Fractional CO2 Laser is a Good Wrinkle Treatment, but can Thin the Skin if Overused

Fractional CO2 Laser is a Good Wrinkle Treatment, but can Thin the Skin if Overused

Fractional CO2 for under eyes vs surgery – what
do you recommend? I had upper and lower eye lid surgery about
10 years ago. I had bags under my eyes, buy my doctor thought my skin was tight enough
so didn’t recommend cutting the skin to tighten it under my eyes. 10 years later, my under
eye area has a lot of extra skin when I smile. I recently went to a plastic surgeon who told
me surgery was not an option because it would pull my eyelids down too much on bottom. He
recommended I do CO2. I worry CO2 will hyper pigment and not give enough results. Thoughts? Thank you for your question! You submitted a photo and in the question,
you are basically trying to figure out what’s better, a fractional CO2 laser or surgery
for the under eye lines that are apparent in the photo you submitted. You described
in your history that you had upper and lower eyelid surgery 10 years prior and at that
time, it was determined that your lower eyelid skin was tight enough that you didn’t need
any skin incision, that you recently went for a consultation to a doctor who also recommended
not having surgery at the risk of potentially causing the lower eyelid to pull downward.
In addition, you also mentioned that the doctor recommended CO2 laser and you’re concerned
about the potential pigmentary changes as well as the possibility of getting satisfactory
results. Well, to give you a little bit about my background,
I’m a board certified cosmetic surgeon for full body cosmetic surgery. In addition, I
am fellowship trained oculofacial reconstructive surgeon. This means that my specialty training
after eye surgery which was my first residency was in specifically advanced training in surgery
of the eyelids, the orbit, the bones around the eye, the lacrimal tear duct system and
facial cosmetic surgery. So aesthetics around the eyes is something that has been the core
of my practice over 20 years in Manhattan and Long Island. Just to give you some sense of whether or
not you’re in the right direction, I say that you are directly guided very well. The
complication your doctor referred to is something we deal with a lot. I achieved a certain reputation
for repairing complications of cosmetic eyelid surgery and one of the most common problem
we see in our practice of patients coming for all over the world is lower eyelid retraction.
This is due to cosmetic eyelid surgery as well as from different thermal devices specifically
laser devices. What happens is that the eyelid retracts downwards or sometimes it actually
everts out and retracts downward. Basically my job is to restore the integrity and the
support systems that have been compromised from the surgery. Now the evolution of the way to approach under
eye lines has been a progression over the past 20 years. In the beginning, we were using
a full ablative very aggressive CO2 laser which could create very good results but unfortunately,
a lot of people also had complications which then kind of veered people away from the full
ablative CO2 laser. We were using the erbium laser for many years. This same erbium laser
is now been retooled in different ways for various fractionated devices but that were
lasers which had less thermal energy. Part of treating wrinkles does require a certain
amount of heat but it must be just a certain amount. So in the past 2 years, we have been
using fractional CO2 laser. Now it’s very important to understand the
words fractional CO2 laser is not a solution in itself. It’s how the doctor uses fractional
CO2 laser that makes a certain difference. Experience and method and technique are critically
important. It’s not a generic procedure. At the same time, I would also say that what
we’ve done in our practice to address those two concerns. Pigmentary issues and for lighter
skin people, it’s not hypopigmentation or loss of pigment that’s of a concern as well
as getting optimal results. It’s important to understand that you should define success
by improvement not by achieving porcelain smooth skin. Trying to get porcelain smooth
skin under the eyes is very difficult and impractical. The skin is only a half a millimeter
in thickness. It can only be heated so much. Now we actually developed a combination approach
in our practice. We use something called platelet-rich plasma (PRP). Now platelet-rich plasma is
derived from your own blood and it’s the healing growth factors that are needed for
wound healing that we have found works very well in synergy with thermal energy whether
it’s fractional CO2 laser or with Pelleve. And it’s something we can do ongoing to
help improve the skin quality. When you are dealing with a structure that
is this thin, you really have to be strategic. Too many people go to too many different places
getting too many different heating devices and ultimately, their skin gets thinner and
crepey. So I think that you’re on the right track with this doctor. I think you have to
learn the balance of this risk of hypopigmentation and as a general rule of thumb in this world
of either ablation by chemical or laser, this critical amount of depth needed to get a certain
level of result. But the deeper you go, the higher the risk. So it’s always a balance. So continue talking to this doctor about this
CO2 laser. You are probably on the right track. And hopefully what I’ve provided for you
is a value. So I hope that was helpful, I wish the best
of luck and thank you for your question!


  • irene HANSEN says:

    I was very impressed by this doctor. He wasn't making a sell. I did learn from his video. I had laser surgery 25 years ago and always wondered why my lower lids look more droopy making me look older now. I also did not stay out of sun. In any case I am looking to do damage control now. always research I'm glad to have stumbled on this informative video.

  • payas architects & interior designers says:

    hello doctor
    i am from india vadodara .want to consult for under eye dark circle

  • bill says:

    One of the greatest videos from a P.S.

  • Carrie P says:

    Very helpful information! Thank you!

  • Skintech Aesthetics Mumbai says:

    Can I have your Whatsapp no. please; I am following you to learn; your videos are very helpful for me ..thank you so much

  • Millie Milagros says:

    Can (CO2 laser Surgery) get rid of Under eye bags ??? Thanks

  • lisabhoffman says:

    Hi Dr. Prasad, is there an occular plastic surgeon in Houston, Texas that you know of that combines this treatment of fraxel C02 laser treatment paired with Platelet Rich Plasma?

  • محمد خالد says:

    hello doc. I used a drug which is known to inhibit collagen production and it caused many wrinkels under my eye which they became better now after discountinuing the drug but they did not disappear , I am only 25 years old , could u tell me please what is best option for me to treat this problem

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