We have been using fractionated laser technology to tighten eyelid skin for many years. Essentially, we are doing a "laser peel" to tighten the eyelid skin.The original C02 laser worked by vaporizing the top layer of skin completely. This gave very nice tightening, but had a very long recovery time (3-6 months). 5-6 years ago, we moved to fractional technology, where instead of vaporizing all of the top layer of skin, columns of skin were vaporized, leaving islands of normal skin intact. This allowed the skin to heal both from the bottom up as well as from the sides inwards. The results were not quite as a good (but still very good), but people healed much faster (5-7 days). Because of this, for the past 4-5 years most laser procedures done on the face have been fractionated procedures. The Madonna Lift is simply the name that one surgeon gave to his treatment using a particular fractionated C02 laser, and because they have marketed it like crazy, have established it as a "new" procedure, when in reality it is not new at all. In fact, there are newer technologies (Erbium Lasers, for instance) that get similar results with an even faster healing time. The key to great results depends on a careful evaluation of your issues. Often, multiple technologies are needed to give a real, youthful looking result. While tighter, smoother skin is important, often fillers are also necessary to add back some of the lost youthful volume around the eyes and in the upper cheeks. There are some newer skin care products that have shown noticeable improvement by adding back some of the elastic qualities to the eyelid skin. And yes, as much as we would like to be able to use the available non-surgical techniques, sometime surgery is the only thing that will help the issue. Given the wide range of options available, and given the ever-changing improvements that continue to be added, it is important to consult with someone that uses all of these technologies, so that the right combination can be used to give you the best result possible. Good luck.