Fractional CO2 for under eyes vs surgery - what do you recommend?
I had upper and lower eye lid surgery about 10 years ago.
I had bags under my eyes, buy my doctor thought my skin was tight enough so didn't recommend
cutting the skin to tighten it under my eyes.
10 years later, my under eye area has a lot of extra skin when I smile.
I recently went to a plastic surgeon who told me surgery was not an option because it would
pull my eyelids down too much on bottom.
He recommended I do CO2.
I worry CO2 will hyper pigment and not give enough results.
Thoughts?
Thank you for your question!
You submitted a photo and in the question, you are basically trying to figure out what’s
better, a fractional CO2 laser or surgery for the under eye lines that are apparent
in the photo you submitted.
You described in your history that you had upper and lower eyelid surgery 10 years prior
and at that time, it was determined that your lower eyelid skin was tight enough that you
didn’t need any skin incision, that you recently went for a consultation to a doctor
who also recommended not having surgery at the risk of potentially causing the lower
eyelid to pull downward.
In addition, you also mentioned that the doctor recommended CO2 laser and you’re concerned
about the potential pigmentary changes as well as the possibility of getting satisfactory
results.
Well, to give you a little bit about my background, I’m a board certified cosmetic surgeon for
full body cosmetic surgery.
In addition, I am fellowship trained oculofacial reconstructive surgeon.
This means that my specialty training after eye surgery which was my first residency was
in specifically advanced training in surgery of the eyelids, the orbit, the bones around
the eye, the lacrimal tear duct system and facial cosmetic surgery.
So aesthetics around the eyes is something that has been the core of my practice over
20 years in Manhattan and Long Island.
Just to give you some sense of whether or not you’re in the right direction, I say
that you are directly guided very well.
The complication your doctor referred to is something we deal with a lot.
I achieved a certain reputation for repairing complications of cosmetic eyelid surgery and
one of the most common problem we see in our practice of patients coming for all over the
world is lower eyelid retraction.
This is due to cosmetic eyelid surgery as well as from different thermal devices specifically
laser devices.
What happens is that the eyelid retracts downwards or sometimes it actually everts out and retracts
downward.
Basically my job is to restore the integrity and the support systems that have been compromised
from the surgery.
Now the evolution of the way to approach under eye lines has been a progression over the
past 20 years.
In the beginning, we were using a full ablative very aggressive CO2 laser which could create
very good results but unfortunately, a lot of people also had complications which then
kind of veered people away from the full ablative CO2 laser.
We were using the erbium laser for many years.
This same erbium laser is now been retooled in different ways for various fractionated
devices but that were lasers which had less thermal energy.
Part of treating wrinkles does require a certain amount of heat but it must be just a certain
amount.
So in the past 2 years, we have been using fractional CO2 laser.
Now it’s very important to understand the words fractional CO2 laser is not a solution
in itself.
It’s how the doctor uses fractional CO2 laser that makes a certain difference.
Experience and method and technique are critically important.
It’s not a generic procedure.
At the same time, I would also say that what we’ve done in our practice to address those
two concerns.
Pigmentary issues and for lighter skin people, it’s not hypopigmentation or loss of pigment
that’s of a concern as well as getting optimal results.
It’s important to understand that you should define success by improvement not by achieving
porcelain smooth skin.
Trying to get porcelain smooth skin under the eyes is very difficult and impractical.
The skin is only a half a millimeter in thickness.
It can only be heated so much.
Now we actually developed a combination approach in our practice.
We use something called platelet-rich plasma (PRP).
Now platelet-rich plasma is derived from your own blood and it’s the healing growth factors
that are needed for wound healing that we have found works very well in synergy with
thermal energy whether it’s fractional CO2 laser or with Pelleve.
And it’s something we can do ongoing to help improve the skin quality.
When you are dealing with a structure that is this thin, you really have to be strategic.
Too many people go to too many different places getting too many different heating devices
and ultimately, their skin gets thinner and crepey.
So I think that you’re on the right track with this doctor.
I think you have to learn the balance of this risk of hypopigmentation and as a general
rule of thumb in this world of either ablation by chemical or laser, this critical amount
of depth needed to get a certain level of result.
But the deeper you go, the higher the risk.
So it’s always a balance.
So continue talking to this doctor about this CO2 laser.
You are probably on the right track.
And hopefully what I’ve provided for you is a value.
So I hope that was helpful, I wish the best of luck and thank you for your question!