Laser Resurfacing or Non-surgical Procedures to Tighten Under Eye Area?

Question

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.

Brent Moelleken, MD · Answer

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.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Larry S. Nichter, MD, MS, FACS · Answer

Lower lids: Ceramide creams for the lower lids which in minutes as they dry the clear membrane tightens the lower lid skin minimizing bags and wrinkles. This lasts from 4-8 hrs and can be reapplied as needed. Radiofrequency, laser and peels tighten the skin with minimal downtime. Fillers for fat transfer #lipoinjection, to the lower lid to fill in the cheek-lid depression that casts shadows also helps many.For the upper lids, Botox in the crows feet area just below the brow will gently lift the lateral brow and lift a bit of the hooding on the side of your eye. This lasts about 3-4 months. Make sure you go to an expert injector associated with a Plastic Surgeon, Facial Plastic Surgeon, Dermatologist, or Ophthalmologist skilled in injections.#LowerLidNonsurgicalHelp

Sonia Badreshia-Bansal, MD · Answer

First, you need to have determined if you are a good candidate for any more procedures. Eye revisions are often followed with complications because only so much skin can be removed before the eyelid droops, known as an ectropian. Only go to a Board Certified Plastic Surgeon experienced in eyelid revisions to understand your options.

Mitchel Goldman, MD · Answer

The most effective laser for tightening the skin around the eyes is the Active and Deep FX Ultrapulse CO2 laser. There are many different fractionated lasers that may help. But the Ultrapulse CO2 appears to be the most effective with the least pain and down-time. Physician experience is also important, since the laser can be used in a variety of settings. So be sure to select an experienced Board Certified Dermatologist or Cosmetic Surgeon. In my office, this procedure is performed entirely under topical anesthesia and patients can put make-up over the area in 4-5 days with complete healing in 7-10 days.

Sam Jejurikar, MD · Answer

Hi,
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!

David Shafer, MD, FACS · Answer

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.

John L. Burns Jr., MD · Answer

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.

Otto Joseph Placik, MD · Answer

Yes, laser resurfacing may be useful and/or skin peels.
Fillers to the tear trough may also be used to soften the deep groove between your eyelid and cheek which may help to give the illusion of a tighter lower lid.

Shawn Allen, MD · Answer

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.

Laser Resurfacing or Non-surgical Procedures to Tighten Under Eye Area?

Answers (16)

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