Fractional CO2 laser resurfacing or upper blepharoplasty first?

Fractional CO2 can be done either simultaneously with
upper blepharoplasty or after the surgery. Factors such as cost, recovery
times, and quality and degree of skin laxity all can play a role in the
decision making on case by case basis.

It sounds like you have excess eyelid skin, a droppy eyelid (ptosis), as well as lines/wrinkles around the eye. All this surgical techniques can be performed together, however, one has to be careful in order to avoid dry eye problems postoperatively. If you have ptosis (droopy eyelid) I would recommend evaluation by an Oculoplastic surgeon as they have the most experience in ptosis surgery and evaluating and treating dry eye disease which can be a side effect of eyelid surgery and periocular laser. 

Typically, upper blepharoplasty can be combined with Fractional CO2 laser resurfacing to allow the patient to have both procedures at the same time.  A board certified facial plastic surgeon, oculoplastic surgeon or general plastic surgeon should be able to easily perform both procedures for you without the need for visiting two physicians.  This will also allow you to have one recovery period instead of two.  Typically, there is not need to resurface the upper eye lids, as upper blepharoplasty will provide the needed correction.  Good Luck!

In our practice we typically do the surgery and laser together in one session.  There is really no reason to separate them out into two different sessions and it creates 2 separate recovery periods.

I would absolutely recommend doing them simultaneously: one round of sedation and numbing, one recovery period! I almost always perform these procedures together. If you have to separate them, I’d wait 6 weeks minimum and have the surgery performed first. To ensure you are receiving the highest level of care, seek out a modernly trained, new-school dermatologic surgeon, oculoplastic surgeon, facial plastic surgeon or plastic surgeon who is board certified and fellowship trained in one of these “core four” cosmetic specialties. Membership in organizations like the American Academy of Facial Plastic and Reconstructive Surgery help to identify a highly trained surgeon.Cameron Chesnut #realself100 Physician 

Generally because an upper blepharoplasty removes skin, an ablative laser is no longer necessary.  By performing the upper blepharoplasty first a plastic surgeon can remove excess fat, and set the eyelid crease (if necessary).  Once this is complete a patient can then be assessed for further treatment.  The problem with doing a laser at the same time is that this can lead to lagopthalmos (inability to close the eye) which is dangerous as it can lead to corneal abrasions.  There are cases where lasers can damage the levator muscles of the eye lid (especially when done repeatedly) which can lead to eye lid ptosis or a droopy eyelid.  

you are not anticipated to need laser resurfacing, unless you are doing your lower lids (which you do not mention) where it can be done at the same time as a transconjunctival lower lid blepharoplasty.  But if the laser is being considered for the upper lid, the blepharoplasty should minimize or even eliminate the need for the upper lid laser.

  It is probably best to perform  the eyelid surgery first, and then approximately 8 weeks later you can undergo fractionated laser resurfacing which can also laser the incision as well to improve it. Potentially both procedures could be performed together under one anesthesia with one recovery, however you  just would not be lasering the upper eyelid area

Dear Anne, Most surgeons would combine these procedures together to allow for one recovery time and savings on anesthesia and operating room expenses. If you decide to separate them then you should discuss your options with your providing surgeons. Best regards, Michael V. Elam, M.D.