54 y/o f concerned about crepey lax under eyes - which procedure other than blepharoplasty would be best for this?

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

At least from the photos there appears to be some volume deficit in the cheeks. And since the cheeks are a major physical support for the under-eye regions, the use of a robust HA volumizing filler as a nonsurgical cheek augmentation would not only create a more ideal, feminine, oval, heart-shaped face and a more desirable ogee curve, but would very likely secondarily improve the under-eye region--decreasing the crepeyness. If still necessary, additional benefit can be achieved with a series of in-office superficial under-eye peels, using full strength glycolic or salicylic acid, Jessner's Solution or low concentrations of TCA coupled with regular at-home use of an appropriate topical retinoid. You would be wise to consult with an experienced, board certified cosmetic dermatologist who can help you with all these approaches. Hope this helps and best of luck.

A lower bleparoplasty would be a procedure of choice for you. This will address tear trough deformity and fat pads above it, and tighten you eyelid skin. It is unlikely that less invasive procedure like chemical peel, laser and micro-needling would be as effective. Hope this helps.

You can have surgery here, but, as it is not too extreme and your skin is thin, I would be able to get a good result with laser or rf skin tightening. Both can be done right in the office.

With age and sun damage, your skin has lost elasticity.
We don’t have great procedures to restore skin elasticity.
Treatment Options include the use of retin A, ablative laser resurfacing, chemical peels and volume restoration using filler.
For a long-term strategy using sunscreen and avoiding excessive sun exposure are probably the most effective options.Best,
Mats Hagstrom MD