Loose Skin Under Eyes After Blepharoplasty

Question

I had Blepharoplasty done over a year ago but still have loose skin under my eyes. I have had CO2 laser done to correct this, but it did nothing. A doctor recommended Fraxel, but I've read it does nothing for skin tightening. I want to spend my money doing what's going to work. Could you suggest what I can do to get this fixed? I was considering lower eyelid surgery again. Is this necessary?

James R. Gordon, MD, FACS, FAAO · Answer

Good question. The resurfacing lasers (CO2, Erbium and Fraxel) are very good at improving skin texture, removing irregular skin pigmentation, improving fine lines, but not as helpful at skin tightening. If you have a lot of loose skin I recommend excising a strip of skin. This should do the trick.

Richard J. Bruneteau, MD · Answer

The vast majority of patients are happy with the results of blepharoplasty surgery, but occasionally, patients require secondary surgery. Your history suggests an extremely complicated post-operative course with the additional use of CO2 laser treatments. Despite this, you continue to have loose lower eyelid skin.Without pictures or a physical examination, it's hard to make a definitive treatment recommendation. After one year, it's probably reasonable to perform a minimal skin resection to tighten the lower eyelid. This type of procedure should be approached with caution. Over resection of skin can result in the development of a condition called an ectropian in which the lower eyelid is pulled in a downward direction. Unfortunately, laser treatments will have no impact upon loose eyelid skin.It's important to maintain close contact with your plastic surgeon and carefully consider your treatment options. Hopefully, a relatively minor skin resection can successfully correct this problem.

David Shafer, MD, FACS · Answer

You really need to be careful about too many procedures around the eyes performed in a short period of time. If you post some pictures, we may be able to give you more specific advice. However, you may want to review your pre-operative pictures to appreciate the difference that you already have. It may be impossible to smooth out your skin 100% without leading to other problems. Hopefully, you have had open and honest discussions with your surgeon. Good luck.

Kenneth D. Steinsapir, MD · Answer

Dear Hawaiian Girl
It is very difficult to provide a meaningful answer to your question without knowing more about your situation.  What you perceive as loose skin maybe viewed as an acceptable post-operative result to your surgeon.  We don't know how deeply pigmented you eyelid skin is.  This may have something to do with how agressively your first surgeon laser resurfaced the lower eyelid skin.  I would disagree that laser resufacing is the best lower eyelid skin tightening treatment.  This has to be reserved for phenol chemical peeling. Would this be right for you?  Only a master chemical peeler can answer this.  Note that just because someone does laser resufacing or is a board certified plastic surgery they are not necessarily trained to do chemical peels of this strength.  So you need to be especially cautious.  You need to do your homework or you will quickly find that you have a permanent, unrepairable skin texture change form too much skin resurfaceing or a pulled down lower eyelid from too much lower eyelid surgery.  Take your time and if your family members are telling you are crazy, sometime, sometimes, it is worth pausing to think about what they are saying.

Edward Buckingham, MD · Answer

Be very cautious pursuing further treatment for your loose lower eyelid skin.  
The fact that you have already had a blepharoplasty performed and CO2 laser puts you at risk to develop complications such as pulling down of the eyelid (retraction) or pulling out of the eyelid (ectropion).  
You may want to really assess the results and consider if your expectations are realistic.  If your surgeon feels that you can have a minor touch up safely Fraxel:repair can tighten eyelid skin.  Fraxel:restore will not.

Otto Joseph Placik, MD · Answer

There are numerous modalities for skin tightening but most of these provide insufficient correction. Without photos and the ability to assess lower eyelid skin/muscle/ligament tone, vectors, and other anatomic/physiologic facotrs, it is difficult to make a recommendation via this format.
Perhaps you would want to post a picture. You could benefit from a skin peel such as TCA at the least or you may need a complete revision blepharoplasty.
Get a least two opinions from surgeons.

Basim A. Matti, MBChB FRCS · Answer

You really need think twice about secondary surgery under the eyes.  Maybe seek the opinion of your Surgeon to see what he suggests, it is difficult to imagine your result with any images. Alternatively it would be advisable to see the advice of a board certified Surgeon who specialises in blepharoplasty.  Good luck on your journey!

William Portuese, MD · Answer

There is a technique for the lower blepharoplasty, which involves a pinch of excess skin on the lower lids. This can be done under a local or general anesthesia and is typically done when excess eyelid skin is present at rest and not upon animation. It is very important to take a conservative pinch of lower lid skin so that there will be no change in the shape of the lower eyelid structure.

Joseph M. Perlman, MD · Answer

Depending on your age and the amount of skin laxity there are different things that can be done. I would be wary of doing another CO2 laser treatment although the fractional CO2 lasers safer to use in my experience. If there is a slight "crepiness", then a superficial laser resurfacing may be in order but make sure that the physician treating you has experience in this area. The same goes for removal of excess skin. As one of the other commenters stated, removal of too much skin can cause lower eyelid retraction where the white part of the below the iris is exposed. As one of my professors once told me, sometimes the opposite of "good" is "better" and you can open up a whole can of worms turning a small problem into a major one.

Hisham Seify, MD, PhD, FACS · Answer

Only a clinical exam or at least a picture will allow a plastic surgeon to give you the best advice. The options you have:1. Do nothing for now.2. CO2 ( which you already did)3. Revision.In any case, get a good advice from a board certified plastic surgeon in your area.

Loose Skin Under Eyes After Blepharoplasty

Answers (16)

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