Thank you for your question.
You are 37 years old, you submitted two photos and you describe your under eyelid skin as
being thin and crepey.
You’ve seen a doctor who had advised against doing any type of significant intervention,
so you're looking for an option for treating your crepey eyelid skin.
Well I can certainly help you with this.
I'm a Board-certified cosmetic surgeon and a Fellowship-trained oculoplastic or oculofacial
plastic surgeon, practicing in Manhattan and Long Island for over 20 years.
Skin texture and quality of the eyes has been one of the great challenges for which we've
had many good options and solutions.
The key today is to really customize what's right for the individual patient.
So, thinking more holistically, just looking at your skin, it triggers questions in my
mind about what has caused the skin to be this crepey.
Thirty-seven is still very young, and when someone comes in with that quality of skin,
we always look to the history.
Is this mostly a genetic factor, which is more of a hereditary skin quality—people
who have very light skin, light eyes, and light hair tend to have thinner quality skin
compared to people with darker skin.
Then there's also other factors that include sun exposure, smoking, physical stress, medical
stress, and environmental exposures.
So we try to think holistically and try to intervene as best as we can through advice
and guidance as to what you can do—if you're using tanning beds, don't do that, if you're
spending a lot of time in the sun, work on reducing that and wear protection.
With all that being said, what we've discovered and developed in our practice is the use of
something in addition to lasers.
Lasers, I think, have a potential role in your treatment, but I would caution you that
with the proliferation of a lot of lasers, and even on laser devices such as radio frequency
devices, we're seeing more and more patients who have actually damaged their skin long
term from very aggressive use of lasers or thermal energy devices.
So it's important to master how much is the right amount for the skin.
I always think of it as comparable to exercising in the gym—there's training and then there's
overtraining.
So when it comes to skin, what we've done is we've actually moved a little bit towards
more of a regenerative methodology.
What we do is we use something called platelet rich plasma.
Now this is derived from your own blood, and it's a concentration of the healing and growth
factors that we inject under the skin.
There is a distinct advantage over lasers and thermal energy in that this procedure
actually doesn't "damage" the skin in order to get a certain college in response.
We do combine this with lasers and radio frequency, but we tend to be more conservative with lasers
and radio frequency and we can be much more liberal with the use of platelet rich plasma.
Essentially, what we're doing is we're stimulating collagen and blood supply to the skin the
way it would if the skin were injured, but in distinction is that with thermal energy,
thermal energy can actually break down the skin, it can overheat the skin and we're seeing
that more and more.
So I would say that with lifestyle changes and exploring the option of platelet rich
plasma as well as lasers, I think the right combination can help you in the long term.
Platelet rich plasma doesn't always work with just one treatment—we routinely do it as
more than one over the course of the year, so maybe twice a year or as frequently as
four times a year.
But a lot depends on the patient's response.
There’s something about cosmetic skin enhancement that often requires observation before doing
the next step.
So I recommend that you explore this information, learn more, and meet with doctors who are
comfortable with using platelet rich plasma, as well as use of lasers.
A lot of times, doctors get one laser, then another laser, then another laser, and will
use one laser to do one treatment, and when the patients dissatisfied, move them over
to another laser.
Inevitably the skin ends up getting thinner, and this is something that's not a very popular
opinion, but it's something that I've observed over 20 years of practice beginning with the
original CO2 lasers.
So I hope that was helpful and I wish you the best of luck!