How to Treat Wrinkles Under the Eyes After a Lower Bleph? Will Evolence Work?

How do you get rid of wrinkles that occured after having a lower bleph done 1 yr ago? Do you have fat redeposited? I think the wrinkles look worse than the under eye puffiness.

Doctor Answers 8

Lasers not Fillers

Laser resurfacing is most often the answer to wrinkles under the eyes during or after lower eyelid blepharoplasty. Most patients find that their skin has many wrinkles or crinkles due to looseness or laxity of the skin. The CO2 laser does a wonderful job of smoothing and tightening skin. Generally htis is done at the same time as the lower blepharoplasty, but can be done after the surgery. Fillers are mainly effective for depressions, shadows or troughs under the eyelids.

Beverly Hills Dermatologic Surgeon
5.0 out of 5 stars 1 review

Fillers probably not the best choice

As in the previous post, a skin tightening procedure is probably your best choice, whether by more skin removal, chemical peel, or laser. Fillers can help on occasion but I would assess this after addressing the skin laxity. Evolence is a good filler for some areas, because it integrates into the skin and provides good support, but it would probably be a little too firm for under the eyes. If you do end up needing a filler there I would suggest Restylane or Juvederm.

Richard Baxter, MD
Seattle Plastic Surgeon
4.9 out of 5 stars 52 reviews

There are several options

Lag, In lower blepharoplasty, fat and or skin is removed to help improve the contour of the lower lids. In most cases, removing the fat turns convexity of the lower lid into a slight concavity. For this reason, not much skin needs to be excised. Occasionally, there is excess skin after the swelling has resolved. You have several options. First you could have a simple "pinch" blepharoplasty where just a small amount of skin is excised under the eyelashes. This can be done under local anesthesia in your doctor's office (assuming that they are set up and qualified to do procedures in their office). Other modalities can be used to tighten up the skin, including chemical peels and laser - both of these can be very effective depending on your skin quality. I hope this is helpful. David Shafer, MD New York City

David Shafer, MD
New York Plastic Surgeon
4.9 out of 5 stars 75 reviews

Laser resurfacing will remove wrinkles around the eyes after eyelid surgery.

Even after tightening the skin after eyelid surgery, wrinkling may persist.  Laser resurfacing can reduce and even eliminate the wrinkles.  The CO2 laser is my choice.  There are side effects however and patients need to be fully informed about the downside.  Nevertheless, it is generally a very excellent treatment in the properly selected patient.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Laser resurfacing not fillers or skin excision is best for eyelid wrinkles after blepharoplasty

It is important to understand that wrinkles on the eyelid skin are actual indentations in the skin--permanent skin creases caused by sun damage and aging woith loss of skin collagen. Simply excisiong more skin or injecting Evolence, retsylane or other soft tissue filler will NOT remove a skin wrinkle. The lid will be shortened or the eyelid puffed, but the wrinkles in the remaining skin will still be present.

Laser resurfacing will smooth the wrinkles by building new skin collagen. It is important that the support of your eyelid is normal so that the laser resurfacing does not tighten the eyelid and pull it downward.

New fractional ablative erbium laser resurfacing (2940) is safest for the eyelids

Consult an expert with experience in laser.

"Pinch" can help

Wrinkles underneath the eyelids are caused from excess skin and muscle contraction of the orbicularis oculi muscle in the lower lids. The excess skin has to be measured at the time of repose (not animated). A small strip of skin can be pinched just immediately below the lash line and the subciliary area excised and then closed with Histocryl tissue adhesive. The excess skin is only removed at repose and not on animation. If patients get a lot of wrinkling during the smiling process, that cannot be removed. Botox can be performed for crow’s-feet.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 143 reviews

Laser resurfacing can work well for eyelid wrinkles

To lag,

Hi!  Hard to tell exactly without examining you, of course,  but I have had good results in this situation with the dual modality erbium laser made by the Sciton Corp.

If the wrinkles become worse when you smile (muscle activity), then  Botox injections might help.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
4.8 out of 5 stars 9 reviews

Resurfacing may be needed.

It is very common for patients to have all of the following components prior to eyelid surgery: excess skin, excess fat, and poor quality of skin. Unfortunately, only two of the three are treated with the eyelid surgery: excess skin & excess fat. In addition, the quality of skin is not normally addressed at the same time as the eyelid surgery to prevent damage to the delicate skin around the eyes. In the situation where you have all three components, it is safer and most common to have a two step procedure to give you the best overall result. Either a chemical peel or other resurfacing technique is often performed at a later time. Fortunately, this final step should not be too expensive, should be able to be performed under local anesthesia, and should have minimal downtime.

Thomas T. Nguyen, MD
Orange County Plastic Surgeon
3.9 out of 5 stars 19 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.