Post-blepharoplasty Skin Tightening?

I had lower Blepharoplasty done to my bottom eyes. I had orbital fat grafting with Pearls add in lower eyes as well. The outside skin could be a little tighter.

Is there any type of thermal or heat sysem to tighten the skin without additional surgery? This operation was done on Nov 13 and this picture was taken about a month and a half later (Dec 29).

Doctor Answers 9

Skin tightening after eyelid surgery.

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There are many ways to tighten the skin in the lower lids.  The more important question is, whether that is the optimal choice for you.  Judging just by your photos, it might not be the best choice.  An experienced and talented surgeon would thoroughly examine your particular anatomy ( first we'd wait another few month for all the healing to finalize) and only then determine the best approach.  There are a number of factors to consider in your particular case, you appear to have a "negative vector" ( weakness of your eyeball socket and cheek bone), your fat grafts might have ended up a bit too high, in fact re-creating the appearance of the prolapsed fat pads, may be even residual fat pads.  In the short term you could benefit from expertly performed filler treatment to  your lower lids.  Revision Blepharoplasty is a very exacting surgical procedure, make sure your surgeon is skilled and experienced and able to prepare a proper surgical plan and execute on it.

Newport Beach Plastic Surgeon
4.8 out of 5 stars 62 reviews

CO2 laser is only treatment that will significantly tighten skin.

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There are many plastic surgeons whom I respect that have faith in the factional laser to tighten skin.  I remain a skeptic.  You are too close to your operation to consider any further treatment.  All swelling must have subsided before trying skin tightening and my guess is that you won't need it.

The CO2 laser will tighten skin but there is collateral.  I'm not sure you are a good candidate based on the color of skin I see in the picture.  You might want to consider the fractional laser but be prepared for disappointment.

Fractional ablative laser resurfacing an option for post blepharoplasty skin tightening

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My preference for tightening loose skin after a lower blepharoplasty is fractional ablative laser resurfacing using the 2940 Erbium laser.

You are far too early to consider this. You need to heal for 3-6 months and it may not be necessary after you have healed.

You need to have good lower eyelid support for any tightening procedure after blepharoplasty including laser resurfacing.

I prefer the laser resurfacing approach because it avoids an incision in the lower eyelid skin. An incision risks weakening the lower eyelid support and causing an ectropion or sad eyed look.

The Erbium laser, in my opinion, is less risky than the CO2, radiofrequency or other thermal skin tightening technologies

Thermal or heat systems not recommended

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After a blepharoplasty if there is still extra skin present on the lower lids without animation (or at repose), then a small pinch of lower lid skin, usually 2 to 3 mm, can be taken at the subciliary lash line. This incision is then closed with Histocryl tissue adhesive. We do not recommend thermal or heat systems to tighten skin around the eyelids.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Baby Joe needs more time

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Dear Baby Joe, In reviewing your photos, I see several things:

  1. You are likely still swollen so you must give it more time.
  2. The fat pearls to the tear trough and orbital rim do not seem to have taken adequately.
  3. You may still have some herniated fat under the left eye.
  4. You are a set-up for less then stellar results because you have what is called -MPE - morphologically prone eyes - in lay mens terms, your cheek and cheekbone are not very prominent and as a result your eyeball bulges out a little bit. This makes you susceptible to injury to the lower eyelids during surgery.

My advice is to wait until the swelling resolves, then consider a Transconjunctival procedure to remove any excess fat on the lower lids and then add significantly more fat to the cheek and tear trough.

Robert M. Freund, MD
New York Plastic Surgeon
4.8 out of 5 stars 34 reviews

Laser or Thermage for Skin Tightening

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There are several important issues to consider. First you have to make sure that all of your swelling has gone away. Even though this picture is about 6-7 weeks post surgery, you could still be experiencing some swelling that accounts for the laxity in your lower eyelids.

Lower eyelid surgery usually does require some type of procedure to address the loose skin in addition to the bulging fat so a skin tightening procedure is very common. If all swelling has resolved and there is indeed some loose skin that needs to be tightened, then you do have a few choices.

Thermage does a pretty good job of tightening the eyelid skin without any down time. It might require 1-2 treatments to achieve notable tightening. The more reliable option is to have laser resurfacing. This could be done with either a fractional CO2 or traditional CO2 resurfacing.

The fractional CO2 laser has a shorter healing time of around 7 days versus 2 weeks for the traditional fully ablative CO2. In either case you should expect some very nice results with smoother and tighter skin.

It is best that you be assessed by an experienced surgeon to assess for any residual swelling and to see what the best choice is for you.

Edgar Franklin Fincher, MD, PhD
Beverly Hills Dermatologic Surgeon

Hold the phone Joe

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From the photograph, it is difficult to appreciate the skin excess or looseness. At any rate, you should wait another 3-6 months before undergoing a skin tightening procedure, such as CO2 laser resurfacing.

It appears that you still have swelling present, as well as, the fullness from the fat grafting and the treatment needed may change once the swelling has resolved and the fat has resorbed. Presumably your surgeon made a determination before your surgery as to whether or not you had excess skin that needed to be addressed.

You did not mention whether your surgery was done through the inside of the eyelid (transconjunctival) or the outside of the eyelid (subciliary). If it was subciliary, your surgeon probably removed some skin. Have a frank discussion with him/her about the skin and whether anything more needs to be done.

Good luck!

Yes, crepey skin could be tightened

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Crepey skin could be tightened in some cases by resurfacing the skin with a deep chemical peel or laser resurfacing.  Based on your photos, I would recommend evaluating the present deeper contour of your lower eyelids as well.

Robert Schwarcz, MD
New York Oculoplastic Surgeon
4.5 out of 5 stars 23 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.