How can I get rid of crepey under eyes?

I had my upper and lower eyelids done last year and my under eyes are so crepey. What can be done about that.

Doctor Answers 16

Eye bags can hide crepey skin before they are surgically removed, but skin quality can be improved with laser and PRP treatments

Thank you for your question. You are asking how to get rid of crepey skin after you had upper and lower eyelid surgery done last year.

I can give you some guidance as to how I counsel my patients who I do blepharoplasty or eyelid surgery for. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years and providing comprehensive solutions for the eye area is a significant part of my practice. I can walk you through my thought process, where the decision points are, and how I advise my patients about ongoing care.

With someone who has lighter skin and a crepey skin quality, typically it is a combination of aging changes, sun exposure, and other factors such as smoking and environmental factors. If someone has bags under their eyes, very often the bags will push forward and almost camouflage the quality of the skin because it stretches it out. I always counsel my patients to anticipate things we can do things during surgery. For lighter skin patients,  understand the eyelid skin is half a millimeter thickness,so  the question is how much can we do during surgery. Generally speaking, I rarely feel there is any benefit in doing any skin removal. I think that skin removal is overdone and a lot of people end up with rounded eyes. I want to distinguish skin quality from skin quantity, and rarely is there a situation where there is a significant amount of excess skin under the eyes. There can be some relative redundancy because of deflation and loss of volume but that’s a very different scenario.

The first line of treatment has always been some type of thermal device, typically a laser. For a lighter skinned person, there is a benefit of using fractional CO2 laser, ablative CO2, fractional erbium, or ablative erbium, which all have their own special benefits. What always comes to mind for me is the capacity for the individual to generate enough collagen to make a significant difference in skin quality, which is where balance becomes a challenge. The general tendency and expectation are the more aggressively you do a laser, the better results. However, when you follow a lot of people over many years, and I have been doing lasers since the mid 90’s, when I look at these patients, they had very aggressive treatments done elsewhere , but came into my practice still concerned about crepey skin.

I realized that aggressive laser can’t be the only modality. There is definitely a place for laser, and I do use laser pretty much consistently every time I do lower eyelid blepharoplasty in a lighter skinned person. In addition, I use something called platelet-rich plasma (PRP) to encourage collagen formation, restoration of blood supply and other elements from an under the skin approach with the laser. After I do the laser, I also apply platelet-rich plasma (PRP) to the skin surface to improve healing and the rate of healing.

I would say for crepey skin, you have the option. If you didn’t have laser at the time of surgery or if you have something very light, you can consider laser, but I would also recommend platelet-rich plasma (PRP). If this person has darker skin then usually laser is not the best option. Sometimes you can do a light erbium fractional laser for darker skin, but generally I’ll end up using some type of thermal energy device such as Pelleve which is radiofrequency-based to help improve skin quality, and combine it with platelet-rich plasma (PRP). Very often, for either light skin or dark skin, platelet-rich plasma (PRP) will also help the skin quality and improve the appearance of dark circles.

Beyond that, I explain to my patients once we reach a maximal benefit from the treatment, we consider how to be proactive to maintain the skin, and prevent or minimize the continual deterioration of the skin, and that’s where a program of doing some platelet-rich plasma (PRP) with some regularity or consistency has some value. The use of some topical also has some value whether it is something in the retinol family, topical vitamin C, and other topicals benefit the skin. When it comes to crepiness, you can’t 100% get rid of it, but you can improve it, and go beyond a single procedure so you do something for maintenance. When you have lower eyelid blepharoplasty, I always tell the patient after I treat the fat pockets, you have a long-term benefit, so it’s unlikely you get the same appearance or re-herniation of fat. You may get small amount of fat from here and there, but when it comes to the skin it requires some type of maintenance plan, so you need a good relationship and discussion with your doctor about that.  In summary, think about some type of thermal device for your darker skin, radiofrequency for lighter skin, laser. And for both, I also recommend platelet-rich plasma (PRP) as well as topicals.I hope that was helpful, I wish you the best of luck, and thank you for your question.

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Wrinkeled skin under the eyes

Hello and thanks for your question.

Generally speaking, most of the improvement you are requesting are reasonable and possible with either fractionated CO2 laser resurfacing or a combination of eyelid and laser procedures.  

Botox, filler or chemical peel also can help a great deal.

I would highly recommend visiting a few plastic surgeons who specialize in this exacting and artistic procedure. In our office we provide patients with a personalized, individualized and complementary consultation to address these similar issues.

Best wishes,

Dr. Sajjadian 

Triple Board Certified Plastic Surgeon

Ali Sajjadian, MD, FACS
Orange County Plastic Surgeon
5.0 out of 5 stars 195 reviews

Crepey lower eyelid skin is treated with either Erbium laser resurfacing or Fractionated CO2 laser resurfacing

Crepey lower eyelid skin is treated with either Erbium  laser resurfacing or Fractionated CO2 laser resurfacing. This improves the skin quality and reduces fine lines and wrinkles.  The downtime in this region is minimal due to a different type of skin in this region as opposed to other regions of the face for laser resurfacing.  In addition, in the right individual it actual firms up the lower eyelid skin like a "girdle" and helps " tuck in" the eye bags as well. 

Ritu Malhotra, MD
Cleveland Facial Plastic Surgeon
4.6 out of 5 stars 10 reviews

Fractionated CO2 Laser Resurfacing for Lower Lids

It is difficult to accurately assess your concerns without photos.  Typically crepey under eye skin is effectively treated with fractionated CO2 laser resurfacing.  The resurfacing allows a degree of skin tightening at the lower lids, while helping to improve fine lines and wrinkles.  Good Luck!

Anthony Corrado, DO
Philadelphia Facial Plastic Surgeon
4.9 out of 5 stars 34 reviews

Crepey under eyes

There are usually one of two reasons for crepey skin under the eyes. One is too much skin. This can be treated with a pinch excision of the excess skin. This procedure can be performed in the office, sutures are removed in 3-5 days, and the scar becomes nearly invisible. The second reason for crepey skin under the eyes is simply poor skin quality with a lack of elasticity. In this case, a laser is the answer, preferably an Erbium laser. This will smooth and tighten the skin while minimizing downtime and risk.Andrew Campbell, M.D.Facial Rejuvenation SpecialistQuintessa Aesthetic Centers

Andrew Campbell, MD
Milwaukee Facial Plastic Surgeon
4.7 out of 5 stars 26 reviews

Getting rid of crepey under eye area

Hi ivygirl,I believe that laser resurfacing is one of the best ways to reduce the crepiness of the skin of the lower lid. We use an Erbium YAG laser by Sciton and have had great success with this technique. It is usually one to two weeks of downtime followed by a period of redness / pink skin that can be covered with makeup. Other resurfacing techniques like chemical peels can also work but are not as precise. Skin pinching or skin removal techniques are also possible but can lead to problems with the lower lid position if not done carefully and do nothing to increase the quality of the remaining skin that is not excised.
I hope that helps and have a nice day.Michael M. Kim, MD

Michael M. Kim, MD
Portland Facial Plastic Surgeon
4.9 out of 5 stars 39 reviews

Crepey Skin Under the Eyes

Creepy skin under the eyes is traditionally a difficult area to address.  However, there are several options to help improve this area, including state of the art non-invasion technology to help smoothen out that area.  Other options include laser, peels, and surgery, but many patient will opt for the non-invasive treatment that can be done with little to no downtime.  Please consult with a board certified specialist who can assist you with achieving the results you seek.

Kimberly Lee, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Crepey skin under the eyes

Upper and lower eyelid surgery can take care of excess lax skin. The remaining skin that appears crepey in the lower eyelid is due to thinning of the skin with effects from cumulative sun damage over the years. The skin needs to be tightened and this can be done by skin resurfacing using chemical peels or fractional ablative lasers. 

Kristina Tansavatdi, MD
Los Angeles Facial Plastic Surgeon
5.0 out of 5 stars 33 reviews

Crepey skin

Crepey skin quality around the eyes would likely be best with a resurfacing procedure such as CO2 laser or a phenol-based peel.  One must have good support to the lids in order to minimize complications.  You would do well to consult with a facial plastic surgeon, oculoplastic surgeon, general plastic surgeon, or a dermatologist who does lots of cosmetic treatments and resurfacing about your goals.  Good luck!

Inessa Fishman, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 4 reviews

Laser Resurfacing or Dermal Fillers

Hi Ivy, It's hard to say without photos, but given that you have had eyelid surgery so recently, there are other alternatives including injections and laser resurfacing for eye rejuvenation.  If it's specifically related to crepiness, we often improve this with Scition Profractional laser resurfacing using coagulation mode to tighten the skin and if it's related to volume loss, we will add Restylane after the resurfacing.To see a recent example in our Orange, CA office, please click on the link below.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.3 out of 5 stars 6 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.