Erbium Laser Resurfacing on Lower Eyelids. When Can I Get Filler?

It is generally better to accomplish the laser resurfacing of the lower lids prior to fillers.  The laser treatment will usually tighten the skin by stimulating collagen formation.  By about 6 weeks after the laser, the skin should be optimal for precise placement of filler. 

 

Mark Lucarelli, MD, FACS

Madison, WI

This is a difficult question to answer. There are many types of erbium lasers, which can be set to perform fractionated or confluent treatment. In general, it should not matter what order to do the procedure; a filler can be performed at the same time as a laser procedure. Since a filler will also smooth the skin, you may not need a laser procedure after, so I would recommend getting the filler first and then after a week, schedule the laser procedure.

I have routinely performed fillers prior to laser resurfacing such as Fractional CO2 laser and have not seen quicker degradation of fillers. In fact, I believe better laser resurfacing can be achieved with the skin stretched vs. crepey skin.

It would be best to wait until after your skin has healed from your resurfacing procedure to have the filler placed. Waiting at least a few weeks would be prudent. Confirm this with your laser surgeon to make sure your skin has healed adequately before having filler placed.

As long as the face has healed 100%, which is usually by 2 weeks after most resurfacing, then fillers may be done. It is best not to inject fillers through raw skin to minimize a chance of infection.

It's best to wait until you're completely healed before having filler injections. That would be after the skin is completely healed, a week or two after the procedure. Even better... wait until the pinkness has resolved completely since your own new collagen contiues to be laid down after the procedure, and this new collagen helps to fill some of the wrinkles that you would be injecting with filler.

I always tell my patients to wait until after they have healed and received maximum tightening from their resurfacing until they have their filler done. The reasons for this are that you want the skin to maximally tighten and then see where the filler is needed. In many cases, a patient may not even need a filler or they will need only a small amount.  In general, 2 months is a good time to assess eyelid tightening.

It probably makes the most sense to first undergo the erbium laser resurfacing. Most likely you are considering injection of a filler to help fill in the tear trough between the lower eyelid and the nose. The erbium laser resurfacing will help smooth the wrinkles on the lower eyelid and may result in some improvement in the tear trough. Because there is some tightening of skin resulting from the erbium laser resurfacing, you may see modest improvement in the tear trough, which would enable the use of less filler.

The standard fillers including Restylane, Juvederm and Radiesse can be used to improve the tear trough but must be used with caution to avoid a visible lump or discoloration of the treated area. These fillers are usually placed deep beneath the skin, just above the bone. The results are temporary.

The best filler for the periorbital area, including the lower eyelid, is autologous fat. Fat is the only substance that can be evenly distributed throughout this area (it should be placed beneath the orbicularis muscle) and is also the only filler that gives permanent improvement. Fat grafting in the periorbital area is an advanced technique that must be done with care in this delicate area. Restoring lost volume in this area re-creates a youthful appearance and also reduces wrinkles because the skin has greater volume beneath it.

I would definitely wait until the laser treatment is completely healed, I would say a month afterwards.  More so because after the eyelid resurfacing you may not need filler there.  The fractional erbium treatment may get your eyelids in great shape.

However if filler is still needed, a month afterwards should be fine.