Best Way to Refresh Eyes After Lower Bleph (S. CA Expert)? (photo)

I had a lower bleph in 07. Now Im 34 and look much older then my years around the eyes. I have darkness and deep set wrinkles (under and at crows feet) especially when I smile. Im looking for treatment suggestions (from lasers to surgery) and recommendations for Dr.s who have extensive practice with this area in the S. CA area. Any advice would be great and would love to do a consult. Thx

Doctor Answers (5)

Possible causes and a combination of non-surgical treatments

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It’s important to understand that when people consider blepharoplasty, the puffiness can artificially make the wrinkles look smoother. Just like when someone is obese, their skin can look smooth without wrinkles even when they don’t look healthy.

When dealing with fine lines and wrinkles under the eyes, my approach depends on a couple of factors with one being skin type. For light skin and skin that may be sensitive to the sun, I do a couple of key procedures. The first is a procedure called fractional CO2 laser, which is based on a principle of applying thermal energy to the backbone of the skin called the dermis so that new skin or new collagen is generated. By doing that, there’s contraction, flattening and smoothing of the skin so the wrinkles become less deep. It’s important to understand that the goal is not to get porcelain flat skin. Regardless of how smooth your skin when still, when you smile there will be some wrinkling.

In addition to the fractional C02 laser, we employ an application called platelet-rich plasma, where we take your own blood in a typical blood draw and spin it down to isolate platelets. This part of the blood which is used for healing works very well in our practice for the treatment of wrinkles, fine lines, acne scars, small pox scars and things that can be helped with new collagen. Platelet-rich plasma also stimulates blood supply to the area which fillers can’t do.

Last in this equation is to diminish the depth of the wrinkles by reducing the activity of the orbicularis oculi muscle that causes wrinkles to form when you smile. I would use Botox or Dysport to relax the muscle so the skin does not wrinkle continuously to cause creasing.

In addition to these other procedures, if you have a tight schedule, we can use a radio frequency device called Pelleve. Pelleve is a non-surgical radio frequency technology where the skin is heated at the level of the dermis, similar to a CO2 laser. Unlike the CO2 laser, it doesn’t penetrate the skin so you can have no sign that you had anything done. And like the CO2 laser, the skin generates collagen to help improve the quality of the skin.

In summary, the combinations are always better than treatments individually. So fractional CO2 laser, platelet-rich plasma, dysport or botox as well as pelleve are options to help the fine lines under the eyes. I hope that was helpful, and thank you for your question.


New York Oculoplastic Surgeon
4.5 out of 5 stars 25 reviews

Skin texture

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The problem here is mostly skin texture and wrinkling.

Dynamic wrinkles can be improved with botox, but the static wrinkles [that don't go away when you are not smiling] will need resurfacing. Whether you achieve this with a laser or chemical peels depends on the degree of your wrinkling and redundancy of the lower eyelid.

AN inperson consultation is required for that.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 21 reviews

Multi-modality treatment to rejuvenate periorbital area

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I think there are a number of nonsurgical treatment options available to you that will significantly refresh your eyes.  Botox and Dysport will be excellent to soften your crow's feet.  Even if some of the lines have been etched into the skin, starting a consistent regimen of Botox/Dysport will help to improve those lines.  

A series of medium depth TCA peels or fractional resurfacing laser treatments will help to reduce the appearance of the fine lines under your eyes, and provide some degree of tightening.  I would not even consider surgery until you have optimized treatment of your skin first.  

Donald B. Yoo, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

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Your best bet is a very detailed assessment of your eyelids.

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This needs to be correlated with your concerns.  Based on this an appropriate plan can be made.  The photograph you have provided makes it difficult to know what options will be right for you.  While you do have fine lower eyelid lines, your lower eyelids look pulled down and I suspect that you are relatively short of skin in the lower eyelid.  The important thing is to understand that less is more.  At 34, you need improvement and not surgical procedures that make you look worse.  I personally would carefully assess you to determine what might be possible without further surgery.

Kenneth D. Steinsapir, MD
Los Angeles Oculoplastic Surgeon
5.0 out of 5 stars 15 reviews

Options to improve eyes after lower blepharoplasty in past

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It appears that the main issue with your lower eyelid area is excess skin.  Your options for improvement would be to have some of the skin surgically removed or to have laser resurfacing or a chemical peel to tighten up the skin.  All of these procedures could potentially help, but there are differences in terms of recovery and cost with them.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
5.0 out of 5 stars 14 reviews

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.