Improving upper and lower eyelid skin - would you suggest Thermage? If not, what is my best option?

Question

I am a 53-year-old, olive-toned female considering options to tighten upper & lower eyelid skin: to improve sagging, texture, and fine lines around this area. Would you suggest Thermage? If not, which procedure would be my best option? I'd like to avoid surgery.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Robert L. Kraft, MD, FACS · Answer

I would not recommend any of the non-invasive methods to you for direct application to the eyelids.
If your upper lid sagging is related to brow sag, which is often the case in your age group, then Botox above the eyebrows may be of benefit. Additionally, causation needs to be determined because, if your eyelids themselves aren’t the only reason for the problem, treating them alone will not produce adequate results.  As to the lower lids, again, without photos, I am speaking on a purely hypothetical basis, but filler here may be of benefit.
Upper lid blepharoplasty is the shortest and least costly procedure that I personally perform. If this is the procedure of choice, it would be inappropriate to offer something that cannot generate acceptable results.
Please see a board certified plastic surgeon, not anyone less credentialed, for a meaningful consultation.  Best wishes.
Dr Kraft

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