Thank you for your question.
You submitted your question with several photos.
And you’re asking what can you do about your under eye skin, about wrinkles and thin
skin.
And several of your photos you have from different angles and with expression and without expression.
Well, I can certainly share with you how I counsel my patients who come in every day
in my practice with exactly the same concerns.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon.
I have been in practice in Manhattan and Long Island for over 20 years.
Customizing solutions to help people with wrinkles around their eyes whether it’s
with injectables or with regenerative medicine technology and of course the many lasers has
been an evolving and continuously interesting process that helped me really optimize the
treatment strategies for my patients over 20 years in practice.
So to begin with, I always try to help my patients learn some basic principles to help
guide them before they jump on what is the latest and greatest gadget.
So to begin with, it’s very important to understand and to distinguish dynamic wrinkles
from static wrinkles.
When you’re smiling, when you’re moving and the skin appears to wrinkle more, you
have to understand that there is a dynamic process.
So when I say dynamic, I’m basically talking about muscle action.
So to help manage wrinkling from muscle action, you use a neurotoxin such as Botox® or Dysport
and that helps to diminish the intensity of the wrinkling with movement.
That’s fairly straightforward.
And so it’s been well established particularly around the eyes that it’s very good for
crow’s feet lines as well as some activity of the muscle underneath the eyes.
Now when it comes to the quality of the under eye skin, I would say a lot has been learned
at least from my perspective over the years of different modalities being introduced.
And in the mid 90s and in the late 90s, the procedure of choice was to use ablative CO2
laser.
And although it certainly worked very effectively, over the years, what I realized especially
as people got older that their skin continued to get thinner and then you have to ask yourself
what’s the upper limit.
How much can you laser the under eye skin?
The eyelid skin is the thinnest skin in the body.
It is half a millimeter in thickness.
And so as time went on, of course, less ablative lasers like the Erbium laser came along and
then came the fractional lasers.
But further, what has helped me a lot in my practice has been a strategy where I try to
help counteract the progressive thinning of the skin which occurs with aging.
It is a commonly held belief in the medical community that after the age of 20, you lose
1% of collagen in the skin every year.
Now that is very meaningful so in a way you also want to try to be proactive and help
build the skin and find ways to strengthen the skin.
And this is where something called platelet-rich plasma (PRP) comes into play.
A lot of my patients who have crepey skin and fine wrinkled skin from aging as well
as sun exposure and smoking, what I do is basically skin rehabilitation.
We periodically inject with platelet-rich plasma (PRP) under the skin to help build
the skin up and to improve it.
We can also employ light microneedling or the use of a skin booster to help deliver
PRP to stimulate collagen as well as deliver hyaluronic acid within this very thin layer
of skin.
When it comes to also ways to stimulate skin with thermal energy, well we can do everything
from a fractional CO2 laser or fractional Erbium laser as well as this additional modalities
such as long pulsed Erbium lasers that can be used to help tighten the skin or generate
heat into the skin without taking out the top layers of skin and that also has become
another strategy that I’ve been employing to help manage the skin.
Basically, you cannot eliminate it but you can improve it.
And the goal is to do as little significant trauma to the skin and do as much as you can
that can sustain the skin quality for as long as possible.
So it’s very common for me to customize a treatment plan which involves the regular
use of a neurotoxin, use of PRP as well as the lasers depending on what kind of skin
issue there is whether it’s a long pulsed Erbium, fractional CO2, fractional Erbium.
What I would caution you is not to be overly aggressive.
Patients come all the time who have had multiple lasers, who have had thermal energy devices
especially the more aggressive high intensity radiofrequency devices and they often complain
that their skin got worse, the skin got crepier.
And it’s a very important detail to consider.
Remember that the skin is so thin, it’s half a millimeter in thickness.
It’s practically transparent.
It has to be treated very carefully, very gently.
And you cannot eliminate wrinkling but you can manage it.
And so I think that this technology of regenerative medicine with platelet-rich plasma (PRP) for
me has been very useful.
And it is also further important to understand that in addition to the wonderful interventions
that we have, prevention is very important.
And so it’s important to wear sunblock, protect your skin.
The eyelid skin as I said earlier is the thinnest skin of the body and it is vulnerable to a
lot of environmental stressors such as sun exposure and smoking.
So meet with qualified, experienced doctors who can help you learn about these modalities.
Be careful about not just jumping on the train of whatever is the latest and greatest devices.
If you've been around this field for any time, you have learned that things are literally
hot for awhile and then become very cold very quickly.
And so it’s important to find a doctor who has that experience and judgement to guide
you in a way that is appropriate and ethical and will be in your best interest and with
your understanding of the limitations and that’s very important.
So I hope that was helpful, I wish you the best of luck and thank you for your question.