Should I Consider Transconj. with Laser or Peel Resurfacing?

I am 54 years old & have bags under the eyes & a good bit of loose skin. One doctor recommended Transconj. w/skin pinch & laser resurfacing (erbium I think). Another Transconj w/hetter peel. Others recommended the incision under the lashes. Years ago I had facial resurfacing with a CO2 laser. My cheeks had mild hypopigmentation and a waxy look. I'm afraid the peel or the laser may have the same effect under the eyes. Any suggestions or feeback would be greatly appreciated!

Doctor Answers 4

Blepharoplasty and browlift

Looking at your posted photo I see a drooping brow, excess upper eyelid skin with overhanging skin or hooding at the outer corners and a lot of excess lower eyelid skin. The upper eyelid skin covers the eyelashes so I would bet you have some degree of a visual field defect. You need a visual field test. If the test shows a 50% or more deficit of the upper fields corrected by taping the eyelid skin up then your health insurance (even Medicare) would cover the upper eyelid surgery and maybe even a browlift since the majority of the excess may actually be due to brow drooping.

I see so much excess lower eyelid skin that I would bet if you try to burn the excess off by laser or chemical peel the risk of problems like ectropion would be much greater than a conservative controlled surgical removal of the excess skin. The excision is not a good option for fine lines of the lower eyelid but you are past the fine line stage. I do not see much fat bulging into the lower eyelids and I think if you take the fat out via the conjunctiva (transconj.) you will end up with a hollowed out over done surgery look.

Your current situation is very similar to the woman in the second/lower set of photos in the referenced web page.

My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Los Angeles Plastic Surgeon
5.0 out of 5 stars 2 reviews

Should I Consider Transconj. with Laser or Peel Resurfacing?

Yes, each olastic and cosmetic surgeon that does eyelid surgery will have a slightly different way to get the job done.  IMHO however, the transconjunctival lower bleph is superior to the transcutaneous (incision below the lashes) because the incidence of lower eyelid malposition is much less with the transconjubctival approach and was the scientific paper I published on the subject in 1990 or 91.  I also prefer to use a peel, on the lower eyelid skin over the more aggressive lasers.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.6 out of 5 stars 24 reviews

A skin pinch is another way of describing an incision under the lashes!

A lot of what cosmetic surgeons do is think up better ways to sell the same surgery.  You do have a degree of lower eyelid skin laxity.  You also have significant eyebrow ptosis.  

It makes no sense to propose to both excise lower eyelid skin and laser resurface it.  Although to be honest, the effect of erbium laser resurfacing are no modest that it may make no difference here.  The could be an argument to staging a skin pinch and then at a later date, performing the laser resurfacing if more lower eyelid skin tightening is needed.  Unfortunately the photo you posted here shows you smiling so this naturally causes the lower eyelid skin to bunch up.

One thing that is important to understand that Newtow law (for every action there is an equal and opposite reaction) hold for eyelid surgery as well.  The more skin that is removed under the lower eyelid, the more pulled down the lower eyelid will become.  

You live in Atlanta so I am going to strongly advise you against procedures that strike you as being too radical.    Although you are concerned about more laser resurfacing, you have already been damaged by this procedure, so a little more skin hypopigmentation after skin rejuvenation may not be so terrible if the lower eyelid is tightened.  It is important to understand that only so much can be done with the CO2 laser.  It is not the most powerful skin resurfacing technology we have.  That distinction goes to Baker Phenol peeling.  Even Phenol 89% which is considered medium depth peeling goes deeper than the CO2 laser and does not create the thermal injury associated with the laser treatment.  This is very important in the thin lower eyelid skin and a fact not aways well appreciated by surgeon who are still looking for ways to recoup their investment in a $159,000 laser.  I suspect that you might have a dramatic lower eyelid result without surgery just by having a very careful lower eyelid chemical peel with phenol 89% and save surgery if this does not achieve everything you are looking for. 

Good luck out there.

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

Different Surgical Approachs To Lower Eyelid Aging

What you have been described are multiple ways to treat the effects of aging on the lower eyelids. Each one of these from transconjunctival to an external pinch to a formal lower eyelid incision have advantages and disadvantages and none of them are wrong. They all will make improvements, it is just a question of how much and at what risk. The greater amount of loose lower eyelid skin the more an external skin approach is needed. Do not be too concerned about the differences between laser vs a chemical peel on the lower eyelid. The laser depth used is much less than that on the rest of the face as the eyelid skin is very thin.

Barry L. Eppley, MD, DMD
Indianapolis Plastic Surgeon
4.7 out of 5 stars 72 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.