Age 33, blepharoplasty or laser resurfacing for lots of wrinkles on my lower eyelid when smiling? (Photos)

Question

I am 33 yo with lots of wrinkle on my lower eyelid when smiling (almost none at rest) and kind of heavy upper eyelid, again especially when I smile and more on the outer corner. I have been advised laser skin resurfacing (erbium 1540 nm) by a dermatologist and blepharoplasty (upper + pinch on the lower) by an eye surgeon. I am lost in assessing what would be the best solution between the 2 options. Any advice?

Lexie Wang, MD · Answer

Upper eyelids- you could definitely consider an upper bleph (surgical), possibly even a brow lift as well. For the wrinkles on the lower eyelid, I would start with aggressive botox here because your lower lid is already looking somewhat retracted and you will be at higher risk for ectropion if you do a skin pinch and that is the case. Laser absolutely will always be helpful but it will not give you as dramatic of results as what you are probably looking for.

Nelson Lee Novick, MD · Answer

Before jumping into expensive, invasive blepharoplasties or laser resurfacing with its risks for scarring and dyspigmentation, you may wish to consider some simpler alternatives, particularly at age 33. The bulging seen with smiling only may very well be from hypertrophy of the belly-like muscle that lies directly beneath the lower lids. If so, then a couple of microdroplets of Botox can help to soften this considerably. And, if it is primarily the outer corners of the upper lids that primarily bother you, then you may wish to explore The Ten Minute Eyelift. In this case, the lateral corners of the upper lids can be easily numbed with local anesthetic and then a light electrocautery applied to the underside of the those areas leading to immediate shrinkage of the excess skin and greater exposure of the lateral segments of the upper lids. I have been performing this for over twenty-five years already with gratifying results. Complete healing is pretty much like a that of a abrasion. You would be wise to make sure to consult a board certified cosmetic dermatologist and best of luck.

J. Renee Booth, MD · Answer

I recommend botulinum toxin (there are multiple brands, so use which ever works best for you). There is a thickening of the muscle along your lower eye lid (orbicularis oculi). It is sometimes called a "jelly roll" This can become thinner if you get botulinum toxin every 3 months for a few years. Of note, it is important to talk to your provider about using a very low dose in this region since relaxing the muscle too much can allow a temporary bulge to form under the eye. 
A lower pinch will be able to remove a small amount of skin, but will not remove any of the strong muscle there. If you are unhappy after a few years of botulinum toxin, then you can consider a subciliary blepharoplasty which can remove some of the muscle. In most cases, the botulinum toxin is enough.
Laser is fantastic for skin and is always a wonderful choice to improve collagen and elasticity which gets rid of fine wrinkles (and with stronger settings can also get rid of deep wrinkles). Laser will not thin or remove the muscle that is causing what concerns you.

Kenneth R. Francis, MD, FACS · Answer

Dear Shirayukib,
My advice is to get a few more consultations.  At rest you have minimal wrinkling.  There is no excess lower, and minimal upper eyelid skin.  In general, lasers can be used to tighten lower eyelid skin, erbium not being the best.  But you don't even need that.  Blepharoplasty at 33 is a bit premature.  Your lower lid issue appears to be muscular bunching and crows feet, which can be corrected with small doses of a chemodenervator (Botox, Dysport, Jeuveau, Xeomin-off FDA label for the lower lid).  Your upper lid heaviness, since it appears to be mild brow ptosis (sag) may also be corrected with chemodenervation.  Of course, those effects are temporary, lasting on average about 3 months and would require repetition.  Good luck!

Mats Hagstrom, MD (license on probation) · Answer

Dynamic wrinkles should not be treated. We usually make aesthetic assessments based on a neutral face without facial expression.
Having an ablative skin, laser resurfacing isn’t going to stop your zygomaticus muscle from contracting, forming wrinkles when you smile.
I see no clear need for an upper eyelid blepharoplasty.
I recommend you continue wearing daily sunscreen, avoid excessive sun exposure, and avoid surgery until it’s indicated.
Botox can be used to weaken the orbicularis oculi muscle. this will not prevent lines from forming with a large smile, but will help in reducing crows feet when squinting.
There’s no shortage of providers offering treatment if you’re looking to spend money.
Best,
Mats Hagstrom, MD

Age 33, blepharoplasty or laser resurfacing for lots of wrinkles on my lower eyelid when smiling? (Photos)

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Age 33, blepharoplasty or laser resurfacing for lots of wrinkles on my lower eyelid when smiling? (Photos)

Answers (5)

Answer: Advice?

Answer: Advice?

Answer: Dynamic wrinkles

Answer: Dynamic wrinkles

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Everything you need to know about Eyelid Surgery

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