Accutite vs lower bleph - I’m not keen on the general anesthesia, though. thoughts? (photo)

While surgery for the lower eyelids is the more traditional and reproducible result for the lower eyelids, Accutite combined with Morpheus is a close second.  Accutite is not for everyone.  Those patients with laxity of the lower eyelid are generally not good candidates for the treatment.  Additionally, the swelling can last for a while afterward.  However, we have seen improvement in the patients that have "bags" of the lower eyelids and some crepey skin.  The treatment does not make everything go away but patients comment that they look more rested and in some instances is clearly greatly improved.  There is also improvement in the veins that are visible through the skin of the lower eyelids which gives a brightening effect. 

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. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. 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

From your photos you are a better candidate for a lower blepharoplasty. This would address excess skin and the herniated fat. It can be combined with an upper blepharoplasty for a refreshed look. I've included a video on the procedures that I hope you find helpful.

Do both! I feel lower eyelid lift can give your lower eyelid area a powerful lift and good shape change but will not fix the crepey skin- that's where Accutite comes in. Accutite deals with skin tone and laxity and may have some effect on the "bags" but not nearly the effect that an eyelid lift. Accutite can really be considered an adjunct to eyelid surgery and not a replacement. Best Wishes!!

AccuTite with Morpheus is a great alternative to a surgerical lower lid blepharoplasty. The results are about 60% of surgery with no need for general anesthesia. The improvement in the lower eyelid bags and skin tightening would be great in your case

A lower lid blepharoplasty is still the gold standard for fat pseudoherneation in the lower eyelid. Based on your photos, you have a moderate amount of herniation along with some fine lines. Even surgery usually doesn't fix the skin quality on the lower eyelid and many patients need a superficial energy device after the fat is repositioned. FaceTite and AccuTite can be used in patients who would benefit from a facelift as well but sometimes you can get enough improvement to buy some time before surgery. They aren't mutually exclusive and if you are not happy with the AccuTite results, you can always have surgery. I would probably recommend the AccuTite along with Morpheus8 microneedling and give it about six months. You would likely need a few more Morpheus8 treatments to improve skin qualityBest of luck