Why Eyelid Surgery Does Not Address Under Eye Wrinkles & Why Non-Surgical Treatments are Appropriate

A 31-year-old woman wants to know the best option to remove wrinkles and saggy skin around her eyes, and if eyelid surgery (blepharoplasty) will help.

Dr. Amiya Prasad, an oculoplastic cosmetic and reconstructive surgeon, deals with these types of concerns everyday in his practice. Wrinkles and excess skin are not always synonymous. In fact, blepharoplasty, a surgical procedure defined by removal of extra skin, addressing fat pockets, puffy bags under the eyes as well as over the eyes, will not make a significant improvement when someone is dealing with the textural quality of skin.

When Dr. Prasad looks at a patient, he determines their age and skin type. It's very well established that people who are Caucasian with lighter skin tones will have more accelerated aging of the skin, commonly manifested by fine lines and wrinkles, as compared to an African-American skin type. Genetics play a major role in skin aging, as well as what's going on in the inside and outside of the body. Fine lines, wrinkles, and skin aging will be accelerated by smoking whether it's from carbon monoxide, generation of free radicals and other cell wall damages because of smoking. If someone does smoke, they should consider stopping. Sun exposure is also a major factor in photoaging. If someone spends a lot of time in the sun or they live in a place where there's incidental sun exposure, then they have to be mindful of always wear sunblock and avoid the sun as much as they can.

The skin under the eyes in only half a millimeter in thickness so there are limitations on what kind of fillers or other options one has. Conceptually, this woman will be someone Dr. Prasad manages in a combination approach. A non-surgical strategy which includes neurotoxins such as Botox or Dysport, fractional cO2 laser and a regeneration technique using platelet-rich plasma is the right strategy for someone like her.

To address the fine lines and wrinkles, then Dr. Prasad has to reduce the activity of the muscles. With the photo this woman submitted, it appears that she is squinting a little bit and she is smiling. The wrinkles that are generated are called dynamic wrinkles. Dynamic wrinkles means that a muscle is activated and those wrinkles appears. Dr. Prasad manages dynamic wrinkles using materials such as Botox or Dysport. These are neurotoxins that are injected directly into the muscle in a very specific way to minimize the activity of those muscles so that those wrinkles would less likely to form. Not only does the residual activity of the muscle diminish, those lines become less pronounced.

When the wrinkles are present at rest, they are called static wrinkles. These are the crisscross wrinkles that are around the eye and are parallel to the muscle around the eye called the orbicularis oculi muscle. There are options to treat those lines. Lasers such as a fractional cO2 laser that applies thermal energy in a very specific way to tighten the skin and to resurface the top layers of the skin. It doesn't eliminate wrinkles but improves the appearance of the lines.

Something else that Dr. Prasad does and is slowly becoming well known is the use of platelet-rich plasma. Platelet-rich plasma is derived from the patient's own blood and it is the concentration of the healing aspects of the blood called the platelets. Platelets with plasma contain growth factors called vascular endothelial growth factor which stimulates blood supply. All of that has been shown to significantly enhance skin quality. It has a reversing effect to the changes of aging skin.

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