Happy Birthday! There are many ways to treat undereye bags

Hello, you look great. The best "plastic surgery" is smiling, and your smile makes you look very young.

Now as far as your under eye area - it is difficult to advise you based on this picture alone. If you have minimal fat under your eyes then a fractionated carbon dioxide laser such as Fraxel re:pair gives great results alone. If you have excessive skin, then it can be combined with a skin "pinch" excision. If you have a lot of fat protrusion then a transconjunctival approach (from inside your lower eyelid) incision is best to remove or in some cases reposition the fat. If there is hollowness under the eye that is creating the "bag", then carefully placed filler such as Restylane (temporary), or your own fat (permanent) can smooth out the bag and give you a youthful lower eyelid and cheek.

"Laser" blepharoplasty can mean different things. When used as a cutting tool, laser blepharoplasty is not much different from "scalpel" blepharoplasty, other than using the laser as a scalpel. The laser can be used to make the transconjunctival incision or to make the lower eyelid incision. With the laser incisions there is initially less swelling and bruising, but by the second to third day, the healing, swelling and bruising is the same as scalpel incisions.

Again, with the old traditional CO2 lasers and the new Fractionated CO2 lasers, laser resurfacing of the crepe skin of the lower eyelid gives great smoothing of the skin without any incisions in the skin.

I began this answer by trying to make matters less confusing for you, but have likely made you more confused than ever. The most important thing that you can do is choose your surgeon most carefully and be sure that your expectations meet your surgeon’s expectations and ability. Be well and keep showing your beautiful smile.

Dr. P

The laser offers no proven benefits when used as a cutting tool except slower healing.

Of the options for your lower eyelids, if there is just a small amount of puffiness, transconjunctival (from inside the eyelid) reduction in fat combined with a peel of the lower lids or CO2 laser resurfacing conservatively for the entire face to avoid color changes should be considered.

In patients with a great deal of undereye skin, we have found that a limited incision superficial cheeklift, often with LiveFill (non-traumatized fat-fascial graft from the patient's own tissues) graft preserves eye shape much better than a subciliary (below the eye) incision. 

Traditional skin-muscle lower eyelid surgeries or skin only lower eyelid surgeries often lead to a rounding of the eye or pulling down in the corners of the eye.

Fat preserving surgeries are now the rule in many practices, and techniques like the arcus marginalis release with fat repositioning are also possible.

Your doctor should be able to discuss the pros and cons of each of these procedures with you.

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