Laser Resurfacing or Pinch Excision for Loose Skin on Eyelids?

Question

I have consulted with two surgeons, and they both agree that a transcutaneous lower eyelid surgery is not indicated in my case because of the shape of my eyes, and the resulting risk of lower lid drooping, thus revealing too much sclera. As such, the recommendation is transconjunctival; however, there is concern about loose skin. Which approach will be better between Laser resurfacing and pinch excision?

Julio F. Gallo, MD · Answer

As always, each case is individual and the treatment plan should be customized for each patient after careful evaluation and discussion with your surgeon. In general, laser resurfacing ( I prefer fractional lasers such as the Active and Deep F/X) is used to smooth out wrinkled skin. The CO2 fractional lasers have the advantage of creating more collagenesis because of the thermal (heat) component of the laser. Of course, it is limited because the surgeon is not removing skin or muscle. A transconjunctival lower lid blepharoplasty plus a laser is a great option for rejuvenating that area. Conversely, if there is a significant muscle roll, laxity of the lower lid tendon, or a lot of redundant skin, then an external incisional blepharoplasty is indicated in order to access these structures to tighten and/or remove them. Thank you.

Sam Goldberger, MD · Answer

That is a difficult question to answer without examining you. If your skin problem is treatable with laser, then, in general, I would prefer that route. However, complications related to lower lid drooping is also possible from either laser resurfacing or "pinch" excision. You need to make sure that you are a good candidate for those procedures as well.

Steven Wallach, MD · Answer

If there are risks in the lower eyelid because of concerns of scleral show, then I would recommend a canthopexy to support the lower lid. Excising lower lid skin as a "pinch" can improve the crepey appearance. But, a laser can also do that as well.

Brooke R. Seckel, MD, FACS (retired) · Answer

Your surgeons feel you are pre-disposed to ectropion-you are fortunate that you were examined by doctors who knew the risk and did not operate on you.
In a person pre disposed to ectropion or lid droop after blepharoplasty, both pinch excision and laser resurfacing could cause an ectropion. Even a transconjunctival blepharoplasty should be done cautiously.
If your surgeon is comfortable doing a canthoplasty to tighten the lower eyelid then the risk of ectropion is lessened. In that situation a transconjunctival blepharoplasty and fractional ERBIUM ablative laser resurfacing is your best option to tighten eyelid skin.
I would avoid CO2 laser-flat beam or fractional (Fraxel, activeFX) because the CO2 is much more likely to result in ectropion than the Erbium laser.

Theodore Katz, MD, FACS (retired) · Answer

There seems to be some inconsistency or misunderstanding. If there is loose skin and fatty tissue then a carefully executed lower lid blepharoplasty (and canthopexy if necessary) should be quite safe. If the transconjunctival route is decided upon and subsequently there is excess skin, then laser resurfacing (Fraxel re:Pair) may help but there are limits. It doesn't hurt to get a third opinion and ask questions to your physician as to why they recommend one over the other and what the potential outcome should be. They should evaluate your goals and expectations to be able to tell you if they can accomplish that. Is the concern about excess skin on your part or theirs?

Laser Resurfacing or Pinch Excision for Loose Skin on Eyelids?

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