I had upper eyelid surgery about 4 years ago and fat removal and laser resurfacing as well. I would like to further tighten the skin under my eyes. Can I do that with more laser resurfacing or other non-surgical techniues? I prefer not to be under anesthesia again.
Laser Resurfacing or Non-surgical Procedures to Tighten Under Eye Area?
Doctor Answers 15
Skin resurfacing for improving lower eyelid appearance
Laser resurfacing, chemical peel, and injectable fillers all are minimally invasive procedures that will help improve the appearance of your lower eyelids. Your lower eyelid seems to have a reasonably large tear trough (groove between inner portion of lower eyelid and cheek), which can be treated very effectively with Restylane or Juvederm. If you also have some loose skin, an in office chemical or laser peel can effectively tighten the lower eyelids.
Best of luck!
Ultrashort incision cheeklift to tighten skin under the eyes
The lower eyes are a tricky area. If you just remove fat, hollowness ensues. If you remove skin in order to tighten the area, the corners of the eye pull down. This in turn causes a rounding of the eye or a distored eye shape.
Yet the lower eyelid has both hollowness and bulges as fat deflates and the center mass of the cheek slides downward.
In our practice we prefer to perform an ultrashort incision cheeklift to tighten the lower eyelid skin.
The premise of this procedure is that when skin is tightened, the tissue must first be GIVEN to the lower eyelid, not taken from it. A cheeklift does this by elevating the cheek, "giving" tissue to the lower eyelid, thereby enabling safe tightening that does not alter eye shape.
Laser resurfacing does tighten the skin and we use it frequently, but does not accomplish the structural changes your eye would need to get the best result.
Remember the cheeklift is the trickiest operation in plastic surgery, in my opinion, so be careful to choose a surgeon with great experience in the area.
Prefer Peels under the eyes
I actually prefer phenol chemical peeling under the eyes and actually peel more than 50% of my lower blepharoplasty patients. Generally this is done 2-3 months following the surgery. At times we actually combine the peel with a transconjunctival blepharoplasty (internal incision only) while the patient is under intravenous anesthesia.
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I agree with all that Dr Fincher says (see his comments below). Laser resurfacing will tighten the lid skin and address crepey skin and fine lines and wrinkles. Hyaluronic acid soft tissue filler for the sunken area under the eye is a nice easy procedure. All of these can and should be done under local anesthsia as the risks of general anesthesia compared to using local far outweigh the need and make the procedure safer for you and less expensive as well.
Many options for the lower eyelids
There are several techniques that are effective for the lower eyelids depending upon what needs to be altered.
Laser resurfacing is great for tightening loose skin, removing pigmentation and sun damage and for smoothing wrinkles. For bulging fat pads, surgery is still the best treatment and can be done without deep general anesthesia. Almost all of my eyelid procedures are done under local anesthesia with some oral sedation ( valium or ativan).
Filling in hollows or a prominent tear trough such as what is shown in your picture is most often accomplished either through moving or repositioning fat during a lower eyelid surgery, or by injecting hyaluronic acid fillers such as Juvederm or Restylane. These are simple in office, out patient procedures that require simple local anesthesia, ice packs and about 20 minutes of time. The filler is placed in the hollow or shadow and plumps the skin to create a smooth contour. Some bruising may occur, but when performed properly it is a safe procedure.
Of course, some patients will require a combination of these procedures to accomplish the ideal outcome. When you are ready for another treatment, consult your cosmetic surgeon to find out the best options for you.
Laser able to tighten lower lids in most cases
This should be possible , however only after a skilled surgeon can evaluate your lower lids. You have to make sure there is no laxity that needs to be surgically tightened, prior to laser.
I use the Pearl laser for its unique wavelength, but others could be used as well.
Down time also varies with each device.
Ask your physician all these questions.
Tightening the skin under your eyes
Laser resurfacing of the lower lids is very effective at tightening the skin and treating fine wrinkles. You may also consider a TCA peel which can achieve a similar effect and possibly for less cost. Good luck.
Lower eyelid options
The appearance of your lower eyelid is very typical but very difficult to address using only laser. Your lower eyelid had small compartments of fat (3 compartments) which are held in place by a fibrous structure. In youth, the fat is not visible but as we age the fibrous support system weakes and the fat begins to bulge out giving you the appearance of having "bags." In addition this creates transition zones between the lower eyelid and cheek and the lower eyelid and nose (teartrough deformity).
For the best result, I would suggest having your lower eyelids done with surgery where the fat could be removed through a small internal incision in the eyelid (transconjunctival) and the excess skin could be removed an incision below the lash line. During this procedure the fibrous support structure can also be tightened (septal reset procedure). Alternatively, you could have the fat removed with a transconjunctival approach and the lower eyelid skin treated with an ablative laser (Erbium, CO2, or Fraxel Repair) or deep peel.
The least invasive alternative would be to opt for a laser and facial filler which will lessen the appearance of the lower eyelid/cheek and lower eyelid/nose (teartrough) grooves. The laser should be done before the filler but both could be done the same day. You need to be extremely careful with filler in this area because the skin is extremely thin and the filler can appear lumpy and artificial.
Tightening lower lid skin
Your photo is a little blurry, so it is hard to give you a good recommendation. Probably Botox injections and laser resurfacing or Active and Deep FX can help you with further tightening the under eye skin. You have to be careful not to overdo lower lid tightening to prevent the lid retraction and similar problems. See an experienced provider to further discuss your options.
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.