Usually a blepharoplasty will give the best result

A 69-year woman who has never had surgery will most likely benefit from an upper blepharoplasty.

Fortunately, almost all upper blepharoplasties can be done under local anesthesia or local anesthesia with light sedation.  The risk of the local anesthetic should be very low in competent hands, even in patients with medical issues.

The recovery for a simple upper blepharoplasty should also be very fast, with most patients back in public after 5 days feeling comfortable.  Most patients have minimal or no bruising from simple upper lid surgery.

Lasers, even the most effective CO2 laser, typically tighten far less than a blepharoplasty can.  And the recovery for CO2 laser resurfacing on the very sensitive upper eyelid skin can be considerable.  So rather than have the eyelids lasered or waste time and money on ineffective creams, it might be best to do talk to your plastic surgeon about having a blepharoplasty.

If you have a lot of excess skin then surgery would be necessary to remove the excess skin (although lasers will tighten it somewhat). If your only concern is the quality of the skin (the crepiness) and you don't have excess skin, then you're better off not having surgery.

Options to address the crepey eyelid skin are prescription creams like Retin-A or non-prescription creams containing glycolic acid, lactic acid, or a similar exfoliant. Be careful - these will likely cause irritiation, redness and swelling, so start off with minimal amounts and gradually increase as tolerated.

Lasers or chemical peels can also be used on the eyelid skin to treat the condition of the skin and create a tightening which will reduce or remove the crepiness.

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