Under-Eye Wrinkles: Botox, Polynucleotides, RRS Eyes or Fractional Laser?

Under-Eye Wrinkles: Botox, Polynucleotides, RRS Eyes or Fractional Laser?

When lines appear beneath the eyes, the first question is often: What is the best treatment?

Before choosing Botox, polynucleotides, RRS Eyes or fractional laser, however, there is a more important question:

What type of wrinkle is present, and why has it developed?

Lines caused by muscle movement are not the same as lines associated with dry or thin skin, and superficial fine lines are not identical to more established textural changes.

A treatment that is useful for one type of under-eye wrinkle may therefore be inappropriate for another.

What Types of Under-Eye Wrinkles Are There?

Lines may be dynamic, appearing or becoming more pronounced when smiling, or they may remain visible while the face is at rest.

They can also become more noticeable because of dehydration, thin skin, chronic sun exposure and age-related changes in skin elasticity.

Many patients have more than one contributing factor.

When Is Botox Appropriate?

Botulinum toxin temporarily reduces the activity of selected muscles.

It is therefore most relevant when muscle movement is a major contributor to the wrinkles.

Treatment of the lower eyelid requires careful assessment. The objective is not to eliminate all movement, and lower-eyelid treatment is not appropriate for every patient because anatomy, muscle function and eyelid support vary.

Does Botox Improve Skin Quality?

Botulinum toxin does not directly treat dehydration, skin thickness or pigmentation.

It may reduce the movement responsible for certain wrinkles, but it does not address every component of under-eye aging.

This is why distinguishing dynamic wrinkles from skin-quality concerns is important.

When Are Polynucleotides Appropriate?

Polynucleotides may be considered when thin or dry skin, superficial fine lines and overall skin quality are important components of the concern.

The objective is not to relax a muscle like Botox or to replace volume like filler.

The treatments therefore address different problems even though a patient may describe all of them simply as “wrinkles.”

What About RRS Eyes?

Products specifically designed for the periocular area may be used to improve aspects such as hydration, skin quality and fine lines depending on their formulation.

However, an injectable eye treatment should not automatically be expected to correct dynamic wrinkles, significant laxity or every cause of a tired appearance.

Read more: Skin Boosters vs Polynucleotides vs RRS Eyes

When Is Fractional Laser Appropriate?

Fractional laser resurfacing creates controlled microscopic treatment zones and may be used to improve selected textural changes and fine lines in appropriately selected patients.

Fractional Erbium laser targets water within tissue and can be used at different treatment intensities for skin resurfacing.

Laser treatment around the eyes, however, requires appropriate patient selection, expertise and specific ocular protection.

Which Is Better: Botox or Fractional Laser?

They should not be viewed as direct substitutes because they address different targets.

If a line appears predominantly when smiling, muscle movement is an important part of the problem.

If the skin itself has persistent lines and textural changes, a skin-resurfacing approach may be more relevant.

Some patients have both components.

Do I Need Filler?

The presence of under-eye wrinkles does not automatically mean filler is required.

Filler primarily addresses volume and structural support rather than surface skin quality.

If a genuine tear trough or volume deficit is present, filler may form part of the plan in an appropriately selected patient.

If volume is not the problem, adding filler simply because wrinkles are visible may not address the cause.

Read more: Under-Eye Filler — Who Is a Good Candidate?

Can Botox and Polynucleotides Be Combined?

Combination treatment may be reasonable in selected patients when two different problems coexist: muscle movement producing dynamic lines and poor skin quality requiring a different approach.

However, combination treatment is not necessary for everyone.

Each treatment should have a clearly defined purpose.

Can Fractional Laser Be Combined with Injectable Treatments?

More than one technique can be incorporated into a staged treatment plan when appropriate.

Timing, skin condition, laser intensity and the type of injectable treatment all need to be considered.

The objective is not to perform the maximum number of procedures in the shortest period. Tissue should be allowed appropriate recovery time, and the response to each treatment should be assessed.

Can Under-Eye Wrinkles Be Completely Removed?

Complete elimination of every line should not be promised.

Normal movement, eyelid anatomy, skin quality and aging all influence the appearance of the area.

A more realistic objective is to improve wrinkles and skin quality while maintaining normal function and natural movement.

How Do We Choose the Right Treatment?

The decision can be simplified by identifying the primary problem.

If the wrinkles are predominantly dynamic, treatment directed toward muscle activity may be considered.

If thin, dry skin and fine lines are the main concern, skin-quality treatments may be more relevant.

If there are persistent surface lines and significant textural changes, resurfacing may form part of the plan.

If volume loss or a tear trough is present, a separate structural assessment is required.

The Bottom Line

There is no single “best treatment” for every under-eye wrinkle.

Botox, polynucleotides, RRS Eyes, fractional laser and dermal filler are different treatments designed to address different problems.

The best treatment plan therefore begins by identifying the cause of the lines: muscle movement, skin quality, volume loss or a combination of factors.

Only then can an appropriate and individualized treatment strategy be developed.

Related Articles

Polynucleotides for the Under-Eye Area

Under-Eye Filler: Who Is a Good Candidate?

Under-Eye Dark Circles: Causes and Treatments

What Is Fractional Erbium Laser?

This article is intended for general medical education and does not replace an individual medical consultation or examination.