I am a 31 year old female who has under eye bags and fine wrinkles . I recently seen a surgeon who recommended between 2 ways of doing the Lower eye Blepharoplasty. One was was under the eyelid with Erbium Laser resurfacing. I am unsure if that will help very much with under eye wrinkles Option 2 was the standard way with the cutting and removing excess tissue. I have been researching I can't make a choice , Do you have any advice for me to help me choose
Blepharoplasty Vs. Laser Resurfacing for Under Eye Lines?
Doctor Answers (15)
Eyebags and wrinkles
If you have under eye bags, then the fatty tissues have to be addressed surgically. And sculpting the fat from the inside of the eyelid(transconjunctival blepharoplasty) is a good approach. Erbium/CO2 resurfacing will help the fine wrinkles, but not the fatty under eye bags.
The standard blepharoplasty which removes fat and skin under the eyelash line(subciliary) is also a popular way to tighten the bags without a laser.
I would recommend to discuss with a plastic surgeon who performs many eyelid surgeries as to which technique fits your needs.
Blepharoplasty or lower eyelid LASER
Blepharoplasty and lower eyelid LASER do different things. LASER resurfacing (or, for that matter, a resurfacing chemical peel) can eliminate a mild amount of purely excess skin and reduce wrinkles. It can not, however, remove “bags.” One of the developers of LASER resurfacing and I tried for years to get it to do so, but never succeeded.
To get rid of bags and/or extra fat as well as tighten loose skin, there is no substitute for a blepharoplasty. For you, if your description is right, and you have bags and finely wrinkled skin, the only way to go is with the surgical blepharoplasty, even at your young age.
Recommend that you get some additional opinions
For so many 31 year olds, we are now treating the under eyes with Restylane avoiding the need to perform lower eyelid surgery. You might consider this option.
Regarding the two options you have been given, I personally think it is wrong to make my patients practice medicine. This is what you are being asked to do in choosing which approach is right for you. I think it is unlikely that the Erbium laser treatment will iron out your lower eyelid wrinkles. Erbium resurfacing is not as damaging as CO2 but it is also not nearly as effective. In general it is better to under treat than over treat but it is not fair to subject people to treatments that have almost no hope of achieving the desired goal.
You description of the proposed surgery is also a little vague. If the doc is proposing to cut your lower eyelid skin, remove fat and skin, you should thank that person for their time and move on. It doesn't matter if he or she did a great boob job on your best friend. Go find yourself a different surgeon. I would suggest looking for an eyelid plastic surgeon with a cosmetic surgery orientation.
Check the ASOPRS website (ASOPRS.org). The site has a directory by zip code. Check the surgeon's website and make sure they offer cosmetic surgery. You are also welcome to fiy out to LA and have a free consultation in my office.
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For under eye lines, laser definitely is the more effective treatment
Under eye lines can not be removed by removing skin. When surgeons remove skin they take a small snip of skin and this does not "iron out" the wrinkles. The best way to sooth wrinkles under the eyes is to use a resurfacing laser. There are many of these to choose from based on the color and texture of your skin.
Skin removal and laser resurfacing
Skin removal and laser resurfacing do different things. Skin removal removes excess skin but does not change the quality of the skin. Laser resurfacing changes the quality of the skin but does not remove excess skin. Your surgeon has to determine if the problem is predominantly too much skin or poor quality skin. At 31, it is probably to some extent neither. Some wrinkles are natural and normal and the goal shouldn't be to remove all wrinkles. To attempt to do so will lead to over-treatment. Laser resurfacing is probably all you need if your skin is the appropriate type and it will save you a scar with its possible complications. Better to undertreat rather than overtreat.
Laser versus surgery for lower eyelids
It sounds like you have two issues. First, the lower lid wrinkles. This can be addressed with surgery or with laser. It all depends on how much loose skin you have and the integrity of your lower lid support. Second, the lower lid bags. This is most likely due to herniating fat, which requires surgery to remove. Sometimes a combination of surgery and laser is most effective. You can have the fat removed from the inside of your eyelid to hide the incisions and then have laser resurfacing on the skin to tighten it up. I hope this is helpful. Good luck.
Both laser resurfacing and skin removal are accepted choices for lower eyelid surgeies
It sounds like your doctor is doing a great service to you by carefully reviewing your options during the consultation.
Both approaches are used by surgeons but at age 31 it would be more common in our practice to advise lower eyelid fat removal from the inside of the eyelid with laser resurfacing. If you are not quite ready to make the surgical choice remember that lower eyelid sculpting with one of the hyaluronic fillers can give a very nice result and avoid the surgery for awhile.
Hope this helps
Choices for lower eyelid rejuvenation
You would be a candidate for a lower eyelid blepharoplasty. You have herniation of orbital fat causing bags of the lower lids with lack of soft tissue fullness. These features can be corrected with a lower eyelid blepharoplasty. If the condition is only lose skin then you may want to consider SmartSkin or SmartXide microablative fractionated CO2 laser resurfacing. A consult would be needed to advise you which procedure would meet your expectations.
NEW SCIENCE byVillar
Recent research reveals fat herniation is due to a proliferation of orbital fat, not a weakness of the orbital septum, skin, or muscles as we all assumed in the past. That is why attempts to remove bags by laser tightening have failed the test of time. Laser may soften fine lines and can be used in conjunction with blepharoplasty. Best wishes. Knowledge is power. Luis F. Villar MD FACS
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.