Lower Blepharoplasty with Laser Resurfacing for Best Results?

There are several options when addressing the lower eyelids including surgery, laser or combinations of both to achieve the desired result. An individual patient must ahve a thorough examination and consultation to discuss what procedures are necessary to achieve this ideal outcome.

In general, however, lower eyelid fat pads can be reduced using a transconjunctival approach and the skin can then immediately be resurfaced using either a CO2 or Erbium laser. The laser reduces lines, tightens the skin and removes unwanted pigment and sun damage. Most surgeons consider this to be a safer approach than surgically removing eyelid skin and potentially causing an altered lower eyelid shape. The tighteness of the lower eyelid needs to be assessed by your surgeon prior to the procedure, and sometimes a seperate eyelid tightening procedure (canthopexy) needs to be done. The laser does add to the healing time ( usually 10-14 days depending upon the laser) but the results are worth it.

There are many ways to skin a cat, and laser resurfacing of the lower lid with a transconjunctival fat excision can also cause ectropion and retraction.  Canthopexy and precise treatment can certainly minimize the risk with whichever technique is chosen.

Traditional lower blepharoplasty with an external lower eyelid incision does weaken lower eyelid support and create a risk of an ectropion or sad eyed look.
This traditional approach also DOES NOT rejuvenate the lower eyelid skin-simply removes some of the old damaged skin, but wrinkles and sun damage remain on the lower eyelid skin left behind.
Transconjunctival lower blepharoplasty, because the incision is made on the inside, poses less risk to eyelid support and thus ectropion can be avoided.
The addition of laser resurfacing rejuvenates the eyelid skin, improves wrinkles and tightens skin.
In addition, modern blepharoplasty also includes repositioning or grafting fat into the depression benath the lower eyelid to improve dark circles and plump the upper cheek area to rejuvenate the peri ocular region.
Be aware that aggressive laser resurfacing with the CO2 laser of the lower eyelid can also cause an ectropion if you have a lax lower eyelid to start with.
Newer fractional Erbium ablative laser resurfacing is safer for the eyelid and recovery is quicker.
See an example of transconjunctival arcus release and fat grafting for under eye hollows, with fractional resurfacing on lower eyelid to reduce crepiness.

While transcutaneous lower eye lid Blepharoplasty can cause retraction/ectropian of the lower eyelid, this is rare if performed properly and in patients who are good candidates for the procedure.
There are several techniques for correcting the eyelids. Some surgical approaches are internal, (the transconjunctival approach) or external (transcutaneous). When I see a patient with very little excess eyelid skin, good lid support, some fine "crepe paper" wrinkles in the skin and some fat pocket bulges, I often recommend a transconjuntival Blepharoplasty and laser resurfacing of the lower eye lid skin.
On the other hand, if a patient has excess skin and/or poor lid support an external approach may be required. With this technique, the lower eyelid can be supported with a canthopexy to prevent lid retraction and the excess skin can removed.
As you can see, the proper choice for you depends upon your specific condition. Consult with a physician who has a good reputation and is experienced in eyelid surgery. Make sure your doctor explains the different options and that procedure is the best for your particular case.