Misinformation Concerning ECO2 Laser and Malar Bags?

I'm 42 and about to undergo laser resurfacing of my lower eyelids to improve some crepiness of the skin. My surgeon uses the eCO2 laser,which brings me to my question. I've read a few posts from patients expressing concern that this particular laser caused damage to their Malar Bags.Is this a complication that is more likely with a full face resurfacing procedure,or is it a complication to be concerned about at all? Looking for a clarification on the topic.

Doctor Answers 8

Caution CO2 Laser Resurfacing on Eyelids and Malar Bags

Thank you for your important question.

Great care must be taken using any CO2 laser on the eyelids. Complications such as scarring and ectropion (pulling down of the eyelid) are much more common when any resurfacing is done on the eyelids.

The eyelid skin is very thin and Laser Power settings should be 1/2 of what they are for the rest of the face. Your lid should be firm and tight-the eyelid should snap back against the eyeball when pulled down and released.

I agree the problem is not the machine but it is the skill and experience of the user.

Find an expert Laser Doctor-Board Certified in Dermatology or Plastic Surgery.

Ask to see photos of their results

Malar bags require surgery, laser will help improve skin texture

If you have malar bags under your lower eyelids, you may likely need surgery to remove or reposition the fat in order to improve the contour. If you also have excess skin, some of the skin may also need to be removed. A laser can help tighten the skin of this area and can work-if you only have some mild loose skin. Sometimes the combination of laser and surgery is the best approach. Consult with a board certified plastic surgeon for more information on this topic.

Best wishes,


William Bruno, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 377 reviews

ECO2 Laser

It is not the tool that makes the carpenter. It is his skill and artistic eye. Laser skin treatments can cause scars. So can chemical peels, microneedling and blading when performed poorly. Make sure your surgeon has experience and the capability of handling all potential complications.

Marc Schneider, MD
Fort Myers Plastic Surgeon
4.5 out of 5 stars 25 reviews

ECO2 Laser

The performance of various laser systems is largely dependent on the competency of the practitioner. It's important that patients seek the help of a board certified physician who has the experience and skills needed to deliver successful procedures. 

CO2 lasers (e.g. E & Fraxel Repair) can help tighten skin, but they are not sufficient in elimination,  Malar bags which are a structural concern that may require surgery depending on the circumstance.

Sanusi Umar, MD
Redondo Beach Dermatologic Surgeon
4.6 out of 5 stars 32 reviews

Laser resurfacing for eyelid crepiness

I am not aware of one fractional carbon dioxide laser being more risky than another.  Swelling is common in the lower eyelid / cheek area after resurfacing, especially if someone has malar bags preoperatively.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Co2 laser can tighten the skin but will have a hard time decreasing the malar bags

The malar bags is a consequence of volume loss in between the lower eyelid fat and the cheek fat / volume. You need to either remove the fat in the lower eyelids or do volumizing in between these two structures. co2 laser would be good for the creieness but will be limited

Philip Young, MD
Bellevue Facial Plastic Surgeon
4.2 out of 5 stars 84 reviews

Laser and malar bags

Regardless of the type of laser, you will likely have some post treatment swelling in the malar area. This may be called a malar bag as a result of the swelliing. If you already have malar bags, the laser treatment may take longer to resolve. The laser treatment alone is not an effective treatment for the malar bags.

Richard Sadove, MD
Gainesville Plastic Surgeon
4.9 out of 5 stars 22 reviews

ECO2 and Malar Bags

The eCO2 laser, made by Lutronic is a very effective form of fractionated CO2 laser.  It is no more or less likely to cause damage to the malar area or any other area than any other brand of fractionated CO2 laser.

Stephen Prendiville, MD
Fort Myers Facial Plastic Surgeon
4.8 out of 5 stars 93 reviews

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.