Question
Eyelid surgery - which is better, traditional blepharoplasty or laser blepharoplasty?
I am turning 50 next month and want to have an undereye procedure to remove the bags under my eyes. I've seen two plastic surgeons. One suggested laser blepharoplasty and the other an under eye incision. I'm confused now. Is laser blepharoplasty better than undereye surgery?
I would appreciate any suggestions or clarification regarding these two procedures.
Answers (2)
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1
November 14, 2008
Laser blepharoplasty vs transconjunctival vs subciliary vs cheeklift
The laser offers no proven benefits when used as a cutting tool except slower healing.
Of the options for your lower eyelids, if there is just a small amount of puffiness, transconjunctival (from inside the eyelid) reduction in fat combined with a peel of the lower lids or CO2 laser resurfacing conservatively for the entire face to avoid color changes should be considered.
In patients with a great deal of undereye skin, we have found that a limited incision superficial cheeklift, often with LiveFill (non-traumatized fat-fascial graft from the patient's own tissues) graft preserves eye shape much better than a subciliary (below the eye) incision.
Traditional skin-muscle lower eyelid surgeries or skin only lower eyelid surgeries often lead to a rounding of the eye or pulling down in the corners of the eye.
Fat preserving surgeries are now the rule in many practices, and techniques like the arcus marginalis release with fat repositioning are also possible.
Your doctor should be able to discuss the pros and cons of each of these procedures with you.
2
September 2, 2008
Happy Birthday! There are many ways to treat undereye bags
Board Certified
Facial Plastic Surgeon
Facial Plastic Surgeon
Answer by Michael A. Persky, MD
Hello, you look great. The best "plastic surgery" is smiling, and your smile makes you look very young.
Now as far as your under eye area - it is difficult to advise you based on this picture alone. If you have minimal fat under your eyes then a fractionated carbon dioxide laser such as Fraxel re:pair gives great results alone. If you have excessive skin, then it can be combined with a skin "pinch" excision. If you have a lot of fat protrusion then a transconjunctival approach (from inside your lower eyelid) incision is best to remove or in some cases reposition the fat. If there is hollowness under the eye that is creating the "bag", then carefully placed filler such as Restylane (temporary), or your own fat (permanent) can smooth out the bag and give you a youthful lower eyelid and cheek.
"Laser" blepharoplasty can mean different things. When used as a cutting tool, laser blepharoplasty is not much different from "scalpel" blepharoplasty, other than using the laser as a scalpel. The laser can be used to make the transconjunctival incision or to make the lower eyelid incision. With the laser incisions there is initially less swelling and bruising, but by the second to third day, the healing, swelling and bruising is the same as scalpel incisions.
Again, with the old traditional CO2 lasers and the new Fractionated CO2 lasers, laser resurfacing of the crepe skin of the lower eyelid gives great smoothing of the skin without any incisions in the skin.
I began this answer by trying to make matters less confusing for you, but have likely made you more confused than ever. The most important thing that you can do is choose your surgeon most carefully and be sure that your expectations meet your surgeon’s expectations and ability. Be well and keep showing your beautiful smile.
Dr. P
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11/20/08
I suspect that the different suggestions had to do with where the incision might be placed. The plastic surgeon offering the laser blepharoplasty may have been discussing a transconjunctival approach to the lower eyelid herniated fat. Another approach is a lower eyelid skin crease incision. Much depends, as has been discussed, with what the problem is. Many now favor a posterior transconjunctival approach which can be accomplished with a CO2 laser, cutting cautery, etc. Fat can then be conservatively excised and/or repositioned over the lower orbital rim to soften the transition between the lower eyelid and cheek. If some skin needs to be removed an anterior "pinch" skin excision can be performed leaving the underlying orbicularis muscle intact and thus reduce the risk for inferior retraction of the lower eyelid, which can be a difficult problem to solve.
Looking at your photo you appear to have some thinning of the overlying lower eyelid skin revealing the underlying contracting orbicularis muscle which causes the wrinkles in this area. I agree with a former comment that this is accentuated by your lovely smile. This can often be improved non-surgically by injecting small amounts of BOTOX into the orbicularis muscle in the lower eyelid...something not previously mentioned.