How Close Can the Fraxel Restore Laser Go Under the Eye?

Question

I want to get Juvederm under my eyes for tear troughs, however, I also want to get Fraxel Restore for skin resurfacing. I have two questions: 1) How close can the Fraxel Restore laser get to the eye for fixing under eye wrinkles and crepe under eye skin? I notice some doctors treat right under the eye in photos, and 2)Is it safe to have Fraxel Restore done full face and including under the eye two months after injecting Juvederm under the eye for tear troughs? Could this cause pigmentation?

William Groff, DO · Answer

1. It is safe to treat right up to the lash line, but the physician needs to place a corneal shield (fits like a contact lens) over the eye for protection.

	2.  It is safe to treat 2 months after Juvederm injections, but there is a slight risk of hyperpigmentation (temporary), and this is more likely if you have darker skin.  If you have fair skin, this would be a rare complication.

Ron Shelton, MD · Answer

We routinely treat with Fraxel Restore right up to the eyelashes. There is a risk of post inflammatory hyperpigmentation with any resurfacing technique and even fillers, but this is rare, not common. Some skin types are more prone to hyperpigmentation and often the individual knows this about their skin as it gets darker and stays dark for many months after they get a mosquito bite, get an acne blemish, bump their extremity, burn their skin in the kitchen, etc. There has been no evidence that the laser interferes with the Juvederm which is placed more deeply than the laser's penetration.

Timothy G. Rodgers, MD, FAAD · Answer

Fraxel can be used to treat under the eyes, including the eyelids, assuming appropriate precautions and safety measures are taken. Metallic eye shields are put into the eye to protect from the laser if treatments are being performed on the eyelid itself. Also, it is safe to have the Fraxel performed under the eyes if you have had Juvederm used there previously. In most cases, fillers such as Juvederm are placed deep under the skin so that they will not be affected by the laser.

Richard Galitz, MD, FACS (in memoriam) · Answer

We routinely go just below the eyelash line and get all the lower eyelid skin to respond to the laser. This can be done carefully without injury to the eye. There is no problem doing this 2 months after juvederm injection for a tear trough deformity. If you are not very olive skinned or afro-american pigmentation should not be a problem.

Jana K. Rasmussen, MD (retired) · Answer

I have very good results with Fraxel Restore laser beneath the lower lids. It is dependent on intensity of treatment (mj or depth of treatment) ,treatment level (amount of surface area treated) and number of treatments performed. Fraxel significantly improves the texture and fine wrinkling around the eyelids, even after one treatment, although a series of 3 or 4 is usually recommended.  If a new patient tells me they tried Fraxel elsewhere but didn't see improvement, I ask them....was it REAL Fraxel, who did the treatment (a technician will not be as aggressive....PS in Florida, only a physician or physicians assistant is legally permitted to do  laser....many facilities do not follow these statutes), and what were the settings (those well trained will feel comfortable recommending aggressive settings, thereby getting better results).

	BOTOX is a good adjunct to the fine wrinkles, known as crows feet, although this is an off label use of BOTOX,

	I am not a proponent of Injectables fillers in the lower lids. Perhaps this is because I have had several patients come to me in second opinion with horrendous results....excessive swelling that persists for months, or even rock hard "foreign body" types of responses in the "nasojugal groove" or tear trough. This is a very sensitive area and Injectables can result in problems that may persist for months, if not longer.  The key as a plastic surgeon is to avoid over resection of fat in the lower lid when we perform a lower lid Blepharoplasty.

How Close Can the Fraxel Restore Laser Go Under the Eye?

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