How Can I Correct Redness Around the Eyes 10 Weeks After Fraxel Laser?

I do not have experience with the Palomar Starlux fractionated system, but do use the Fraxel Restore (1550nm) so I would expect the systems to be similar. We typically see redness for one to two weeks following Fraxel treatments. In patients who have a greater tendency for flushing, post-Fraxel redness may persist for a week or so longer, but this is uncommon. The eyelid skin can be more sensitive than other areas on the face so it is possible that redness may persist here for a longer period of time. We recommend that our patients apply a combination aloe vera / hydrocortisone cream following their Fraxel treatments, and continue to use this until the redness and swelling resolve (usually about 5-10 days).

Is it possible that there are some active ingredients such as retinol, vitamin C, or something else in the creams that you are applying that are causing persistent irritation and redness? We certainly have seen skin care products cause this type of problem in a few a patients.

If the redness does persist it would be reasonable to consider IPL or Laser Genesis as a means of improvement; but I would be patient / and proceed cautiously as these treatments could certainly produce redness as well.

In comparison, I have seen redness persist up to four months following Pearl Fractional or Pearl Fusion treatments (2790nm). The primary difference between these two lasers is the affinity for water: the Fraxel causes tissue coagulation, while the Pearl produces tissue vaporization. I have used the Pearl Fractional laser many times to treat the eyelids and peri-ocular lines and wrinkles (using metal intraocular shields for protection). Redness may last 8 – 12 weeks, but that is expected for this procedure. Patients apply a petrolatum, as part of their post-treatment regimen, while their skin integrity is compromised; and then switch to a light moisturizing cream for several weeks afterward.

Your pictures show prominent lower eyelid fat. I don’t know if there is still swelling of the lower eyelids which accompanies the redness. If this is close to the usual appearance of your lower eyelids I would not have recommended Fraxel. You would be better served with lower eyelid surgery to remove the excess fat (transconjunctival approach). If you do not desire surgery then using some fillers to carefully re-volumize the upper midface may be helpful.

Best wishes, Kenneth Dembny MD
 

Lower eyelid dark circles are not easily treated.  There are different causes for redness and pigmentation of the lower eyelids and we are not certain of the biologic reasons for any of them. Why do people with bad allergies and those who are tired get dark circles? Is sluggish blood flow the actual problem? If we're not sure, then how can doctors say what treatment would work best?  We have tried many different treatments and have found that in some patients, there lower eyelid darkness improves with Fraxel Restore, but this usually is if it is related to pigment and not purple or red circles.  The V-beam laser can, at times, not always, improve the coloration of the lower eyelid vascular (blood flow) circles.