Thermage or Blepharoplasty for Sagging Under Eyes?

Will Thermage fix my under eye sagging skin, or will a lower Blepharoplasty work better?

Doctor Answers 21

Thermage will not fixing sagging lower eyelid skin

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Thermage will not fixing sagging lower eyelid skin. The primary goal for a lower blepharoplasty is to remove excess fat bags on the lower lids. If there is excess skin, this is removed through a pinch technique and closed with Histocryl tissue adhesive. There are no sutures placed on the lower lids. Thermage will not get rid of fat bags, and it will not get rid of excess skin. The skin needs to be removed conservatively on the lower lids so as not to change the shape of the eye.

Seattle Facial Plastic Surgeon
4.8 out of 5 stars 157 reviews

Thermage should never be an option

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I agree with the others on this.  Thermage is expensive and has not been shown to provide great results.  Most good surgeons do not offer this treatment any longer.  Blepharoplasty is usually the way to go.

Henry Daniel Sandel IV, MD
Annapolis Facial Plastic Surgeon

Just say No to Thermage

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Thermage in my opinion, is not a good treatment, especially around the eye.  Not enough control.  A blepharoplasty can get you what you want, safely, reliably.


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Depends on how severe the skin is

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First, let me say I'm not a fan of Thermage. I don't think there's any real significant data that show that it works. What does work to different degrees is Retin-A for mild aging and sun damage, CO2 or fractionated CO2 laser, peels and if the more severe cases surgery. In addition surgery will fix the other issues that typically go with aging lower lids such as laxity of the lid margin and fat bulging.

Don't waste your money on Thermage. I think there's no bang for the buck.

Only mild improvements will be notice with radiofrequency (thermage)

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For very lax skin radiofrequency treatment will not produce a dramatic result and it works best in areas with less dynamic movements..... neck skin loose abdominal skin etc.

Ablative Fractional Laser rejuvenation and excision with blepharoplasty will produce the best results.

Richard D. Gentile, MD
Youngstown Facial Plastic Surgeon
4.5 out of 5 stars 45 reviews

Thermage is no blepharoplasty.

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Dear SR

A lot depends on exactly what your issues are. Thermage might make a modest difference but it is not going to correct fullness from herniated orbital fat, it will not get rid of significant lower eyelid wrinkles. If you issue is just a few lower eyelid lines it might benefit the appearance of the lower eyelid skin but if you are looking for surgical results, then it is very likely you will be disappointed with the results of thermage.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Do not do Thermage under eyes

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Thermage uses radiofrequency energy which is transmitted very deep into the skin. In some patients, Thermage has dissolved the fat beneath the skin and caused visible depressions.

In my opinion, it is dangerous to use thermage on the eyelids. The skin is very thin and structures around the eye beneath the lower eyelid could be injured.

A blepharoplasty is a much more effective procedure to correct eye bags and eyelid aging. In some cases of wrinkled excess lower eyelid skin I also use a 2940 Erbium laser peel.

Be sure to consult a board certified plastic surgeon who is very experienced at eyelid surgery. The skill and experience of your surgeon will determine the success of your result.

See before and after photos of upper and lower laser blepharoplasty.

Pros & Cons to Each

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Dear SR in TX,

Unfortunately, Thermage treatment around the eyes is a problem as anything done inside the orbital rim can possibly cause serious eye injury. Although eye shields can be used during treatment, the risk of corneal scratching and infection make this a poor, but possible choice of, treatment. A blepharoplasty (eye lift) can make dramatic changes, but is still an  invasive surgery. I would suggest seeking a consultation with a skilled Thermage technician who can tell you which treatment is best for you. Hope this helped!

Dr. S

Bruce Saal, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Thermage works well for eyes if there is minimal skin laxity

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I have been pleased with Thermage for minimal skin laxity. That is why patient selection is most critical. If you have a small amount of extra skin either below or above the eyes it will tighten it by one to two millimeters to give a brighter more open eye area.  However if you have extra fat pad deposits or excess skin wrinkling your best bet is investing in a surgical blepharoplasty.

Thermage is not the answer.

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Thermage may work on some areas of the body in some individuals some of the time!! For specific and distinct skin excess, the results may be disappointing. For mildly loose skin or to prevent it, Thermage may be valuable. Lower eylid can be improved with Fraxel, peels or surgery.

Reza Nabavian, MD
Santa Monica Plastic Surgeon

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.