Why Surgery for Under Eye Wrinkles is Generally Not Advised, and Safer Treatment Options

Why Surgery for Under Eye Wrinkles is Generally Not Advised, and Safer Treatment Options


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

Leave a Reply

Your email address will not be published. Required fields are marked *