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

Laser is extremely effective for skin resurfacing and reducing fine wrinkles, and some surgeons have used it as an aid in making incisions and removing fat during the performance of blepharoplasty, but most surgeons do not feel it has any advantage over blepharoplasty performed with a scalpel. It is important to clarify whether the surgeon feels that resurfacing is sufficient to correct the problem. Surgery is generally necessary to remove fat bags under the eyes.

They are both suggesting blepharoplasty. The laser suggestion is likely thinking he can do it transconjunctival which means making the incision inside the eyelid so there is no external scar. The external approach is used if there is significant excess lower lid skin. You can also laser the external skin. I often due this in conjunction with blepharoplasty and fat transfer for a very smooth transition. Below is a list of some common causes of eye bags and my treatment protocol. Most people have a multifactorial problem meaning they have more than one problem causing this demarcation.

1. Prolapsed orbital fat through the orbital septum: treated with lower lid blepharoplasty and fat transpositioning. Can also be helped with fillers or auto fat transfer to the face but the ideal treatment in my hands is surgery for this issue.

2. Eczema: much more common in young people with fair skin. The treatment for this is to hold off on makeup and any manipulation of the lower lid for a few weeks and try some topical anti inflammatory creams. If you have allergies those should be treated also.  A dermatologist is the best person to see for this. We have a multidisciplinary clinic with myself, a plastic surgeon, and my partner, a dermatologist which I think is ideal!

3. Fluid accumulation and/or redundant skin. Could be possible in young patients but would need a good facial analysis and exam to determine. A low salt diet (< 1000mg/day) and a warm compress can help.  I would consider treating with filler/fat transfer, lower lid fractional ablative laser and/or lower lid blepharoplasty.

4. Descent of midface cheek pad. This then causes the nasojugular ligament to become more prominent creating a demarcation and separation of the eye from the cheek subunit. Treated with mid face lift and/or fat transfer.

It is all about the balance of this transition from the orbit to the cheek. There are many ways to treat this and they vary by the underlying cause. I recommend seeing a surgeon who also does a lot of these treatments. This can make a big difference as most people have a combination of the above that lead to the issue.

Hope this helps.

Best of luck,

DrC

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!

So a laser can be used like a knife blade (scalpel) or scissors to make an incision and do surgery.  In the end the result is the same - the recovery may be quicker with a laser.  A laser can also be used to improve the texture, quality and "tightness of the skin". This is called skin resurfacing. Sometimes both procedures are needed.  Just know true surgery can be done either with a laser or non-laser to cut tissue.  Hope this helps

Thank you for your question.I brings out a general issue of what appears to be the old way or "Traditional" and the new way or "Laser".  In my view, most laser procedures are over marketed and generally underperform.  Although laser may help to tighten the skin in a very limited way, most patients with lower eyelid bags need much more than laser tightening can deliver.  In most cases, I remove at least 1/8 to 1/4 inch of skin from the lower eyelid for a smooth result  To expect laser treatment of the skin to do this is magical thinking, so common in the laser marketing world.I have developed my "Traditional" blepharoplasty technique to address all the components involved in lower eyelid bags:  The loss skin, the loss and excess underlying muscle, and the excess fat.  The incisions are designed to heal in a very inconspicuous way.  I do these routinley in the office under local anesthesia and oral sedation.  I feel that my technique goes way beyond what the Traditional techniques would describe.Your case is interesting.   Really nice picture by the way!  You are smiling so your obicularis muscles are activated possibly hiding your bags caused by excess fat.  If there really isn't excess fat, then the bags you are referring to may be a combination of excess skin and excess obicularis muscle bulk just below the skin.  If that is the case, then laser blepharoplasty, in my limited evaluation of one picture, would not address the excess muscle component and perhaps not the skin as well.You probably had your blepharoplasty by now and would love to hear on what you did and how it went.All my best. 

It wont make a bit of difference in results.  It may increase with laser for no added advantage.  the surgeon skills and experience is paramount and keeping things simple will have no complications in this operation.