Under Eye Wrinkle Treatment with Blepharoplasty

I am scheduled for an upper Blephroplasty . For under my under eye wrinkle, what would be most effective and longer-lasting treatment? Will TCA Peel or Fraxel CO2 Laser work?

Doctor Answers 19

Under Eye Wrinkle Treatment lasers vs Chemical Peel

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Both fractional C02 laser and  TCA peels can be used for under eye wrinkles, and we offer both treatments.  In comparing the two modalities, the laser perhaps produces more immediate wrinkle reduction, which is evident at the time of treatment.  It does cause more inflammation and incur a longer recovery.  TCA peels are reserved for less extensive wrinkles and redundancy. We use a straight 30% TCA peel over other blends such as VI peels as it produces more skin tightening. The peel and recovery is well tolerated. Surgery is reserved for fat herniation and excessive skin redundancy.   Have a  candid conversation with your physician to discuss your specific circumstances.

Arthur Falk, MD

Albany Facial Plastic Surgeon

Treatment of Under Eye Wrinkles

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Thank you for the great question. In short, it really depends on the location and quantity of the wrinkles. Dynamic wrinkles lateral to the eye ("crow's feet") can be softened with Botox. Once these are more permanent, laser resurfacing using a fractional CO2 laser is my preferred treatment. In the area directly under the eye, it is common to have some thin or crepey skin. If there is a significant amount of extra skin, a lower eyelid lift is likely a better choice. This can address the skin excess as well as any fat herniation that is present. Lastly, lower eyelid surgery can be combined with laser procedures for a more complete rejuvenation. Best of luck moving forward!

under eye wrinkle treatment

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 The primary goal for lower eye lid surgery is to remove the fatty deposits creating the puffiness look. In patients over 45 years of age, most  will need a pinch technique to remove the excess skin present at rest on the lower lids. This pinch technique is incision placed at the lash line and closed with tissue glue in our practice.
 Other treatments such as fractionated laser and TCA peel are acceptable once  you have removed any excess skin. For many examples, please see the link below to our eyelid surgery photo  gallery

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Choices for lower eyelid rejuvenation

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You would be a candidate for a  lower eyelid  blepharoplasty.     You have herniation of orbital fat causing bags of the lower lids with lack of soft tissue fullness.  These features can be corrected with a lower eyelid blepharoplasty.  If the condition is only lose skin then you may want to consider SmartSkin or  SmartXide microablative fractionated CO2 laser resurfacing.   A consult would be needed to advise you which procedure would meet your expectations.

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 20 reviews

Under eye wrinkle treatment: Depends On The Amount Of Wrinkles

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Wrinkles of the lower lids come from mild to severe. In severe cases only surgery will help. If the wrinkles are mild to moderate than I'm a firm believer in first, tretinoin, then peels such as the Vi Peel, then possibly Botox. I have yet to be thrilled by any laser. Perhaps fractionated CO2 will help but you have to consider the pros and cons.

Chemical peel of the lower eyes is common for fine lines.

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I like to use TCA peel for the lower eyes. The depth of the peel is fairly controllable and predictable and it works really well to get rid of fine lines on the lower eyes. It also helps tighten the skin a little, which is an added benefit. Chemical peel of the lower eyes is not a substitute for lower eyelid surgery. Lower eyelid surgery is done to remove excess skin and fat bulges from the lower eyes. Chemical peel is done to improve the quality of the eyelid skin. If it is the fine lines around the lower eyelids that is the problem, I definitely recommend a chemical peel for this area.

Good luck!

Thomas T. Nguyen, MD
Orange County Plastic Surgeon

How do I treat my lower eyelid wrinkly skin

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Both TCA peel and CO2 laser can be used for the eyelid skin. A newer, more gentle, but still effective treatment is micro needling. 

Jeffrey M. Joseph, MD
Newport Beach Oculoplastic Surgeon
5.0 out of 5 stars 17 reviews

Under eyes bags, wrinkles and circles

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The fine wrinkles under the eyes can be treated with a few different techniques depending on the severity of the issue. For large deep folds I use a blepharoplasty with a lateral muscle suspension and skin excision. For the fine wrinkles that many people get you are right that a resurfacing technique is best. In my hands the best results are with a fractional CO2 laser. That is pretty standard and is replacing chemical peels in most practices these days. To put the cherry on top I often advocate for some volume in the area as well. The cause of the wrinkles both loss of volume and skin aging. So it is best to treat both issues. Fat is my favorite. The new fillers also do a decent  job but are temporary. 

Hope this helps. 

Best of luck,


Benjamin Caughlin, MD
Chicago Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

The Management Of Eyelid Aging

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It's not unusual for patients to develop lower eyelid wrinkles following normal facial aging. When this situation arises, a variety of treatment options are available to treat this condition. These include trichloracetic acid peels, the Frexel CO2 laser and lower eyelid blepharoplasty. The ultimate procedure chosen will depend upon the patient's anatomic findings and aesthetic goals.

If you're considering treatment of lower eyelid aging, it's important to consult a board certified plastic surgeon. This surgeon should be able to formulate a treatment plan that addresses your concerns.

Under Eye Wrinkle Treatment With Blepharoplasty

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Both procedures are great options, but I generally prefer combining CO2 resurfacing with a blepharoplasty, simply because the the laser goes deeper and yields the short-term benefit of textural improvement (fine lines and wrinkles), with the long-term benefit of skin firming.  I recommend having a wrinkle reducing treatment done the same time as your blepharoplasty so that you have one downtime.  Speak with your surgeon and share your desires to ensure his/her recommendation will exceed your expectation.

Vu Ho, MD
Plano Facial Plastic Surgeon
4.7 out of 5 stars 56 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.