Under Eye Wrinkle Treatment with Blepharoplasty

I am scheduled for an upper Blephroplasty . For under my under eye wrinkle, what would be most effective and longer-lasting treatment? Will TCA Peel or Fraxel CO2 Laser work?

Doctor Answers 13

Under Eye Wrinkle Treatment lasers vs Chemical Peel

Both fractional C02 laser and  TCA peels can be used for under eye wrinkles, and we offer both treatments.  In comparing the two modalities, the laser perhaps produces more immediate wrinkle reduction, which is evident at the time of treatment.  It does cause more inflammation and incur a longer recovery.  TCA peels are reserved for less extensive wrinkles and redundancy. We use a straight 30% TCA peel over other blends such as VI peels as it produces more skin tightening. The peel and recovery is well tolerated. Surgery is reserved for fat herniation and excessive skin redundancy.   Have a  candid conversation with your physician to discuss your specific circumstances.

Arthur Falk, MD


Albany Facial Plastic Surgeon
4.5 out of 5 stars 10 reviews

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.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 13 reviews

Under eye wrinkle treatment: Depends On The Amount Of Wrinkles

Wrinkles of the lower lids come from mild to severe. In severe cases only surgery will help. If the wrinkles are mild to moderate than I'm a firm believer in first, tretinoin, then peels such as the Vi Peel, then possibly Botox. I have yet to be thrilled by any laser. Perhaps fractionated CO2 will help but you have to consider the pros and cons.

Under Eye Wrinkle Treatment with Blepharoplasty

Both TCS peel and Fraxel CO2 laser are effective at treating the lower lids in conjunction with your upper eyelid blepharoplasty. The TCA peel treats more mild cases and has faster healing time, but care is required to ensure it does not get into the eyes. The CO2 laser can be used for more prominent wrinkles and can treat up to the lash line. One laser you did not mention is the Erbium laser. It gives great results with short recovery time and is very safe. 

Treatment of Under Eye Wrinkles

Thank you for the great question. In short, it really depends on the location and quantity of the wrinkles. Dynamic wrinkles lateral to the eye ("crow's feet") can be softened with Botox. Once these are more permanent, laser resurfacing using a fractional CO2 laser is my preferred treatment. In the area directly under the eye, it is common to have some thin or crepey skin. If there is a significant amount of extra skin, a lower eyelid lift is likely a better choice. This can address the skin excess as well as any fat herniation that is present. Lastly, lower eyelid surgery can be combined with laser procedures for a more complete rejuvenation. Best of luck moving forward!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
5.0 out of 5 stars 63 reviews

under eye wrinkle treatment

 The primary goal for lower eye lid surgery is to remove the fatty deposits creating the puffiness look. In patients over 45 years of age, most  will need a pinch technique to remove the excess skin present at rest on the lower lids. This pinch technique is incision placed at the lash line and closed with tissue glue in our practice.
 Other treatments such as fractionated laser and TCA peel are acceptable once  you have removed any excess skin. For many examples, please see the link below to our eyelid surgery photo  gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

Under Eye Wrinkle Treatment with Blepharoplasty

I agree that if the area under the eyes has fat bags and loose skin then a lower blepharoplasty must be performed either by transconjunctival or external approach. For fine lines I would use a ViPeel if there were no fat pads or significant loose skin.

Paul Vitenas, Jr., MD
Houston Plastic Surgeon
5.0 out of 5 stars 65 reviews

Resurfacing treatment for management of fine or significant wrinkles under the eyes

For management of fine or even more significant wrinkles under the eyes, I suggest that you consider some kind of resurfacing treatment.  A fractional CO2 laser could be used or a tunable resurfacing laser could be used to smooth away the wrinkles and tighten the skin in this lower eyelid area. 

While a TCA peel is effective in tightening the skin to a small degree, it is much more effective for treatment of pigmentation irregularities, and improvement of skin tone and texture.  A resurfacing technique would certainly be more effective and long-lasting versus the TCA peel.

Michael R. Macdonald, MD
Bay Area Facial Plastic Surgeon
4.5 out of 5 stars 14 reviews

Lasers go away!

Lasers have been unimpressive and any clinical data is lacking. The best you can say about lasers is that they sound cool!

The best way to treat your lower lid wrinkles:

Daily: Retin-A, anti-oxidants, and sunblock

Weekly to monthly: chemical peels (many kinds - whatever you tolerate), Lactic acid, Jessner's, Glycolic acid, Obagi, weak TCA

Yearly to longer: Strong Chemical peels like TCA or Phenol

Robert M. Freund, MD
New York Plastic Surgeon
5.0 out of 5 stars 25 reviews

Chemical peel of the lower eyes is common for fine lines.

I like to use TCA peel for the lower eyes. The depth of the peel is fairly controllable and predictable and it works really well to get rid of fine lines on the lower eyes. It also helps tighten the skin a little, which is an added benefit. Chemical peel of the lower eyes is not a substitute for lower eyelid surgery. Lower eyelid surgery is done to remove excess skin and fat bulges from the lower eyes. Chemical peel is done to improve the quality of the eyelid skin. If it is the fine lines around the lower eyelids that is the problem, I definitely recommend a chemical peel for this area.

Good luck!

Thomas T. Nguyen, MD
Orange County Plastic Surgeon
4.5 out of 5 stars 16 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.