Under Eye Wrinkle Treatment with Blepharoplasty

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!

Thank you for your question.  There are several ways to address skin wrinkling at the time of blepharoplasty.  Laser skin resurfacing and chemical peels can both be highly effective.  In my experience, a modified skin resurfacing  procedure provides the best outcomes safely.  I do not find fractional ablative lasers like Fraxel as helpful as some others.  Best of luck.

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,

DrC

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.

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.

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. 

I agree that if the area under the eyes has fat bags and loose skin then a lower blepharoplasty must be performed either by transconjunctival or external approach. For fine lines I would use a ViPeel if there were no fat pads or significant loose skin.

For management of fine or even more significant wrinkles under the eyes, I suggest that you consider some kind of resurfacing treatment.  A fractional CO2 laser could be used or a tunable resurfacing laser could be used to smooth away the wrinkles and tighten the skin in this lower eyelid area. 

While a TCA peel is effective in tightening the skin to a small degree, it is much more effective for treatment of pigmentation irregularities, and improvement of skin tone and texture.  A resurfacing technique would certainly be more effective and long-lasting versus the TCA peel.

Thanksfor that question! Fraxel CO2 Laser and TCA Peel are both useful for reducingwrinkles of the under eyes. That said, it must be noted that wrinkles come in acouple of forms such as mild cases of wrinkles and severe cases of wrinkles. Incases where wrinkles are severe, the only suggested procedure is surgery. Formild wrinkles, or even moderate cases, Fraxel CO2 laser and TCA peels may behelpful.
 Fraxel CO2 Laser canyield a speedy result for reducing wrinkles. However, it also causesinflammation as well as prolonged recovery time. TCA Peel on the other hand ismost often suggested for patients who have less redundant and extensivewrinkles. TCA Peel can easily manage under eye fine lines while also helpingskin tightening in the area.
Do not hesitate to askyour board certified plastic surgeon for evaluation regarding the matter. Thiswill help him or her check which is best for your situation.

There are several surgical and non-surgical ways to tighten the skin of the lower eyelid. In general, more aggressive treatments provide the longest lasting effect but come at the cost of increased risk of complications and increased recovery time. 
A TCA peel alone will have the quickest recovery time and improve the appearance of fine wrinkles but will not remove redundant skin. Combination TCA peel with a skin pinch blepharoplasty would conservatively address redundant skin and fine wrinkles with the same amount of down time as your upper blepharoplasty.  
CO2 laser vaporizes the epidermis and will result in greater downtime (erythema) than a TCA peel. The results will likely last longer, but a TCA peel can be applied more than once.
The surgical pinch technique will not address under eye bags or the lid-cheek junction. This would require a transconjunctival blepharoplasty and will have longer downtime than your upper blepharoplasty. It can be combined with skin pinch and any of the previously discussed non-surgical options at the same time. 
Your surgeon can make recommendations based on your anatomy to obtain the best results with the least amount of downtime and risk.