Q: Dr. Eppley, I am 37 yrs old and I have some wrinkles under and around my eyes I would like to get rid of and not sure if I should just do Botox or try and have surgery to remove them. I have attached some pictures for your review.
A: There are basically three treatments for aging eye issues, Botox, blepharoplasty surgery and skin resurfacing. (chemical peels vs. lasers) Botox is the only treatment for wrinkles that occur OUTSIDE of the eyelid area. (e.g. crow’s feet area) Blepharoplasty (eyelid) surgery is the only treatment that can remove excess skin and fat of or ON the eyelids. Skin resurfacing using either chemical peels or fractional laser resurfacing can be used for fine wrinkles ON and OUTSIDE of the eyelids. Given the nature of aging around the eyes, many people need a combination of these approaches to get the best result…not to mention the need for maintenance therapies such as Botox injections, topical skin creams and the avoidance of smoking and extreme sun exposure.
What I see in your pictures is hooding of upper eyelid skin and a roll of skin underneath the lashline of the lower eyelid. These are definitely surgical (blepharoplasty) issues. I suspect there is wrinkling beyond these areas but the quality of the pictures does not permit that assessment. These pictures are also only smiling which creates animated rolls of skin on the lower eyelid which may or may not be present when not smiling.
The short story is that you are likely in need of surgery for major improvement but I would not use the term ‘remove’ when it comes to eyelid aging changes as that is not realistic. You need to think improvement of them that is not going to be a permanent cure to them.
Dr. Barry Eppley
Q: I’m interested in learing more about dermabrasion or micropeeling. Can this be done on the eyelids? (above and below) Will this help reduce the beginnings of a fold in the top eye crease? I live two hours away. If you can answer these two questions about this procedure would help me determine if I should come in for a consultation.
A: By the way your question is phrased, it appears that you seek a non-surgical solution to the appearance of wrinkles on the eyelids. There are a variety of skin resurfacing methods that are commonly used on all other areas of the face so it is reasonable to ask about their use on the eyelids.
The eyelids represent skin that is very unique from that of the rest of the face. It is different primarily because it is so thin. Being thin makes it very sensitive with higher risks of scarring if the skin resurfacing method is not carefully selected and performed.
Microdermabrasion (superficial) and dermabrasion (deep) are not effective (microdermabrasion) or safe (dermabrasion) skin resiurfacing methods for use on the eyelids. Traditional laser resurfacing is not either for the same reason that dermabrasion should not be used, it penetrates too deep.
The use of laser micropeeling and chemical peels, however, are both effective and safe methods for the eyelids. Laser micropeeling at the depth of 20 microns or less, TCA (trichloroacetic acid) chemical peels of 15%, 25% and 35% as well as the newer Vi chemical peel are all potential choices. Which one of these is best for your eyelids will require an actual consultation to determine.
Another very effective option is the combination of ‘mini-blepharoplasties’ with chemical peeling. The actual removal of a small amount of excess skin and then tightening the rest can be a very effective eyelid wrinkle-reducer.
Dr. Barry Eppley
Q: I am in the very early stages of looking into treatment for the area under my eyes. I believe the problem could be easily fixed by the right Dr. and this is my first attempt to find out what is involved and how much it would cost. The skin directly under each eye is all wrinkled and takes completely away from my appearance and has caused me to be completely self conscious for many years now and if I can do something about it, I would like to.
A: Aging around the eyes is often one of the first signs that many people notice as they get older. Changes in the lower eyelid are usually more obvious than that of the upper eyelids since they are not hidden or distracted by the eyebrow and are larger by surface area. Since so much of human conversation involves direct eye contact, how our eyes look is seen by all. It is no wonder then that many people seek plastic surgery for an improved and more youthful eye appearance.
While there are many topical creams out there, and they do have some anti-aging merits, they are no replacement for more invasive eyelid skin treatment methods. Depending upon the amount of loose skin that exists on the lower eyelid, some version of a lower blepharoplasty or eyelid tuck can be very helpful. Through a fine line incision along the lower eyelash line which extends slightly out from the corner of the eye, loose skin is removed and the lower eyelid is tightened.
Lower blepharoplasty will definitely help remove some but not all of the eyelid wrinkles. You never want to risk removing too much skin from the lower eyelid in an effort to work out every sinle wrinkle and then end up with a pulling down of the eyelid after. (ectropion) Lower blepharoplasty is an excellent wrinkle reducer but should not be thought of as a complete wrinkle remover.
Dr. Barry Eppley