African-American Male Transconjunctival Bleph with CO2 Fraxel? (photo)

I am schedule to have my lower eye bags removed this month. I am 33, (Light Brown) African American Male, no wrinkles on my face/skin. Im just concerned that after the lower trans bleph IF I DO HAVE excess skin that does not naturally tighten, when i have the CO2 Fraxel under my eyes how long realistically is the recovery/results time? And is this suggested for my race? Or should I go with a very very small pinch procedure? Or WAIT and do nothing after the lower bleph for 6 months or so? Leo

Doctor Answers 12

Transconjunctival Blepharoplasty for Darker Skin Types

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I have performed a lot of lower eyelid surgery on people with dark skin. In my experience, I don't recommend laser or skin removal for someone your age. The risks of discoloration from laser and a line of incision which can be seen below the eyelashes make the choices you're considering less desirable. I have performed radiofrequency skin tightening under the eyes using Pelleve Skin Tightening which is safe for all skin types. I would suggest you consider having the transconjunctival blepharoplasty alone and making the decision to tighten your skin after the surgery, in which you will probably not need to have a skin tightening procedure. This transconjunctival procedure performed at my practice in New York is internal, producing no outside scars and preserving the natural shape of the eye.

New York Oculoplastic Surgeon
4.4 out of 5 stars 80 reviews

No laser on skin

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Your last plan is the way to go:  transconjunctival fat removal only. And waiting for a few months to allow the overlying skin to settle.

CO2 Laser on your skin type is a no-no.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 42 reviews

Trans conjunctival blepharoplasty in Afican American male.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Just do the transconjunctival blepharoplasty and wait to do anything else since the skin maynotneed anything more. 

Toby Mayer, MD
Beverly Hills Facial Plastic Surgeon
4.8 out of 5 stars 38 reviews

Transconjunctival Blepharoplasty

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I agree that transconjunctival blepharoplasty would be helpful for you. I would recommend minimal fat removal and would also reposition the fat to minimize the bulge. A pinch of skin can be removed, but I would not recommend fractional laser in dark skin. Instead, a radio-frequency device such as the Syneron e-matrix or Peleve can be used to safely tighten darker skin.

David Schlessinger, MD
Long Island Oculoplastic Surgeon
4.8 out of 5 stars 18 reviews

Recommend conservative approach

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Based on the picture posted (dated 2008) I would recommend a transconjunctival approach for infra-orbital fat reduction with no skin pinch or CO2 LASER resurfacing .


Edwin Ishoo, MD
Cambridge Facial Plastic Surgeon

Transconjunctival Lower Lid Blepharoplasty and Fraxel Laser in 33 Year Old African American

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Although the picture is not a standard lower lid view (sunscreen on nose included), there does appear to be enough lower lid orbital fat pseudo-herniation to justify a transconjunctival Blepharoplasty.  At age 33, your skin has enough elasticity to re-drape effectively without need for skin removal.  I would be very cautious in utilizing a CO2 fractionated laser in a patient with your skin type (Fitzpatrick Type 4).  Although the recovery is partially dependent on the power settings used, transient inflammatory hyperpigmentation (TIH) is almost a probability in Type 4 skin; TIH will resolve but can take months to fully go away.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.9 out of 5 stars 103 reviews

Lower blepharoplasty and laser resurfacing of eyelids in dark skinned patients

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

The best idea by far is the blepharoplasty alone, especially given that you have almost no wrinkling. You can always add a skin pinch later. Skip the laser altogether!

Laxmeesh Mike Nayak, MD
Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 230 reviews


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I do not see excess lower eyelid skin in your posted photo. The photo shows a lower bulge of fat and an upper bulge of eyelid muscle with a fine skin crease between them. A transconjuctival blepharoplasty will diminish the lower bulge at the risk of hollowing out the eye and will not do anything for the upper bulge. A fractional laser of the lower eyelid skin will not do much for either bulge. A dermal filler would soften the lower bulge making it contiguous with the cheek but do nothing for the upper bulge.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Aaron Stone, MD
Los Angeles Plastic Surgeon

Decision making about eyelid surgery: To laser the skin or not

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Laser skin resurfacing is often used in conjunction with transconjunctival blepharoplasty to produce an improved aesthetic effect.  While surgery can remove excess skin, the skin left behind will still have wrinkles and/or sun damage.  In a young person with good skin quality, laser resurfacing is less likely to be of benefit as it would if treating older, more damaged skin.  Any patients with darker skin color who undergo resurfacing are at an increased risk of further darkening during the recovery process (a condition known as post-inflammatory hyperpigmentation).  Rather than telling your surgeon what you want him/her to do, find one who makes a recommendation that you understand and with which you are comfortable. 

Brian Biesman, MD
Nashville Oculoplastic Surgeon
4.8 out of 5 stars 43 reviews

Be Conservative With Your Blepharoplasty- You Can Always Go Back and Do More

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I would recommend a transconjunctival lower lid blepharoplasty to remove the fat only. It may be that you will not need any skin removed. A C02 laser could change the color of your skin slightly and because of that I would not recommend that. A pinch technique would tighten the skin nicely but if you don't end up having any extra skin once the fat is removed you would have a scar under your eyelashes for no reason. Once you have healed from the transconjunctival fat removal you can always do a lower lid skin pinch if you are unhappy with the laxity of the lower lid skin. The pinch could be done with a local anesthetic making it an easy thing to do down the road.

Michael R. Menachof, MD
Greenwood Village Facial Plastic Surgeon
4.4 out of 5 stars 28 reviews

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.