I'm a 30-year-old female with fair, slightly freckled skin. I have been very unhappy with the skin around my eyes lately: it is puffy above the eye and slightly droopier on one side, and below the eye, the skin puffs up when I smile and there are some wrinkles forming. Are eye/eyebrow lifts the only ways to solve the eyelid problem? The botox did nothing. Perhaps I didn't get enough? I have been recommended laser resurfacing for under-eye wrinkles. Will this work?
Unhappy with Skin Around Eyes- Will Laser Resurfacing Help Me? Something Else? (photo)
Doctor Answers 12
Proceed with caution.
It is essential not to make a mild issue worse with a poor choice. First your heavy upper eyelid fold is a very important facial feature. Eyelid lift or belpharoplasty will cause the eyebrows to fall. To compensate for this, some surgeons take every bit of available skin in the upper eyelid space. This also causes the eyebrow to fall and the effect is that the eyebrows look sewn to the eyelashes. Some surgoen take out all the fat in this tissue and hollow out the upper eyelid. Again it is critical to preserve the fullness of this area. A judiciously performed forehead lift is an option. However, look at my microdroplet BOTOX method on my website (lidlift dot com). It is my opinon that for a very long time you could have this time of service and avoid surgery. For the lower eyelid, fillers are probably the best option. For your skin, please be very careful here. The freckles represent sun damage. A mild treatment like a physician performed photofacial will lift out the freckles and make your face look much better. Laser resufacing treatments are either so mild that you may see almost no change or so aggressive that they will harm your skin texture. In Austin, I can recommend Texas oculoplastic consultants (TOC) . However, it is still your job to only have services that you are comfortable with. Please don't let yourself get wrecked.
If you are unhappy with the simpler BOTOX treatment, laser resurfacing would definitely improve skin around eyes
At age 30, often a simple BOTOX or Dysport treatment will provide an easy solution to the fine lines in the crows feet area and even underneath the eyes. Perhaps you should give this one more time before considering a more aggressive approach.
If you are still unhappy with the results from the simpler treatment, laser resurfacing would definitely improve a puffiness and/or wrinkling under your eyes. This type of laser treatment can be done with a more gradual approach, through a series of ProFractional treatments that result in minimal downtime or you could use a more aggressive laser resurfacing approach to get the results in one treatment alone. Be prepared, with the more aggressive approach, for some recovery time and care. For example, the Sciton Erbium:YAG TRL laser resurfacing of the lower eyelids would require 5-7 days downtime followed by a longer period of redness in the skin (that is easily covered by makeup). This would give you the most effective results.
The more gradual approach could be taken using the Sciton ProFractional in anywhere from 1-4 treatments, with as little as 1-3 days downtime after each treatment.
Eyelid sagging botox or laser
Botox might help lift the upper eyelids by treating the glabellar region between the eyebrows and outer eyebrow (tail of the eyebrow) and it might flatten the bulge of the lower eyelid muscle, but the latter 0ff-label indication, can induce puffiness of fluid collection if you're prone to this. An upper eyelid lift (blepharoplasty) and possibly brow lift can resuspend your eyebrow / upper eyelid complex. This however, based on your young age, may be a normal anatomic shape for you and you should see an experienced plastic surgeon to discuss the options. Laser resurfacing would not expect to provide any significant eyelid lift, nor would Ultherapy, or Fraxel or Portrait Plasma.
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Laser would be a poor choice
You mentioned that you were "slightly freckled". I therefore would avoid laser resurfacing. In your situation this could remove the freckles where the lasering is performed and give an unsightly demarcation where the freckles remain below this lasered area. I agree that an upper blepharoplasty with recreation of the tarsal crease (as is done in Asian eyelid surgery to make a more caucasion look) would give the best improvement. Your lower eyelids are showing the orbicularis muscle roll with animation. Botox works best for this if the appropriate amount of units is used.
Unhappy with Skin Around Eyes- Will Laser Resurfacing Help Me? Something Else?
The photos provided show excess skin of the lower eyelids that can easilly be removed with a lower lid skin pinch. The upper eyelids are quite full and both eyebrows are low in position. A Brow Lift would be required to raise the eyebrows, into the proper aesthetic position, which would decrease the upper eyelid fullness. At 30 years of age, it's unlikley that much, of the observed upper eyelid fullness, is really excess upper eyelid skin which typically appears later in life. For this reason, the Brow Lift may very well eliminate all the excess upper eyelid fullness.
Treatment of eyelid bags
Your posted photos show upper eyelid puffiness due to a combination of brow drooping and excess upper eyelid skin. The percentage of each component can only be ascertained in a face to face examination. The lower eyelids become puffy with facial animation but in repose look fine.
You say that botox did nothing but not where or how much was injected. Botox usually can only make this worse as botox to the forehead can only make the eyebrows droop down more etc. You need to wait for the botox to wear off before you have any surgery because surgery performed to balance botox related tissue positioning issues will be problematic after surgery when the botox wears off.
Laser resurfacing cannot be used to fix your upper eyelids because the amount of laser energy required to dissolve/shrink that excess skin is associated with high scar & other problems.
You need to be very careful choosing a surgeon and what type of provedure to have. Choosing the wrong surgeon/procedure could make you very unhappy with the result.
I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.
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.
What to do about eyelids?
What I am seeing in your pictures are upper eyelids with a poorly defined crease, and lower lids with a prominenet muscle roll and fine lines. For your upper lids I would recommend what is known as an anchor blepharoplasty. This is not a procedure based on taking away as much as reshaping. I see this problem mostly in younger patients like yourself. The muscle roll may respond to small amounts of botox. If you haven't tried Retin A for the wrinkles in your lower lids, I think this would be a good place to start. There can be some reddness to the skin in the beginning, but essentially there is no down time, as the cream is applied at night before bedtime. I would steer clear of lasers, for reasons already mentioned. Good luck.
Will Laser tighten the lower eyelid skin?
Laser treatment of the lower eyelid skin will decrease the wrinkles. The type of treatment will determine how much. Fractional treatments drill many little holes through the skin but leave the majority of the skin intact. These treatments require little recovery time but multiple treatments to get good results. Laser resurfacing removes the outer layer of all the skin. The recovery is more intense and time demanding, but the results are more dramatic with only one treatment typically.
The upper eyelids would likely do well with a conservative blepharoplasty, which is eyelid surgery where excess skin (and fat if needed) is removed. Removing a little bit of skin and fat would allow more of the upper eyelid to show. Find a surgeon with many before and after photos, a good reputation and proper board certification. Good luck!
Eyelid surgery or laser?
You should do well with a conservative upper lid blepharoplasty which can be simulated if you lift your brows a little. This should lift the excess skin off your lashes so your eyeliner and lashes will show better. Don't insist the surgeon remove all the puffiness from the upper lid because this will age you.
From the photo, I mostly see generous orbilaris muscle rolls and some wrinkles on the side. The wrinkles are best handled with Botox. The orbicularis rolls respond well to Botox or can be thinned surgically.
Eyelids, brow Botox and laser
There is slight brow droop which will increase with age; look at your parents. There is fullness and overhang of the upper lids which is partly due to the brow droop as well as orbital anatomy.
Although you may never achieve the look you want because of the above, I recommend you start with Botox and laser resurfacing (CO2 fractional is my favorite). In a few years you might consider upper blepharoplasty conservatively and in later years a brow lift.
Go slowly, choose wisely and good luck. You may want to see my article "Laser specialist" and the same principles apply to choosing a blepharoplasty 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.