Blepharoplasty or Fraxel Laser for Wrinkled Under Eyes?

Question

I am considering an upper Blepharoplasty and Fraxel Laser. Thought that I needed lower Blepharoplasty, but the doctor said Fraxel will work for wrinkled skin under eyes. Is this true? Also told me down time for Fraxel is only a little more than a week. I'm considering Fraxel whole face. He also said it would help bring down Juvederm overfill. Has anyone noticed this?

Ron Shelton, MD · Answer

Usually, the wrinkled skin of the eyelid does respond better to laser resurfacing than skin removal with blepharoplasty. Fraxel re:pair is a one session treatment but Fraxel re:store is a series of treatments usually done a few weeks apart. The re:pair may take more than one week to heal. It may take up to two weeks and there is a very small chance of scarring to form. I am not aware that it will reduce Juvederm overfill as it doesn&rsquo;t penetrate the depth into which

Jeffrey Zwiren, MD · Answer

You would be a candidate for a  lower eyelid  blepharoplasty.    If 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 with fat repositioning.  An accurate diagnosis of the problem is essential.  .  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.  Other choices would include soft tissue fillers such as Juvederm.

Sutton Graham II, MD · Answer

Actually, the two techniques can compliment each other, giving better results when combined.
The fractional resurfacing (various brands including Fraxel) can improve the surface texture, tone and even pigmentation around the eyes. Down-time depends on the operator. Remember to insist on metal eye shields when having treatments very near the eye. It can't treat the puffiness under or above the eyes. It can't reliably treat Juvaderm over-filling, but enzyme injections can decrease this well.
Blepharoplasty is a surgical technique that reliably removes excessive skin, lax muscle, and protruding fat from around the eyes. It tightens skin by removing lax excess, but the skin that remains still has its natural texture lines (which resurfacing can improve).
If surface texture is the primary concern for your lower lids, the resurfacing may be preferable.

Vincent P. Marin, MD, FACS · Answer

Fraxel is a great resurfacing laser that can improve the texture, pigment and quality of your skin BUT it can only improve "so much" with respect to excess skin and fat. Eyelid surgery can much more easily remove larger quantities of excess skin, and also remove excess fat around the eye that the laser can't improve, but it will not change the quality of the skin.  
Thus, these treatments improve different aspects of aging, and you should see a physician who offers both treatments and isn't pushing one side just because it is the only tool he/she has. The best results often come from a combination of lasers and surgery as they are improving different aspects of the aging process. Lasers are thought to be fairly safe in the presence of fillers, but the excess energy, if appropriately targeted, should be able to reduce the volume of the filler - since the Fraxel travels deeper into the tissues this may help.As for downtime, the social downtime you will experience is virtually equal with a need for some degree of camouflage make-up over the first several weeks with both procedures. Good luck.

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