How can I get rid of crepey under eyes?
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.
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.
Triple Board Certified Plastic Surgeon
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.
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I hope that helps and have a nice day.Michael M. Kim, MD