I had Blepharoplasty done over a year ago but still have loose skin under my eyes. I have had CO2 laser done to correct this, but it did nothing. A doctor recommended Fraxel, but I've read it does nothing for skin tightening. I want to spend my money doing what's going to work. Could you suggest what I can do to get this fixed? I was considering lower eyelid surgery again. Is this necessary?
Loose Skin Under Eyes After Blepharoplasty
Doctor Answers 13
Loose skin under the eyes
It is difficult to know exactly why you have loose skin under your eyes after lower blepharoplasties and CO2 resurfacing, but the problem should not be difficult to fix. As long as the overall result is satisfactory i.e. the fat protrusion is gone, you probably just need a very conservative skin pinch. If your lids are loose or there is still "bagginess" under the eyes for example, you may then need to have lower blepharoplasties performed again.
Be cautious! Re-doing lower eyelid blepharoplasty
Be very cautious pursuing further treatment for your loose lower eyelid skin.
The fact that you have already had a blepharoplasty performed and CO2 laser puts you at risk to develop complications such as pulling down of the eyelid (retraction) or pulling out of the eyelid (ectropion).
You may want to really assess the results and consider if your expectations are realistic. If your surgeon feels that you can have a minor touch up safely Fraxel:repair can tighten eyelid skin. Fraxel:restore will not.
See an expert
Depending on your age and the amount of skin laxity there are different things that can be done. I would be wary of doing another CO2 laser treatment although the fractional CO2 lasers safer to use in my experience. If there is a slight "crepiness", then a superficial laser resurfacing may be in order but make sure that the physician treating you has experience in this area. The same goes for removal of excess skin. As one of the other commenters stated, removal of too much skin can cause lower eyelid retraction where the white part of the below the iris is exposed. As one of my professors once told me, sometimes the opposite of "good" is "better" and you can open up a whole can of worms turning a small problem into a major one.
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Be careful about too many procedures around the eyes
You really need to be careful about too many procedures around the eyes performed in a short period of time. If you post some pictures, we may be able to give you more specific advice. However, you may want to review your pre-operative pictures to appreciate the difference that you already have. It may be impossible to smooth out your skin 100% without leading to other problems. Hopefully, you have had open and honest discussions with your surgeon. Good luck.
Three options but you should first get a good medical advice
Only a clinical exam or at least a picture will allow a plastic surgeon to give you the best advice. The options you have:
1. Do nothing for now.
2. CO2 ( which you already did)
In any case, get a good advice from a board certified plastic surgeon in your area.
Fraxel will not tighten lower eyelid skin after Blepharoplasty-please see an expert
Fraxel will not tigten the skin, save your money.
If an adequate depth CO2 resurfacing had been done you should have seen a difference. I would not repeat the CO2-the problem with flat beam CO2 is that adequate depths of peel to tighten the skin and remove wrinkles could leave your skin white and pull the lid down into a sad eyed look or ectropion.
You need to be examined by an epert plastic sureon who is very experienced in eyelid surgery and laser surgery-there are not many.
The problem is that complications increase the more times you have procedures done on the lower eyelids
Ask your expert about Botox which will reduce crow's feet and will help wrinkles on the outer edge of the lower eyelid.
If you have good lower eyelid support with a normal shape and no drooping of the eylid (called sad eyed look, scleral show or ectropion) you may be able to have additional skin tightening.
The options are a "pinch excision" of skin only. Problem-if too much is removed you may get an ectropion
I have also had good luck with 2940 fractional ablative laser resurfacing (Palomar lux 2940 groove optic-very new), but you really need to be treated by someone who knows how to use this technique on the eyelid.
Also read about transconjunctival arcus marginalis release and fat grafting or fat repositioning. This procedure avoids an external incision and loss of eyelid support. The procedure re drapes the lower eyelid skin and adds volume beneath the lid, both of which can help the skin laxity. (see reference below)
You need an exam and sound, careful honest advice from a board certified, experienced eyelid plastoic surgeon who has knowledge of advanced modern techniques.
If it sounds too good to be true-it always is!
Careful diagnosis needed
Loose skin is a descriptive term, not an anatomic one. A careful examination and a meticulous analysis will point you in the right direction. Loose skin could refer to a textural/qualitative condition due to loss of elasticity and surface etching or fine wrinkles. It could refer to contour changes from fat herniation in conjuncton with oribital rim hypoplasia causing the skin to hang like a beer belly would. It could refer to true excess of skin surface area as seen with actual folds or rolls of skin. Each situation will require a different approach or a combination of procedures. CO2 lasers can work well when applied well.
Loose skin is in the eye of the beholder.
Dear Hawaiian Girl
It is very difficult to provide a meaningful answer to your question without knowing more about your situation. What you perceive as loose skin maybe viewed as an acceptable post-operative result to your surgeon. We don't know how deeply pigmented you eyelid skin is. This may have something to do with how agressively your first surgeon laser resurfaced the lower eyelid skin. I would disagree that laser resufacing is the best lower eyelid skin tightening treatment. This has to be reserved for phenol chemical peeling. Would this be right for you? Only a master chemical peeler can answer this. Note that just because someone does laser resufacing or is a board certified plastic surgery they are not necessarily trained to do chemical peels of this strength. So you need to be especially cautious. You need to do your homework or you will quickly find that you have a permanent, unrepairable skin texture change form too much skin resurfaceing or a pulled down lower eyelid from too much lower eyelid surgery. Take your time and if your family members are telling you are crazy, sometime, sometimes, it is worth pausing to think about what they are saying.
The question is why.
You have already had the most effective methods of tightening the lower eyelid skin. There can be many reasons for continued laxity of the skin. Only examination by a skilled Plastic Surgeon who does a lot of work around the eye can determine what the problem is in your case. Sometimes a re-do blepharoplasty will be necessary. This will have to be done differently than the first one, however, to achieve different results. Usually this requires separating the lid into components, detaching it from its bony attachments, repositioning the fat and reattaching the lid to something solid (like the covering over the orbital bone). Because of what you have already had, this must be done very carefully. Even then, there is no guarantee that the skin will not stretch and loosen again. This tendency must be evaluated preoperatively, if possible. Another alternative is to fill the lid with fat or one of the commercial fillers to take up the extra room under the lid, if this is the reason for the loose skin. Sometimes you also have to just say, “enough is enough” and accept that nothing else can be done safely. No matter what, another laser of any sort, including the Fraxel, will be dangerous and almost certainly a waste of money.
Surgery may very well be the best choice
Lower lid blepharoplasty can definitely be tricky. One of the best decisions that a surgeon can make when faced with skin to be removed is when in doubt take less rather than more. Removal of too much skin is a disaster. The problem of course is that now your still left with too much skin.
CO2 laser is excellent to tighten and resurface skin. Fraxel is simply fractionated CO2 so if the laser you already got didn't do anything neither will Fraxel. My recommendation would be for a revision of the bleph. I don't think any other adjunctive measure will help at this point.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.