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