Traditional Blepharoplasty Vs Laser Blepharoplasty for Eye Bags?

Hello, you look great. The best "plastic surgery" is smiling, and your smile makes you look very young.
Now as far as your under eye area - it is difficult to advise you based on this picture alone. If you have minimal fat under your eyes then a fractionated carbon dioxide laser such as Fraxel re:pair gives great results alone. If you have excessive skin, then it can be combined with a skin "pinch" excision. If you have a lot of fat protrusion then a transconjunctival approach (from inside your lower eyelid) incision is best to remove or in some cases reposition the fat. If there is hollowness under the eye that is creating the "bag", then carefully placed filler such as Restylane (temporary), or your own fat (permanent) can smooth out the bag and give you a youthful lower eyelid and cheek.
"Laser" blepharoplasty can mean different things. When used as a cutting tool, laser blepharoplasty is not much different from "scalpel" blepharoplasty, other than using the laser as a scalpel. The laser can be used to make the transconjunctival incision or to make the lower eyelid incision. With the laser incisions there is initially less swelling and bruising, but by the second to third day, the healing, swelling and bruising is the same as scalpel incisions.
Again, with the old traditional CO2 lasers and the new Fractionated CO2 lasers, laser resurfacing of the crepe skin of the lower eyelid gives great smoothing of the skin without any incisions in the skin.
I began this answer by trying to make matters less confusing for you, but have likely made you more confused than ever. The most important thing that you can do is choose your surgeon most carefully and be sure that your expectations meet your surgeon’s expectations and ability. Be well and keep showing your beautiful smile.
Dr. P

Excellent question! I think unfortunately we as doctors often use confusing terminology which can make things more difficult to understand for our patients. It is unclear exactly what your surgeon meant by "laser blepharoplasty" because this could mean 1) they are using a laser to tighten the skin and not actually performing a blepharoplasty or 2) a blepharoplasty in addition to a laser tightening device or 3) using a laser to make the incision for the blepharoplasty. All of these are options, though I would not say any one of them is "better" than tradiational blepharoplasty.
The second surgeon is referring to where the incision is placed during surgery which can be 1) under the eyelashes or 2) inside the eyelid. Both of these are good options based on your anatomy and alot of it is based on surgeon's preference.
In general, if there is ever confusion of what exactly is being done during surgery, I would make sure you bring this to the attention of your surgeon. If they continue to give confusing answers or you don't feel comfortable, I would seek another surgeon.
Hope this helps!Kyle Kimura, MDFacial Plastic and Reconstructive Surgery

Hi and Happy Birthday!  Like most techniques, there are many options depending on the clinical presentation and plastic surgeons’s preference.  
Lower eye lid surgery is one of the most common anti-aging procedures we perform.  There are usually 3 aspects of the lower eyelid that we address:  “eye bags” which is herniation or orbital fat, wrinkles which is caused by excess skin, and lower eyelid margin laxity.  
There are 3 fat compartments in our lower eyelid.  Depending on patients, we either remove them or transfer some of the fat to fill in the hollow aspect just underneath the fat protrusion which we call tear trough region.  This can be accomplished from either “inside”(through inicision in the inner mucosal lining of the lower lid) or “outside “(through an incision on the skin just below the lower eyelashes).  
The skin can be addressed by either cutting out the extra redundant skin or resurfaced through ablative laser or chemical peel.  This is really dependent on the patient’s clinical state.  
In most aging patients who we excise skin, they will benefit from some form of reinforcement of the lower eyelid margin which we call either canthopexy or canthoplasty.  
Some surgeons use lasers not just to resurface skin but also as a tool for incision instead of knife.  I think most plastic surgeons believe that knife is same or superior to lasers as a cutting instrument in terms of skin trauma and subsequent scar formation.  I hope this helped.

"Laser blepharoplasty" is a confusing term for many patients. A traditional blepharoplasty uses a scalpel or electrocautery device to make an incision (either on the skin or inside the eyelid). A laser blepharoplasty is a term that can be used to describe using the laser to make the incision (similar to a scalpel or electrocautery device), or using the laser to resurface and tighten the skin. Think of the laser as a tool just like a scalpel or electrocautery device. The key is the surgeon using the tool, not the tool itself.
In my practice, I have several different lasers, including some that can be used to make incisions. In blepharoplasty, I most commonly use the laser to resurface and tighten the lower eyelid skin either instead of, or in addition to, a conservative amount of skin excision. I always recommend finding a surgeon that you are comfortable with, look at their before and after results, and make a decision based on these factors rather than the specifics of a surgical technique.
Be sure to see a surgeon who specializes in facial aesthetic procedures.
All the best,

The terminology can certainly be confusing to many patients.Typically if someone describes a lower eyelid surgery as a laser blepharoplasty that is in reference to using a laser (CO2 - carbon dioxide laser) to make the incision and often perform some of the cautery involved in removing fat.This is in contrast to using a combination of scalpel and electrocautery.  The difference in my opinion is negligible.  Using the laser to do some of the work is a nice way to make use of some good technology, but if the more traditional methods of electrocautery or radiofrequency cautery combined with sharp dissection are performed with the appropriate level of attention to detail and meticulousness then there really is no advantage of one technique over another.Laser blepharoplasty often gets over-hyped from a marketing standpoint because it sounds fancy.  The reality is that the skill and judgment of the surgeon are far more important that the tools that he or she chooses to use to help you achieve a great result.

Congratulations- you look fantastic for 50! Looking at your lower eyelids it seems to me that you have rather excess skin than lower eye bags which are caused protruding orbital fat.
Laser blepharoplasties (with a fractionated carbon dioxide laser such as Fraxel re:pair) are less invasive and can deliver great results when you have minor to medium loose skin and wrinkles over your lower eyelids. Once a patient has deeper wrinkles and more saggy skin over their lower eyelids AND if the patient's problem are heavy eyebags a laser treatment won't be enough. In this case you will need a surgical lower eyelift: With not too big eyebags you might be advised to go for a transconjuctival lower eyelift (incision inside the eyelid). This treatment might get combined with a peel of the lower lids or CO2 laser or Fraxel repair treatment to tighten the skin of the eyelid. With heavier/puffy eyebags or excessive skin over the lower eyelids your surgeon will make an incision right underneath your eyelashes. From this incision the protruded fat can removed or even repositioned (arcus marginalis release) and saggy skin reduced. The scar usually hides very well under the eyelashes and the laugh lines.
Some surgeons use a laser instead of a scalpel to cut the skin and the fat pads. Even though 'laser' is a magic word and makes us think of a futuristic and up-to-date way to perform a blepharoplasty the laser offers no proven benefits when used as a cutting tool except slower healing.
Since you got two different treatment advice it might be worth getting a third opinion. Actually it is not difficult to make the right decision. Make sure you see a plastic surgeon who can perform all of the discussed techniques!