlaserpeel and the ActiveFX fractional CO2 laser peel. The ActiveFX fractional CO2 laser eyelid peel is a newer technique, which I use, and I prefer the Active FX because it ablates or removes wrinkles but also tightens the skin better than the Erbium laser, in my opinion.
Non-ablative lasers like the Palomar Lux 1540 fractional laser can be used for static wrinkles on the corners of the eye but it is not as easy to use on the lower eyelid as the ablative laser techniques. The non-ablative laser does not ablate or remove the eye wrinkle, but works by stimulating new collagen growth beneath the eyelid skin to plump the wrinkle. There is less down time with the non-ablative technique but I think the results with an ablative laser like the active FX are better. The non-ablative lasers go deeper and may go too deep on the lower eyelid skin over the eye-so I only recommend the non-ablative laser on the crow’s feet area.
Laser treatments for eye wrinkles are very sophisticated and potentially risky procedures and should only be performed by a very experienced doctor who has treated many patients and takes the appropriate safety precautions.
I use a combination of the ActiveFX Fractional CO2 laser peel for static eye wrinkles and Botox for the dynamic eye wrinkles for the best result.
For further information on eye wrinkles and eyelid rejuvenation please read Save Your Face or contact me.
Thank you,