33 y/o female - would I benefit from a lower blepharoplasty skin pinch or should I hold off for longer? (photo)

Question

I have some crepey under eye skin that I feel is quite noticeable and I would like to have it pinched. I am 33f and unsure if I need to wait until the lines are more severe to have it done.

Michelle Zweifler, MD · Answer

Lower eyelid crepey skin can be improved with several options.  Chemical peels (like TCA) or Laser resurfacing (CO2) help tighten skin.  Microneedling series helps stimulate collagen over a series of treatments with improvement in the lower eyelids. 
For more, moderate wrinkles a lower eyelid skin pinch blepharoplasty is helpful.

Jason Emer, MD · Answer

Hello and thank you for your question. A formal evaluation would be needed to determine the best treatment. There are both surgical and non-surgical options to correct this, depending on your specific situation.

For less significant puffiness and sagging UNDER the eyes, or more mild improvement, there are nonsurgical treatment options: we often use Renuvion helium plasma radiofrequency (RF) energy to achieve incredible results and take years off of your appearance. Combining RF energy and cool helium plasma, the signs of aging (wrinkles, pigmentation, skin laxity) are improved in a ‘Nonsurgical Lower Eyelid Lift.' The focused heating tightens and peels the outer skin layer with extreme precision, leaving the surrounding area undamaged, smoothing and tightening the periorbital skin, and improving the overall skin quality around the eyes. It's an aggressive treatment, and the recovery time is longer than with other nonsurgical procedures, but the results can be life-changing.​

Surgery (a lower blepharoplasty with or without canthopexy/canthoplasty or orbicularis muscle suspension) is a great option for more significant improvement- for example if there are more severe lower eyelid bags / bulging present. Sometimes the surgery can also be used to intentionally adjust the shape and/or size of your eyes, or correct any asymmetries!

Dr. Donald Groves is an expert facial plastic surgeon that I work with, who specializes in these types of procedures. It is important that if you are considering surgery that you go to someone who is well trained and very experienced with these delicate operations to get the best results. I suggest getting a consultation with an experienced cosmetic dermatologist and facial sculpting expert, or an aesthetic facial plastic surgeon like Dr. Groves; we are both located right here in Los Angeles.

Best, 
Dr. Emer

Jeffrey M. Darrow, MD · Answer

Whenever you decide to have a pinch lower blepharoplasty is up to you. The procedure would help to smooth the small lines in your lower eyelid. It is a minimally, invasive procedure and so if the lines are bothering you, I would say that you should proceed now.

Nelson Lee Novick, MD · Answer

As a general rule, postponing cosmetic surgery, whenever possible, especially when there are less invasive ways to achieve aesthetic benefit is a wise decision. Surgeries tend to be expensive and of course entail more prolonged downtime, as well as the risks for post-surgical complications, such as scarring and in some cases in stitch track marks.
The use of a series of superficial peels, using either full strength glycolic or salicylic acid, Jessner's Solution, or low concentrations of TCA is a very reasonable, nonsurgical alternative, especially for a young person with under-eye crepey skin, You would be wise to consult with a board certified cosmetic dermatologist and best of luck. And one other piece of advice: Don't go into any consultation asking for a particular treatment because to your later financial loss, disappointment and frustration, you are very likely to get exactly what you asked for. Hope this helps and best of luck.

Camille Cash, MD · Answer

From the provided photo it appears you can achieve improvement without surgery.  You can consider options such as chemical peels, lasers, or Morpheus8.  These treatments can improve overall skin tone and texture.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.

Thomas Spalla, MD · Answer

You don't appear to have a lot of excess skin. I would recommend you consider a resurfacing procedure such as a laser (CO2 or Erbium) or a chemical peel (medium depth) in order to improve this. The more aggressive you get, however, the more risk there is, so discuss your risk profile and downtime with your physician.

Mats Hagstrom, MD (license on probation) · Answer

I’m not a big fan of removing skin from the lower eyelid.
Doing so well create or increase the risk of a premature ectropion.
The best way to minimize these wrinkles is with the use of sunscreen on a daily basis and avoid excessive sun exposure, starting at an early age.
Once the wrinkles form, it is very difficult to eliminate them.
Treatment options include Botox, skin resurfacing with lasers or chemical peels or skin excision.
All of these procedures are inherently limited and have potential drawbacks.
Skin excision is in my opinion at the worst option with the exception of skin muscle excision which is potentially worse. Even the slightest ectropion is in my opinion worse than skin wrinkles. 
Best,
Mats Hagström , MD

33 y/o female - would I benefit from a lower blepharoplasty skin pinch or should I hold off for longer? (photo)

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