Dear Dr Seckel. Thank you for the input you gave me regarding my blepharoplasty questions. I have a brown skin type 3 or 4 and the doctor suggested that she would use profile sciton contour TM Microlaserpeel® to tighten the skin around the eyes. How many treatments are required for actual results and is it safe for my skin type? How long do the results last? She told me the tiny bag under one eye would not be noticeable if I went ahead with the treatment. Does that sound right? I did the snap test myself and the skin did snap back instantly. Although the wrinkles here are of less concern and the slight bag under one eye more so? How deep can she go with the laser for it to be effective. I only have a tiny bit of lax skin so I would consider secondary surgery with caution. She did say she could take the slight bit of fat out by transconjunctival surgery if needed later on. I would appreciate your advice. Harmohan
Dear Harmohan,
Since I have not examined you personally I cannot give specific recommendations for your treatment. Since you have seen a plastic surgeon who uses the Sciton® microlaserpeel laser skin rejuvenation technique you must depend on her advice for your treatment.
I can however speak generally about my approach to eyelid rejuvenation using the Sciton® microlaserpeel laser skin rejuvenation technique to perform a laser eyelid peel. As I said on my previous response to your questions I am very careful using the laser resurfacing or laser skin peel technique to do a laser eyelid peel to tighten lower eyelid skin. The fear is that the tightening of the lower eyelid skin will pull the lower eyelid down and cause an ectropion or a sad eyed look. It is encouraging that you have performed the snap back test and your lower eyelid seems tight, but you must rely on the expertise of your doctor to perform the test and evaluate your eyelid.
Generally it takes an 80 to 120 micron deep laser eyelid peel to tighten the lower eyelid skin, and I do not go any deeper because of the risk of ectropion.
The other complicating factor in your case is your dark type 3-4 skin type. Generally speaking I do not do a deeper (deeper than 40 micron) laser peel on darker skin types for fear of lightening the skin (hypo pigmentation)-if this happens you could have a light or white raccoon mask appearance around the eyes.
A 40 micron microlaserpeel laser eyelid skin peel would create less risk of skin lightening and I have done it successfully on patients with type 3-4 skin. A 40 micron microlaserpeel would help eyelid wrinkle removal but would not produce a dramatic immediate lower eyelid skin tightening result like the deeper laser resurfacing.
Another new eyelid rejuvenation technology which might help wrinkle removal of the eyelids without the risk of lightening of the skin or hypo pigmentation is LaserGenesis®. LaserGenesis® is a non-ablative, no down time technique that builds new collagen in the deeper layers of the skin. The treatments are simple and painless although the eyes have to be protected with impermeable laser shields. You would require 5-6 treatments spaced 3-6 weeks apart and you would not see improvement in skin texture for a few months. Treatments cost about $350 per treatment. Of all the eyelid wrinkle removal treatments this is in my opinion, the safest one for people with darker type 3-4 skin types. The LaserGenesis will help eyelid wrinkle removal but not tighten skin.
If eyelid wrinkle removal is not your main concern, and your main goal is to remove the small fatty bag, then your physicians advice regarding a transconjunctival blepharoplasty may be your best course of action.
Finally a new laser skin rejuvenation device called the activefx laser skin peel can effect eyelid wrinkle removal and provide some lower eyelid skin tightening and so far has been safe for darker skin types.
All of these eyelid rejuvenation treatments require that your eyelid snap back test is normal. If not, if your lower eyelid is lax you will need a lid tightening procedure such as a canthoplasty or canthopexy before any laser skin rejuvenation procedure can be done on the lower eyelid.
For further information on eyelid rejuvenation visit my Boston Plastic Surgery Website, read Save Your Face or contact me.
Sincerely,
Boston, Massachusetts
Peabody, Massachusetts