What is the best management approach for under eye wrinkles in young adults?

Management of Under Eye Wrinkles in Young Adults

For young adults with under-eye wrinkles, platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) injections represent the most evidence-based first-line approach, administered via intradermal injection or microneedling at 0.25 mm depth, with a treatment protocol of 3 sessions spaced at minimum 21-day intervals. 1, 2

Primary Treatment Recommendation: Autologous Platelet Concentrates

PRP and PRF are safe, effective, and particularly appropriate for young adults seeking natural rejuvenation options for periocular wrinkles. 1 The evidence demonstrates:

• Significant improvement in periocular wrinkles with high patient satisfaction rates across multiple studies 1
• Increased skin thickness and elasticity due to enhanced collagen production 1
• Favorable safety profile as an autologous material with minimal side effects (primarily temporary bruising and swelling) 2
• Effectiveness even in patients in their early twenties, indicating appropriateness for young adults 1

Treatment Protocol

• Three treatment sessions with minimum 21-day intervals between sessions 2, 3
• Maintenance treatment every 6 months following initial treatment course 2, 3
• Administration methods: Intradermal papule injection to the eye area and crow's feet, or microneedling at 0.25 mm depth 1
• For enhanced safety: Use 30G needles for injection or 22G × 2 inches cannula when using albumin-PRF formulation 2

Important Considerations

PRF may be superior to PRP specifically for periorbital wrinkles, with one study showing PRF's advantage over PRP for canthal smoothness and wrinkles at 3 months 2. However, both modalities demonstrate efficacy 1.

Alternative and Adjunctive Treatment Options

Chemical Peels (More Aggressive Option)

Chemical peels are significantly more effective than PRP for periorbital hyperpigmentation, with 38% achieving excellent improvement versus 0% with PRP alone 1. However, chemical peels carry higher risks and downtime 1.

• Trichloroacetic acid 3.75% + lactic acid 15% showed superior results to PRP in comparative studies 1
• Consider for patients with both wrinkles and significant hyperpigmentation 1

Physical Modalities

Radiofrequency, electroacupuncture, and low-level laser therapy all demonstrated significant wrinkle reduction in the under-eye area in adult women 4. These represent viable alternatives or adjuncts to injectable treatments.

Topical Treatments (Preventive/Mild Cases)

For very mild wrinkles or prevention-focused young adults:

• Topical retinoids (tretinoin) for wrinkle prevention and treatment 5
• Alpha hydroxy acids for superficial wrinkle improvement 6, 5
• Antioxidants including ascorbic acid, vitamin E, coenzyme Q10 for wrinkle prevention 6

Botulinum Toxin (Reserved for Dynamic Wrinkles)

Botulinum toxin is highly effective but should be used cautiously in young adults with lower dosing. 7, 8

• Lower doses recommended for toxin-naïve younger adults to avoid frozen appearance 8
• Primary indication: Dynamic wrinkles (crow's feet) rather than static under-eye wrinkles 7
• Risk of eyelid ptosis (major adverse event) must be discussed 7
• Young adults primarily seek prevention and natural appearance, making them less ideal candidates for botulinum toxin 8

Critical Caveats and Pitfalls

Patient Selection

• Young adults in their twenties can develop periorbital aging signs, making them appropriate candidates for treatment 1
• Assess patient motivation: Prevention is the most common reason young adults seek treatment 8

Safety Warnings

• Warn patients about temporary bruising and swelling with PRP/PRF injections 2
• Avoid the delicate periorbital area if not experienced with injection techniques 2
• Use proper depth and needle gauge to minimize complications 2

Adjunctive Recommendations

• Strict photoprotection is mandatory to maintain results and prevent further wrinkle formation 3, 5
• Good home skincare routine enhances and maintains treatment outcomes 2, 3
• Avoid smoking which accelerates skin aging 3

Treatment Limitations

• Protocols remain non-standardized across studies for PRP/PRF preparation and administration 2, 3
• Multiple treatment cycles required for optimal results (not a single-session solution) 2, 3
• Results are not permanent and require maintenance treatments 2, 3

Combination Therapy Approach

Combining PRP with microneedling shows enhanced efficacy compared to either modality alone 1. Consider this combination for patients seeking maximal improvement with natural methods 1.