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 (11)

Choices for lower eyelid rejuvenation

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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.

Atlanta Plastic Surgeon
5.0 out of 5 stars 10 reviews

Under eye wrinkle treatment: Depends On The Amount Of Wrinkles

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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.

Treatment of Under Eye Wrinkles

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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 48 reviews

under eye wrinkle treatment

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 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 60 reviews

Under Eye Wrinkle Treatment with Blepharoplasty

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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 42 reviews

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

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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 12 reviews

Lasers go away!

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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
4.5 out of 5 stars 21 reviews

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

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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

Why don't you have your lower eyelids operated on also?

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Hi! I don't think Fraxel does much. Peels can help. But these things are promoted to avoid surgery. You are having surgery. A well performed lower blepharoplasty can create a smooth lower lid with a long lasting result.

Most of our patients who have eyelid surgery have both the upper and lower lids done.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Ablative fractional laser resurfacing best for lower eyelid wrinkles

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Chemical peeling can work very well for lower eyelid wrinkles. However, chemical peels can go too deep and cause pigmentation and or scarring if not done correctly.

The same holds true for the fractional CO2 lasers, they must be done properly or complications can result.

I personally use the Erbium fractional ablative laser to peel the lower eyelid during blepharoplasty.

The Erbium laser causes less heat injury, usually results in quicker healing, and has less risk of causing the skin to turn white.

The most recent, up to date technique is a combined non-ablative Lux1440 and ablative Lux2940 laser resurfacing. These two fractional Erbium lasers are combined in one treatment and provide excellenmt wrinkle removal and skin rejuvenation with very little risk of scarring or delayed recovery.

You may have to search a while for someone who uses this new technique, however it is an excellent innovation and worth the wait.

The eyelids are very thin and susceptible to scarring if careful technique is not used.

See before and after photos of fractional laser treatment.

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.