Upper/Lower Blepharoplasty and CO2?

Question

I am considering an Upper/Lower Blepharoplasty and CO2. I know I have ptosis as well. Do I really need a lower Blepharoplasty? CO2? What are my options? I have slight dark circles under my eyes. Will this correct it? Is the CO2 really worth it? I have had a consultation but just looking for other opinions. I originally thought just an Upper Blepharoplasty with correction for Ptosis.

Jason Emer, MD · Answer

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your particular situation.

UPPER EYELIDS:
-NON-SURGICAL: For less significant upper eyelid skin excess or more mild improvement, there are nonsurgical treatments: Radiofrequency (Thermage or Venus Legacy/Viva), injectable fillers, and a Botox brow lift can help contour the eyebrows and lift the eyelid skin.
-SURGERY: browlift and/or upper blepharoplasty is a great option for more significant improvement- for example if the hooded eyelids have more excess skin present.

LOWER EYELIDS:
-NON-SURGICAL: For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​ 
-SURGERY: A lower blepharoplasty (with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in all these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best, 
Dr. Emer

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. I recommend treatment with CO2 laser resurfacing. CO2 laser resurfacing offers a range of significant benefits for improving skin appearance and texture. This advanced treatment utilizes carbon dioxide laser technology to precisely remove damaged outer layers of the skin while stimulating the deeper layers to produce new collagen. The result is a marked reduction in wrinkles, fine lines, and age spots, as well as enhanced skin firmness and elasticity. By addressing both surface imperfections and deeper skin issues, CO2 laser resurfacing can significantly rejuvenate the skin, leading to a more youthful and even complexion. Additionally, the treatment can improve skin tone and texture, diminish the appearance of acne scars and sun damage, and offer long-lasting results with a single procedure. I hope this helps and best of luck!

Mehryar (Ray) Taban, MD, FACS · Answer

You are candidate for upper blepharoplasty and possibly the other procedures you listed. Need more detailed evaluation to determine.

Kenneth D. Steinsapir, MD · Answer

Don't have CO2 resurfacing. You really do not need it. Don't have lower eyelid surgery.  You really don't need. it. Don't work with a surgeon who makes you feel bad because you don't want to do the blue plate special. Do what makes sense and don't be bullied into having a procedure you do not want to have.

Gary M. Horndeski, MD · Answer

You are a candidate for an upper blepharoplasty.  A lower blepharoplasty may or may not be worth it as well as CO2 laser.

Best Wishes,

Gary Horndeski, M.D.

Asu Deniz Burhanoglu, MD · Answer

You do indeed need upper blepharoplasty due to your ptosis. Nonetheless you do not need a lower blepharoplasty operation as you do not seem to have under eye bags. As for the dark circles we would recommend under-eye light filling and approximately two weeks after the procedure you would begin to see results (lightening).

Mats Hagstrom, MD (license on probation) · Answer

It looks like you already have mild electrons on your lower eyelids.
I would not recommend a lower eyelid blepharoplasty that involves any skin removal.
Carefully done, trans conjunctival blepharoplasty making the incision on the inside of the eyelid only removing fat pads may be beneficial, but I think volume restoration in your mid face if done well would be a better option.
You already have a slight bit of Halloween in the upper eyelid area with mild skin redundancy.
I generally lean towards being on the conservative side and usually recognize that individuals with northern European heritage should have hooding and fold on their upper eyelid.
You don’t wanna end up looking hollow, and you are at risk if the procedure is done aggressively.
My best recommendation is to have multiple in person consultations with plastic surgeons, facial plastic surgeons, or oculoplastic surgeons in your community.
Bring pictures of your face with you to use as reference during the consultation, preferably imprinted format.
During each consultation, ask each provider to open up their portfolio and show you their entire collection of before and after pictures who had The same or very similar facial characteristics.
An experienced plastic surgeon should have access 100s of before, and after pictures to choose from and should be able to find lots of before, and after pictures of people who looked very similar to yourself in the before pictures.
If they have a hard time showing you an impressive collection of patients with similar characteristics then perhaps you’re not in the hands of the right provider.
Take careful notes during each consultation, especially regarding the quality and quantity of before and after pictures and the overall thoroughness of the consultation.
For lower eyelid blepharoplasty make absolutely sure you understand if the provider is going to remove skin or not remove skin.
If you’re going to remove skinner, then you need to have a conversation about the risk of developing and ectropion.
In my opinion, you’re already heading towards developing an ectropion, and any skin removal from your lower eyelid will just advance the process an aged appearance. For your lower eyelids, I think facial volume restoration is a better option.
In the end, the most important variable is provider selection.
I usually recommend patients have three or four consultations at least before selecting a provider.
Always rely exclusively on in person consultations, avoiding virtual consultations.
When in doubt, slow down and schedule more consultations.
The procedures your contemplating are permanent and irreversible.
Make sure you’re in the hands of a plastic surgeon who has extensive experience with this procedure.
It doesn’t matter if they have lots of good reviews for other procedures.
What matters is their skill and eyelid surgery.
Personally, I would probably start by interviewing oculoplastic surgeons, but there are plenty of plastic surgeons who are very good at eyelid surgery, and there are definitely oculoplastic surgeons who are not so great just as well.
Personally, I’ve never been a big fan of skin ablative procedures, including CO2 laser treatments of the face.
I’m not saying they can’t help. I just don’t think it’s a good idea to burn the skin.
If you’re not wearing daily sunscreen already, then that would be an absolute number one.
I would also get sun hats and simply avoid excessive sun exposure.
Best,
Mats Hagstrom MD

Upper/Lower Blepharoplasty and CO2?

Answers (7)

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