[Dr. Bellevue Column 105.] Crow’s Feet & Under-Eye Wrinkles Have Different Causes, So Why Receive the Same Treatment? (A Complete Comparison of Botox vs. Eye Thermage vs. Rejuran i)

Hello,

This is Dr. Bellevue from Bellevue Clinic, where beauty belongs to everyone.

It is a pleasure to greet you again today.

One of the most common concerns I hear when meeting patients in the consultation room is, “Doctor, is there no way to completely get rid of fine lines around or under the eyes?” or “I hear Eye Thermage is the best treatment for eye wrinkles these days. Would it be right for me too?”

To give you the conclusion first, wrinkles around the eyes can be sufficiently improved and tightened through appropriate treatments. However, there is one very important prerequisite: crow’s feet and under-eye wrinkles are caused by entirely different factors. When the causes are different, it is difficult to achieve satisfactory results by applying the same treatment method to everyone. Surprisingly, many people insist on receiving only one widely recognized treatment and end up not getting the results they expected.

In today’s column, I will distinguish between the mechanisms behind wrinkles around the eyes, explain in detail the principles, advantages, and disadvantages of three representative key treatments—Botox, Eye Thermage, and Rejuran i—and discuss how to choose the treatment that is right for you.

1. Crow’s Feet vs. Under-Eye Wrinkles: The Causes Are Different from the Start

The skin around the eyes is one of the thinnest and most sensitive areas of the body. Because the sebaceous glands are not well developed, it is prone to dryness, and the eyes open and close tens of thousands of times a day. However, the primary factors that create wrinkles around the eyes and under the eyes are different.

① Crow’s Feet: “Muscular Wrinkles” Caused by Muscle Contraction

These are the fan-shaped or diagonal wrinkles that spread outward beside the corners of the eyes when you smile or make facial expressions. They are caused by strong contractions of the orbicularis oculi, the circular muscle surrounding the eyes. Just as repeatedly folding and unfolding a sheet of paper eventually leaves a distinct crease, these expression lines form when the orbicularis oculi repeatedly folds the skin whenever you smile with your eyes.

② Under-Eye Wrinkles: “Loss-of-Elasticity Wrinkles” Caused by Aging of the Dermis

These are fine horizontal wrinkles that appear in a crinkled pattern under the eyes. Rather than being primarily caused by strong muscle movement, they are mainly caused by thinning skin due to aging and the loss of collagen and elastin in the dermis. As the elastic-fiber foundation of the skin stretches and loses its strength, it becomes loose and can no longer maintain its firmness, creating a structural sign of aging that resembles fine ripples.

2. Can They Be Completely Eliminated with Home Care or Eye Cream?

Many people try to care for the area with premium eye creams or massage tools before considering a procedure. Eye creams containing retinol or highly moisturizing ingredients can supply moisture to the skin’s surface and smooth its texture, temporarily making it look more hydrated and firm.

However, there are physical limitations to restoring wrinkles that have become deeply established due to the breakdown of the dermal structure or strong muscle contractions through home care alone. In addition, excessive acupressure or massage around the eyes can irritate the thin skin in this area and may worsen fine lines. A medical approach suited to the cause is therefore necessary.

3. A Complete Overview of the Three Key Treatments for Improving Crow’s Feet and Under-Eye Wrinkles

Below are the features and guidelines for the three representative treatments that show high satisfaction among treatments for wrinkles around and under the eyes.

① Botox (Botulinum Toxin) — The Most Cost-Effective Solution for Expression Lines Around the Eyes

[Recommended for]

• People whose diagonal wrinkles beside the eyes crease more prominently when smiling than when their face is relaxed

• People who want quick results at a reasonable cost

Botox is one of the most reliable and cost-effective treatments for improving crow’s feet, which are muscular wrinkles. It temporarily blocks the release of neurotransmitters in the orbicularis oculi around the eyes, preventing excessive muscle contraction when making facial expressions.

-Treatment details: Precisely administered in small amounts at 3–5 points around the outer corners of the eyes

-Pain: Performed after applying topical anesthetic, with very little pain

-Duration and frequency: Usually lasts 2–4 months; ongoing treatment every 3–4 months is recommended

-Caution (not suitable for the under-eye area)

★ Important

Botox is not suitable for treating fine under-eye wrinkles.

Because under-eye wrinkles are often caused by reduced skin elasticity rather than muscle contraction, incorrectly injecting Botox under the eyes may result in an unnatural facial expression, eyelid swelling, or a hollow-looking under-eye area.

② Eye Thermage — The Standard Treatment for Under-Eye and Eye-Area Elasticity with Long-Lasting Results

[Recommended for]

• People concerned about crinkled fine lines under the eyes and an overall loss of elasticity

• People who have difficulty receiving frequent treatments and want results that last for one year or longer

• People who are concerned about the pain of injectable treatments

This treatment delivers single-pulse radiofrequency (RF) energy deep into the dermis to provide thermal stimulation, inducing immediate contraction of collagen fibers and long-term collagen regeneration and remodeling. It uses Thermage’s Eye Tip, which is designed specifically for the eye area.

-Use of a dedicated tip: A delicate Eye Tip designed for the thin, sensitive skin around the eyes is used, typically with 225 or 450 shots

-Treatment areas: Can be broadly applied to the under-eye area, outer corners of the eyes, and even the thin upper-eyelid line

-Pain and frequency: Pain can be managed with the built-in cooling system and topical anesthetic; firm elasticity can be maintained with just one treatment per year

-Advantage: It makes the dermal layer generally thicker and stronger, fundamentally improving horizontal fine lines under the eyes and reduced elasticity.

③ Rejuran i — Immediate Regenerative Treatment for Thinned Skin Around the Eyes

[Recommended for]

• People who tolerate injectable treatment pain well and want to experience quick improvements in skin texture and a regenerative effect

• People whose skin around the eyes is very thin, easily irritated, and dry

• People who find the cost of device- or laser-based treatments somewhat burdensome

Rejuran is a skin booster that directly injects PN (polynucleotide) into the dermal layer. It directly injects a biocompatible substance extracted from salmon DNA into the dermis to restore damaged skin structure and improve the skin environment.

-Eye-area formulation: A formulation adjusted to have lower viscosity and concentration than the original Rejuran Healer, helping reduce injection marks and bruising on the thin skin around the eyes

-Pain and frequency: Some pain accompanies the injection procedure; the best results are achieved with approximately three consecutive treatments at one-month intervals

-Advantage: It increases the density of the epidermis and dermis, rapidly improving fine lines around the eyes, thinned skin texture, and dryness.

Dr. Bellevue’s Final Summary — Which Eye-Wrinkle Treatment Is Right for Me?

Depending on your symptoms and desired treatment direction, you can consider the following options.

★If prominent diagonal wrinkles form beside your eyes when you smile:

• Botox around the eyes (cost-effectiveness is the top priority; avoid the under-eye area)

★If you want to maintain fine under-eye wrinkles and generally lax skin in a firm condition for one year:

• Eye Thermage (minimizes concerns about pain and supports long-term collagen regeneration)

★If you want to quickly improve the texture of thinned skin around the eyes and improve overall skin health:

• Rejuran i (recommended if you can tolerate injection pain)

The areas around and under the eyes are sensitive areas where even a 1 mm difference can significantly change your appearance. Rather than blindly following a treatment that others recommend, the first step is to receive an accurate assessment of whether your current eye-area wrinkles are caused by “muscle movement” or by “reduced elasticity due to dermal aging.”

Depending on your needs, a customized combination treatment—Botox around the eyes and Eye Thermage or Rejuran i for under-eye elasticity—may provide more satisfying and natural-looking results. We recommend creating a safe and effective care plan through a thorough consultation with an experienced medical professional.

This procedure may be accompanied by temporary redness, swelling, bruising, or other effects depending on the individual, so a thorough consultation with a medical professional is necessary.

For office workers who find it difficult to make time on weekdays because of their busy daily schedules, Bellevue Clinic at Gangnam Station provides regular consultations on Sundays and public holidays to make weekend care more convenient. Please note, however, that the clinic is regularly closed every Wednesday when scheduling your visit. At Bellevue Clinic, where procedures are performed safely, we hope you can care for firm, clear skin even during the hot month of August. Thank you~!

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Bellevue Clinic scientifically analyzes the skin to determine the necessary treatments and strives to provide the most effective and helpful procedures for each patient through kind and detailed consultations.

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