Eyelid Surgery to Eliminate Lower Eyelid Wrinkling?

I am 55. I have some crepiness, wrinkling, and now a slight laxity in my lower eyelid skin. I did have CO2 Laser under the eyes when I was 40, which did a miraculous job of tightening and eradicating undereye wrinkles. I've had several mild under eye TCA Peels also, with barely noticeable results. I would repeat the CO2 laser procedure except that I've heard it thins the skin. Would a lower lid blepharoplasty with some very minor skin removal at this stage be the best answer to tightening the skin and eliminating some wrinkling?

Doctor Answers 10

Lower lid blepharoplasty or pinch

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The goal of lower lid blepharoplasty is primarily to remove the excess fat bags in the lower lids. If there are no bags present, an additional pinch of lower eyelid skin can be performed at the lash line. This is typically closed with tissue glue for tightening the lower lid skin. This must be done conservatively so as not to change the shape of the eyelids.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Eyelid surgery a possibility

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Your suggestion may be a good course, but in-person evaluation is necessary. You have had several procedures which can improve lower lid wrinkling, and skin excision blepharoplasty might be next. You should also consider that it may not be possible to completely eliminate lower lid skin wrinkling.

After consultation with experienced surgeons, consider your situation carefully.

Sutton Graham II, MD
Greenville Plastic Surgeon

Lower eyelid blepharoplasty to tighten lower eyelid skin

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Lower eyelid blepharoplasty done through an under the eyelid incision does indeed tighten the skin.

However in the process, the lower eyelid can move downward, causing a rounding of the eye or a pulling down in the corner of the eye.

We believe strongly that all lower eyelid skin tightening procedures should be supported, that means strategic sutures are placed to prevent a downward drift of the lower eyelid over time. This is NOT synonymous with a canthopexy, which if performed without midface advancement can give an odd upward sweep to the corner of the eye. Rather, midface elevation and advancement are necessary at the same time. This essentially not only raises the cheekpad slightly, but tightens the lower eyelid skin with a minimal chance of pulling down of the lower eyelid.

This procedure is ideally suited for patients who have already had a lower blepharoplasty and have noticed a change in their eye shape, and desire a restoration to a more almont shaped eye configuration.

In our practice, a minimally invasive ultrashort incision cheeklift (USIC) cheeklift, either with or without simultaneous grafting (LUSIC), addresses that problem.

Even with all these measures, the goal is natural improvement, not complete elimination of undereye wrinkles.

Brent Moelleken, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 194 reviews

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Lower eyelid skin wrinkling and CO2 laser

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CO2 laser does not thin the skin. On the contrary it actually thickens the dermis over time as the skin repairs itselft from the procedure. If the only issue you have with the lower eyes is skin wrinkling then a combination of good skin care and potentially adding botox and skin resurfacing with a modality that is significant enough to allow improvement should be beneficial. This modality could be a chemical peel of sufficient depth or a laser. Blepharoplasty might also be of benefit as well as a filler, but that would need to be determined at the time of consultation.

Lower lid blepharoplasty

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If the skin is wrinkling and you have had previous laser procedures, I would probably encourage you to have a simple skin excision of the lower lid. If the lower lid is lax, then you may need a lid suspension procedure like a canthopexy.

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

I would beg to differ regarding the benefits of CO2 laser resurfacing.

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Dear Sapphire One

Ultimately you need to find a cosmetic surgeon who makes sense to you. I think that you have to appreciate that at age 55 there is more going on that just too much lower eyelid skin causing wrinkling. CO2 laser resurfacing has been both a blessing and a curse. Many patients have had too much laser treatment for their thin eyelid skin.

Even though the skin may have healed, these individuals demonstrate long term atrophy of the skin. The thin rehealed skin does not do well with the thickened dermis which occurs as new collagen is deposited in response to healing following the laser. This can lead to abnormal heaping of the lower eyelid skin.

As pointed out by some of the responders to your question, the lower eyelid can be problematic because removing lower eyelid skin can stress the lateral canthal tendon and alter the shape of the lower eyelid.

It is important to analyze the role of deflation of the top of the cheek and loss of lower eyelid support in the development of lower eyelid wrinkle. In some situations, a better approach is to vertically elevate the cheek soft tissue over a rim implant that acts as a felting material. This inflates this area and can improve the appearance of the lower eyelid wrinkles by filling the area. A similar thing can be accomplished without surgery using fillers. I encourage you to look at my website: lidlift.com particularly the pages on fillers.

Finally, TCA, even TCA 35% is insufficient in strength to improve lower eyelid wrinkles. However, Phenol 89% lower eyelid peeling can be nothing short of brilliant and it seems to be much kinder that laser because the thermal injury is avoided.

Dr. Steinsapir

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Treating lower eyelid wrinkled skin can be difficult.

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I always approach the lower eyelids with caution. In fact, I personally don't like to remove excess lower lid skin as an isolated procedure. Your lower eyelid is a free floating border that could get pulled down, and become problematic if too much skin is removed.

If your lower lid skin is getting you down, consult an experienced, board-certified oculoplastic surgeon with many favorable post-op photos of people with similar concerns.

Best regards.

Eric M. Joseph, MD
West Orange Facial Plastic Surgeon
4.9 out of 5 stars 435 reviews

Eyes are the window to the soul

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The eyes are the windows to the soul. All too often, however, they seem to reveal exhaustion. The very delicate skin around the eyes tends to get crepey and puffy due to fatigue and stress. Eyelid surgery has become one of my most popular procedures. If undereye puffiness and dark circles need to be eliminated, an incision is made along the lower lashes that will be almost invisable when it heals. Next, the fat below is either removed or redistributed and the saggy and crepey excess skin is then pulled up and cut off. The incisions is closed with tiny sutures, which are removed in four to six days.

Topical creams can reduce some lines and wrinkles around the eyes almost immediately, even without surgery. Topical creams like Dr Michelle Copeland Rewind Eye Formula containing pentapeptides and antioxidants help reduce the appearance of fine lines around the delicate eye area, increasing collagen production and reducing dark circles and puffiness over time.

Another effective non-surgical option is Thermage, which can tighten the skin around the eyes. Thermage is a non-invasive (no incision!) treatment that can tighten skin and stimulate your body to make healthier collagen—the building block that provides structure to your skin. Fast and easy, Thermage requires no downtime from normal activities.

Michelle Copeland, MD, DMD
New York Plastic Surgeon
4.6 out of 5 stars 10 reviews

Well performed lower blepharoplasty probably would be best.

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It's hard to tell exactly without seeing you, but, from your story, in New York we would probably do a lower blepharoplasty.

We support and tighten the lower eyelids in good position with a canthopexy, so the lids don't slide down. Then it is safe to remove a surprising amount of excess skin. But technique is everything.

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon

Laser resurfacing combined with lid tightening is best for crepiness and wrinkling of eyelid skin

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The crepiness and wrinkling of the lower eyelid is caused by skin changes, and standard blepharoplasty usually is used to remove fat (bags) and loose excess skin, however, blepharoplasty alone does not change the skin and does not remove wrinkles and crepiness.

Laser resurfacing stimulates new collagen production in the eyelid skin and can help wrinkles and crepiness.

The concern I have is that since you have had a previous CO2 resurfacing and several skin peels, a standard incisional blepharoplasty could, by removing skin, shorten the lower eyelid and cause an ectropion or 'sad eyed look".

A canthopexy is a lid tightening procedure which can support the lower eyelid. Newer fractional ablative Erbium laser resurfacing is effective and safer than the CO2.

You need a thorough and careful exam by an expert who can assess your lower lid support and recommend a plan of action to achieve your goals.

I would be very cautious however in performing a standard incisional lower blepharoplasty for fear of ectropion and failure to achieve improvement in the skin changes that bother you.

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.