ActiveFX™ vs. DeepFX™ vs. TotalFX™ for periorbital region? 32 with very mild lines, and mild, moderate laxity under eyes.

Is ActiveFX the only treatment option for the periorbital area, or are DeepFX and/or TotalFX also utilized? Was told ActiveFX is the only option for this area due to the delicate skin; I'd like to verify if this is correct. Additionally, is it customary for CO2 laser treatment to include the upper eyelids, or is this area typically avoided? If upper eyelids are included, should they tighten the skin there a bit? Is this truly the best option for tightening skin/treating mild laxity in this area?

Doctor Answers 4

Periorbital Laser

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I perform Total FX routinely in the periorbital area. ActiveFX alone will only improve this area minimally. Normally we do not laser the upper eyelids.

Fort Lauderdale Oculoplastic Surgeon
4.9 out of 5 stars 91 reviews

ActiveFX and DeepFX around eyes

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Both modes of the Ultrapulsed CO2 laser are options for around the eyes and both can be done at the same time in the right situation with the right settings. I published a peer-reviewed article demonstrating the effectiveness and safety of this treatment.  I believe the benefit is that both active and deep settings target 2 different depths of the skin, and aging takes place in both of these levels. 

You can also have CO2 laser performed on your upper eyelids and I routinely offer this as a standalone treatment to address upper eyelid photodamage and wrinkles or as an add-on to upper blepharoplasty.  It never made sense to me that surgeons routinely resurface the lower eyelids with laser but never touch the upper eyelids which also undergo the same skin aging.  I also published a peer-reviewed article demonstrating the effectiveness of this treatment.

Brett S. Kotlus, MD, MS
New York Oculoplastic Surgeon
5.0 out of 5 stars 63 reviews

Thin lid skin limits treatment options

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Hi, I just added a link that might be helpful...

Hi Shortcake83.  Thanks for your question.  While an in person examination is necessary to say with certainty, there are usually limited options for eye wrinkles because of the thinness of the skin.  I usually use the TotalFX approach (both Active & Deep) over the lower lid skin that can be positioned (pulled down) over bone.  The skin over the brow bone may be tightened as well.  Other options that are less effective, and need to be repeated, like chemical peels, microneedling etc. have the same anatomic limitations.  Good luck!

ActiveFX™ vs. DeepFX™ vs. TotalFX™ for periorbital region?

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Hi Petunia83,

The ActiveFX was designed for fractional resurfacing of the skin that can be tailored depending on the fluence (how strong the energy is applied) to penetrate to a safe depth in the area around the eyes when utilized properly. It works primarily to treat sun damage skin and wrinkles of the skin. ActiveFX can be used in the upper eyelid area to decrease the amount of excess skin, as long as it is a mild amount. Larger amounts of skin will need surgical excision, but resurfacing is a nice way to remove some skin without giving a surgical scar to a 32y/o.

The DeepFX was designed not to resurface sun damage skin, but to help penetrate deeper into the dermal layer of the skin for problems with scaring, like acne scars, surgical/trauma scars, or burn scars. It does very little to resurface the surface of the skin or change mild wrinkles. Due to the deep penetration of the DeepFX, I have never recommended it to treat the area around the eyes, because similar problems with complications with ectropion or scaring can happen with this more aggressive treatment laser head.

The TotalFX is a treatment that combines the DeepFX and the ActiveFX in the same area the same day. Due to the high risk of complications that could happen on the area around the eyes due to the thin delicate skin with DeepFX, I do not then recommend TotalFX for the area around the eyes. Total FX works great for a patient with acne scaring on the cheeks, chin, and/or forehead that has sun damage and the combination of Deep/ActiveFX is then beneficial for this patient.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, used against any physician or as medical witness expert advise or court, but only opinion. This answer is for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. Seek in-person treatment with a trained medical professional for appropriate care."

Hope this helps,
Dr. Gus Diaz

Gustavo A. Diaz, MD
Charlotte Facial Plastic Surgeon

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.