Traditional Blepharoplasty Vs Laser Blepharoplasty for Eye Bags?

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.

Thank you for your question and I think many patients can be confused by the terminology here.
First of all, "laser blepharoplasty" can mean different things depending on how one intends on using the laser.  Lasers can be used in two main ways for lower eyelid rejuvenation. It can be used for skin resurfacing (erbium or CO2) for fine lines and improving texture, or it can be used to make an incision in the skin (typically CO2) just like a scalpel would make an incision to initiate the surgical approach in a blepharoplasty.  Therefore, if the surgeon is simply referring to how the incision is made, there is really no difference in outcomes or results if this incision is made with a laser or a scalpel. Most surgeons prefer a scalpel (including me) but that doesn't mean one is necessarily better than the other.  What's more important is the skill and experience of the surgeon using the technique that works best for him or her.
For under eye bags, this is usually due to excessive fat in the lower eyelid, or sometimes areas of volume loss that accentuates fat pockets or depressions in the skin giving the appearance of bags.  When this is the case, laser resurfacing will not be beneficial. It takes surgical intervention to remove and/or reposition the fat or filler (or autologous fat) injected into areas of hollowing to address changes or issues with volume.
Laser resurfacing is performed to improve the texture and quality of the lower eyelid skin.  This is very different from and would not be considered a blepharoplasty. If someone is marketing the use of laser to reduce fine lines and improve the texture of lower eyelid skin and calling it a "laser blepharoplasty", I would consider this terminology misleading and inaccurate. It's not a bad procedure, but if you have true under eye bags from fat pockets, laser will not help with this.
Sometimes bags can be caused by excessive sagging skin, or at least be a major component of it.  When this is the case, skin will typically have to be surgically removed and laser will not be adequate to achieve these results.  When this is the case I like to combine laser to improve skin quality and surgical excision to address the extra skin.
I hope this is helpful for you and others who might be confused by this language. Good luck!

There are many ways to deal with eye bags.
- Traditional open surgery- possibly more immediate result
- Scarless fat removal and repositioning- less risk then open but need something separate for skin.
- Scarless fat removal and repositioning and skin tightening with laser.- less immediate and less risk but slower and result not as definite as surgery.
All of the above have advantages and disadvantages and cost differences.
Wish you the best in your journey,
Dr Leo Kim, Specialist Plastic Surgeon in Sydney