can I have surgery for under eye wrinkles many people come into my office
and show me how pulling the skin under their eyes outward results in the skin
looking smoother they ask can you do this doctor I showed them with a mirror
how the areas around their eyes become distorted and the level of tension that
they're using with their fingers cannot be sustained long-term with surgery
nonetheless surgery to address under eye wrinkles is still very commonly
performed and the complications of this approach can be quite significant I'll
discuss how I address under eye wrinkles in my practice I'm Dr. Amiya Prasad I'm
a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic
and reconstructive surgeon I've been in practice in Manhattan and Long Island
for over 20 years as a cosmetic eyelid surgery specialist I regularly perform
all types of cosmetic eyelid surgeries for under eye bags
hooded eyelids drooping eyelids or eyelid ptosis as well as revision work
to correct complications from other surgeons such as eyelid skin removal to
treat wrinkles causing rounding of the eyes pulling down to the lower eyelids
or lower eyelid retraction and even a COPI on where the inside of the lower
eyelid is exposed outward a common misconception is that wrinkles under the
eyes are caused by excess skin this perception is reinforced by people
pulling on the skin and seeing how the skin doesn't snap back into place so
quickly this is a reflection of decrease in skin quality not an increase in skin
quantity the eyelid skin is the thinnest skin in the body at about 1/2 of
meter a simple concept remember is that this very thin skin has limited
tolerance for overly aggressive treatment in addition to the skin
quality the appearance of the eyelid skin is also affected by the tension of
the lower eyelid the lower eyelid is like a suspension bridge and a
particularly important point of support is a structure called the lateral
canthal tendon if for any reason there is laxity of this tendon the eyelid
margin can sag and the skin can appear loose and redundant laxity the lateral
canthal tendon is typically seen with aging however I have seen it often in
people who have seasonal allergies in order to improve the appearance of the
skin it's been well established from using chemical peels and lasers that
removal or ablation of the epidermis and the upper part of the dermis can result
in smoother looking skin thermal energy delivered to the dermis
results in the production of collagen which can create an improved foundation
for the epidermis new epidermis after chemical peel or laser appears smoother
after treatment in my practice I've used ablative CO2 and erbium laser as well
as fractionated CO2 and erbium laser the challenge has always been to be able to
perform a procedure for under eye wrinkles without the typical one-week
downtime with this in mind I've been using a long pulsed erbium fractionated
laser which we refer to as the Smooth Eye procedure this procedure is
performed in my exam room with the only topical anesthetic and takes only a few
minutes to perform the patient has no downtime and comes in for about three
sessions each session is about one month apart if a patient has a crepey very
thin quality to the eyelid skin I often use PRP to help the skin be able to
tolerate any laser procedure better I feel that if this thin eyelid skin is
weak it should be prepared in order to respond effectively to any laser
procedure I refer to this as skin rehab if a patient has darker skin is not a
candidate for laser I use radiofrequency technology to induce collagen remodeling
instead of laser many times people with thin lower eyelid skin also have
wrinkles around the eyes like crow's feet lines these lines get deeper with
expression so these dynamic wrinkles can be reduced with regular injections of
botulinum toxin such as Botox or Dysport topical skincare such as the use of
retinols and moisturizers with some active ingredients can be beneficial for
ongoing maintenance this appearance and behavior of lower eyelid skin is often
seen with other changes such as the prolapse of lower eyelid fat pockets in
order to address puffy under eye bags a surgical procedure called lower eyelid
blepharoplasty is indicated the most common approach to addressing under-eye
bags surgery is a procedure called
transcutaneous blepharoplasty during a transcutaneous blepharoplasty an
incision is made just below the eyelashes and the skin and muscle are
elevated separated so the fat causing eye bags can be addressed
typically eyelid skin is trimmed and sutured in a effort to tighten the skin
the problems with transcutaneous blepharoplasty procedure include skin
shortage due to excess skin removal as well as compromising of the lower eyelid
support due to a separation of the tissue layers which previously were
stronger as a unified structure lower eyelid skin is part of the layered
structured responsible for lower eyelid support just under the skin is your
bycula oculi muscle which acts like a hammock and is attached to the bone
biased structure called the lateral canthal
tendon inherently there is a compromise of these support structures when the fat
pockets are accessed through an external incision patients who had the surgery
come to see me every week with lower eyelid rounding retraction and even
ectropion because of skin shortage after skin removal for these conditions I
perform advanced reconstructive procedures including skin and tissue
grafts to restore this compromised anatomy in my practice for under-eye
bags I perform a procedure called a transconjunctival blepharoplasty I
sculpt the fat pockets responsible for the eye bags from the inside of the
eyelid so no external incision is needed this is considered a more advanced and
specialized procedure by performing transconjunctival blepharoplasty I'm
preserving the anatomic structures that support the lower eyelid for under eye
wrinkles I use fractional co2 and erbium laser with PRP this combination has
proven to be safe and effective in improving the appearance of under eye
wrinkles without skin removal again I'm focusing on improving the skin quality
I've observed particularly in people who lack cheek projection that the eyelid
skin appears to be redundant when it's simply sagging from lack of support or
projection instead of removing skin I restore volume in the cheek with
long-lasting hyaluronic acid fillers such as Juvederm Ultra Plus and Juvederm
Voluma these fillers will not weigh the skin down since I placed them at the
bone level similar to the way I would place a facial implant this is called
Structural Volumizing and it's very effective in restoring balance between
the cheeks and the eyes I performed transconjunctival blepharoplasty and
most other cosmetic surgery in my office under local anesthesia with
minimal IV or LITE sedation my patients recover quickly and return to work in
about a week this is opposed to general anesthesia where recovery from the
effects of anesthesia alone can be unpleasant and physically draining so if
you're concerned about wrinkled skin under your eyes understanding that skin
quality is more relevant to your treatment strategy than skin quantity
it's also important to understand the other anatomic factors which can be
contributing to the skin under your eyes appearing to be redundant I cannot
stress enough the importance of recognizing the delicate structure of
the eyelid skin to avoid overly aggressive procedures which can make the
skin look worse and even compromise the integrity of the lower eyelid although
you can get away with a limited skin removal such as a skin print procedure
the underlying qualitative issues are more important in my experience doctors
who advise eyelid skin removal may believe they're doing their best to help
you you need to be sure that you're able to retain the natural shape of your
lower eyelids after that type of procedure is performed I hope you found
this information helpful thank you for your question
you