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 17

Under Eye Wrinkle Treatment lasers vs Chemical Peel

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
4.6 out of 5 stars 10 reviews

Choices for lower eyelid rejuvenation

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 16 reviews

Under eye wrinkle treatment: Depends On The Amount Of Wrinkles

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.

The Management Of Eyelid Aging

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

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
4.8 out of 5 stars 34 reviews

Lower eyelid rhytids (wrinkles)

Fractionated laser resurfacing and chemical peels are both effective at reducing lower eyelid rhytids and tightening the skin to some degree. We use both deep and active FX with good results. Laser is generally better than a TCA peel but is more expensive and takes longer to heal. TCA peels give quite good results and can be done as a simple office procedure without anesthesia. We also like full strength phenol for the lids.  It can give results approaching the laser. All of these decision need to take into account the patients skin type and such. It is important to understand any resurfacing can basically treat the rhytids present at rest but there will always remain dynamic rhyids with smiling. There are good studies showing that Botox before the resurfacing will give a better result because the patient isn't developing new rhytids during the healing phase.

Wayne F. Larrabee, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 13 reviews

Lower lid wrinkles

TCA Peels and Fraxel CO2 lasers are both reasonable options for fine wrinkles on the lower eyelid skin. You must ask yourself about downtime. The laser takes longer to recover from while the peel provides quicker recovery yet may not last as long.  The trend nowadays is 'less is more' and patients are opting for more and more peels because of the decreased down time and ability to follow up for up keep with the peels.

Sean Paul, MD
Austin Oculoplastic Surgeon
5.0 out of 5 stars 8 reviews

Under Eye Wrinkle Treatment with Blepharoplasty

Both TCS peel and Fraxel CO2 laser are effective at treating the lower lids in conjunction with your upper eyelid blepharoplasty. The TCA peel treats more mild cases and has faster healing time, but care is required to ensure it does not get into the eyes. The CO2 laser can be used for more prominent wrinkles and can treat up to the lash line. One laser you did not mention is the Erbium laser. It gives great results with short recovery time and is very safe. 

Treatment of Under Eye Wrinkles

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!

Evan Ransom, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 92 reviews

under eye wrinkle treatment

 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
4.7 out of 5 stars 125 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.