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.