How likely is it that CO2 laser skin resurfacing will pull the lower eyelid downward and how can this be prevented?

Question

I'm 63 and this is a huge concern for me about this procedure. Thank you to all you doctors who take the time to give us your expert opinions!

Douglas L. Vander Woude, MD · Answer

Thank you for your question.  The risk of lower lid malposition is very low for a CO2 laser procedure alone.  It could happen, but that would require a significant over treatment to cause such a problem.  We have been using a fractionated CO2 laser for facial concerns for over 10 years and have not seen such a problem.  Make sure you are talking with an experienced provider and I would suggest the laser should be fractionated - much safer than the older CO2 lasers.  Best of luck.

Dilip D. Madnani, MD, FACS · Answer

The risks of having your eyelid pulled down after CO2 laser is very low and you should ask your treating provider about his/her experience- having performed thousands of these procedures and not seen one - of these type of complications. Having enough skin to tighten with the laser, being conservative with the treatment and spacing the procedure out through 3-4 sessions over a period of at least 1-3 months (if not longer), will all improve the safety and minimize potential complications from this. When done correctly, the results can be truly fantastic.

Jenifer L. Henderson, MD · Answer

Your concern is very valid, especially in someone in your age group.  As we age, the lower eyelid suspensory mechanism weakens.  If the lower eyelid skin is tightened, using a chemical peel or laser resurfacing, the forces of gravity and skin contraction can put too much strain on the lower eyelid suspension and actually pull the eyelid position down.  The strength of your lower eyelid suspension can be tested prior to resurfacing and you can be better counseled about the risk of retraction or ectropion.  If you have a weak suspensory mechanism to start with, this can be supported or tightened surgically at the same time as the resurfacing to minimize your risk for downward retraction.  Hope that helps!  Good luck.

Jeffrey T. Camp, MD · Answer

I'm an ophthalmologist.  I've been using Smartskin Plus fractional CO2 laser treatment (without making an incision with a scalpel) to safely treat upper and lower skin laxity of the eyelids for three years now.  I follow standard safety protocols.  I have never had a lower lid ectropion (the lower eyelid being pulled down) after a lower lid laser blepharoplasty.
This is a known risk for when a lower blepharoplasty is done with a scalpel.

William Marshall Guy, MD · Answer

Hello Vickielp,One of the risks of any resurfacing around the lower eyelids is the eyelid pulling downward.  This is why patient selection is an important part of your consultation.  Patients who have more laxity are the ones at greater risk (although still small), for eyelid malposition.  Furthermore, by staying farther away from the edge of the eyelid (called the lid margin), the risk becomes less.  But if you go too far away then you aren't resurfacing much of the eyelid and there is no benefit.  I'd recommend you consult with a facial plastic surgeon to learn more about the resurfacing options as well as evaluate if you are a good candidate.I hope this helps and have a great day.

Davin Lim, MBBS, FACD - Account Suspended · Answer

The very fist thing we do is to examine the skin for preexisting ectropion or scleral show. If you do have any signs of this, we control the depth and power of the laser to reduce the chances of this happening . Another method is to use gentle erbium fractional then CO2- many ways to reduce the chances of this from happening. Please above all, see a Board Certified Specialist.

How likely is it that CO2 laser skin resurfacing will pull the lower eyelid downward and how can this be prevented?

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