Thank you for your question.
You are asking how to get rid of crepey skin and you state in your question that you had
upper and lower eyelid surgery done last year but you are concerned about the crepey quality
of your skin.
Well, certainly I can give you some guidance as to how I counsel my patients who I do blepharoplasty
or eyelid surgery for.
A little bit of background, 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 and providing comprehensive
solutions for the eye area is a significant part of my practice.
So I can walk you through my thought process and also where the decision points are.
In addition, how I advise my patients about ongoing care.
So, to begin with, if someone comes into the office who has lighter skin and has this crepey
skin quality and typically it is a combination of aging changes and sun exposure with other
factors such as smoking and environmental factors.
So now the skin is very crepey.
So if someone has bags under their eyes, very often the bags will push forward and almost
camouflage the quality of the skin because it kind of stretches it out.
So, I always counsel my patients to anticipate that so that we can do things during surgery.
So for lighter skin patients and understanding that the eyelid skin is half a millimeter
thickness, the question that comes to mind first is how much can we do during surgery.
And generally speaking, I rarely feel like there is any benefit in doing any skin removal.
I think that skin removal is overdone and a lot of people end up with rounded eyes.
I want to distinguish skin quality from skin quantity.
And rarely, a situation where there is a significant amount of excess skin under the eyes, there
can be some relative redundancy because of deflation and loss of volume but that’s
a very different scenario.
So, that being said, the first line of treatment has always been to use some type of thermal
device typically a laser.
For a lighter skin person, there is a benefit of using a laser such as the fractional CO2
laser, ablative CO2, fractional Erbium, ablative Erbium and all those modalities have their
own special benefits.
But the question that always comes to mind for me was how much capacity does the individual
have to generate enough collagen and skin quality to make a significant difference and
that is where the balance became a challenge is that the general tendency or general expectation
is the more aggressively you do a laser, the better results will be.
But when you follow a lot of people out over many years, and I have been doing lasers since
the mid 90’s, and when I look at these patients, they had very aggressive treatments done elsewhere
who came into my practice who is still concerned about crepey skin.
I realized that aggressive laser can’t be the only modality.
There is definitely a place for laser and I do use laser pretty much consistently every
time I do lower eyelid blepharoplasty in a lighter skin person.
But in addition, I use something called platelet-rich plasma (PRP).
And the point of platelet-rich plasma (PRP) is to encourage collagen formation, restoration
of blood supply and other elements from an intrinsic or under the skin approach with
the laser.
And in fact, after I do the laser, I also apply platelet-rich plasma (PRP) to the skin
surface to improve healing and encourage improvement in the rate of healing.
So, I would say that for crepey skin, you have the option.
If you didn’t have laser at the time of surgery or if you have something very light,
you can consider laser but I would also, in my practice, recommend platelet-rich plasma
(PRP).
Now if this person has darker skin then usually laser is not the best option.
Sometimes you can do a light erbium fractional laser for darker skin but generally I’ll
end up using some type of thermal energy device such as Pelleve which is a radiofrequency-based
to help improve skin quality through thermal modality and I also combine it with platelet-rich
plasma (PRP).
Very often, for either light skin or dark skin, platelet-rich plasma (PRP) will also
help the skin quality and improve the appearance of dark circles.
Now beyond that, I explain to my patients, once we reach a certain maximal benefit from
the treatment then we have to consider how to be proactive to maintain the skin and prevent
or minimize the continual deterioration of the skin and that’s where a program of doing
some platelet-rich plasma (PRP) with some regularity or consistency has some value.
The use of some topical also has some value whether it is something in the retinol family
or topical vitamin C and other topicals that benefit the skin.
So when it comes to crepiness, you can’t necessary 100% get rid of it but you can improve
it but you have to also think not only about a single procedure but something for maintenance.
There is a big distinction where when you have lower eyelid blepharoplasty, I always
tell the patient, once I treat the fat pockets, you have a long-term benefit from that and
it’s unlikely that you will get the same appearance or re-herniation of that same volume
of fat.
You may get small amount of fat from here and there but when it comes to the skin, skin
requires some type of maintenance plan and that is something where you have to have a
good relationship and discussion with your doctor about that.
So in summary, think about some type of thermal device for your darker skin, radiofrequency
for lighter skin, laser.
And for both, I also recommend platelet-rich plasma (PRP) as well as topicals.
So I hope that was helpful, I wish you the best of luck and thank you for your question.