Thank you for your question.
You submitted your question with a single photo.
And you say you underwent CO2 laser under your eyes about 2 months prior.
And you’re expressing a concern about seeing more visible lines and puffiness.
Your doctor states that you are dehydrated and is recommending a moisturizer.
And you’re basically asking is this the case or have you wasted your money.
Well, I can certainly share with my experience treating the under eye area.
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.
Treating the under eye area with lasers has been present in my practice since the very
beginning starting with the original CO2 lasers which were very aggressive and fully ablative.
So I think it’s important to understand basic principles as to the effect of laser
on lines and wrinkles.
And I think, chances are your doctor already discussed this with you but I think it’s
very important to understand this.
When most people think about lasers, they often have a perception that like science
fiction, that lasers can literally erase wrinkles.
But the reality is, we have to understand the types of wrinkles that we are treating
before we treat them.
So to understand that difference, you have to remember that there are two types of wrinkles
we look at.
We look at static wrinkles which are the typical fine lines and crisscross lines that are there
when the eyes are at rest.
Then we have dynamic wrinkles which are there when the eye is in motion.
Now of course, dynamic wrinkles can cause static wrinkles to occur.
So which accounts for crow’s feet lines and these are fine lines around the eyes that
radiate.
Now generally speaking, if someone has very deep lines, then I will often combine using
a neurotoxin such as Botox® to relax the eyes before doing the laser.
In fact, I was featured years ago in the early days of the lasers for this idea on the news
because I basically went with this logic that I thought made intuitive sense that if you
relax the muscles that are creasing the eyelids or creasing the wrinkles around the eyes,
well if you relax those muscles, when the skin heals, the collagen will remodel in a
way so that the skin will be smoother.
Now that being said, there is still a role for a neurotoxin such as Botox® after the
laser.
The point is, I always tell my patients that even if you iron clothing, if you crease it
again, you keep folding it, it will crease.
So there’s a strategy there where you not only laser to try to resurface and remodel
the skin but you also want to prevent the skin from getting more wrinkled.
Also understand that, speaking of remodeling, in terms of wound healing, there is the active
phase of wound healing which is called the proliferative phase that lasts about a month
or so but there is this ongoing remodeling phase where the collagen realigns.
And I’ve had many times patients be anxious about the presence of lines and wrinkles particularly
when I did facial resurfacing and then noticed that as time went on, they look better and
better.
So it is a test of one’s patience to watch and see what happens after a treatment like
this.
There is probably a need for more treatments but you have to also look at what kind of
improvement has occurred.
Generally speaking, we try to go for whatever maximum improvement is possible with minimal
downtime.
And I think that of course, what is factored in as well is how thin the skin is.
The skin can only tolerate so much laser energy and therefore, you have to sometimes walk
a very fine line as a practitioner on how aggressive you treat the skin.
In addition in my practice, I commonly, frequently, almost always, use platelet-rich plasma when
I do lasers because I like the way the platelet-rich plasma stimulates collagen, stimulates healthy
skin through the generation of blood vessels and collagen.
And basically, works very well in combination with the laser to get the most results that
one could hope for.
You have to also think about the capacity of the skin to generate collagen.
A lot of times, people with very light skin who have a lot of sun damage, the under eye
skin is less than half a millimeter in thickness.
You can only expect so much improvement.
There is a strategy where with ongoing maintenance, beyond the laser treatment at one time where
you can, over the course of time, make small incremental improvements that will help maximize
the outcome.
So I would say don't lose faith so quickly but rather maintain this dialogue you have
with your doctor as to ongoing strategy beyond the timeframe which your doctor feels that
your results have stabilized.
So I hope that was helpful, I wish you the best of luck and thank you for your question.