CO2 RE laser or blepharoplasty - Which procedure would address under eye wrinkles and volume loss long term? (photos)

Question

I had an upper and lower blepharoplasty at age 30, but my under eye wrinkles and crinkling when I smiled were worse afterwards, as if the fat had been removed and now I had more lines from the incision scars. Now at age 46, I tried Morpheus 8 and then Dysport, neither of which helped. I was told I should try the CO2RE laser. Is it worth it or would it be better to undergo another blepharoplasty and possibly a fat transfer instead? I'm trying to look for a long-term fix.

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Jeff Rapaport, MD · Answer

Treating contour loss and periorbital wrinkles involves a combination of dermal fillers and CO2 laser resurfacing, each addressing specific aspects of aging around the eyes.
Dermal fillers are used to restore lost volume and smooth out the under-eye hollows, tear troughs, or other areas where the skin has thinned or sagged.
Hyaluronic acid fillers (e.g., Restylane, Juvéderm) are commonly used for the delicate skin around the eyes due to their smooth texture and reversibility.
The filler is injected into the areas with contour loss to create a more youthful and rested appearance. Careful placement is crucial to avoid puffiness or overcorrection.
Immediate improvement is noted, with effects lasting 6 to 18 months depending on the product used.
This is Non-surgical, with minimal downtime, and instant results.
CO2 fractional laser is highly effective for treating fine lines, wrinkles, and skin texture, especially in perorbital area. The laser delivers precise, controlled heat to the skin, creating microscopic columns of damaged tissue that stimulate collagen production and encourage new skin growth. This smooths out wrinkles and improves skin elasticity.
This is typically done under local anesthesia. Multiple passes may be required for deeper wrinkles.
Redness, swelling, and peeling for several days to weeks are to be expected.. Full results are visible after 2-3 months as new collagen forms.
This gives a Long-lasting improvement in wrinkles and skin texture, as well as an overall tightening effect.
The results are Synergistic.....Fillers address the volume loss, while the CO2 laser improves skin texture, tone, and fine lines. Together, they provide a comprehensive rejuvenation of the periorbital area. 
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Jeff Rapaport MD FAAD 
Realself Hall of Fame 
Castle Connolly Top Doctor

Stefan Weiss, MD · Answer

If you are experience under eye hollows I would suggest filler before undergoing fat transfer. From the photos, it appears that the CO2 laser eye lift + Botox/Dysport/Xeomin would provide the correction - especially as it is only the lower eye lids.

Nuket Eroglu, MD · Answer

Hello First of all, the damage around the eyes is a bit excessive for your age. It’s necessary to recommend treatments that improve the skin quality. Thermage FLX should be the first option. You can opt for just the eye area treatment, or include the face and neck as well if you wish. Surgery won’t be a solution for you.

CO2 RE laser or blepharoplasty - Which procedure would address under eye wrinkles and volume loss long term? (photos)

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