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however the prolonged and difficult recovery following laser facial skin rejuvenation with both the CO2 and Erbium lasers prevents most people from considering this wrinkle removal technique. Initial recovery can take three weeks and the facial skin is left red to pink for up to 3 months. MicrolaserPeel®, another wrinkle removal technique, during which a superficial erbium laser skin peel is done is an improvement, but recovery is still 2-7 days, and the treatment needs to be repeated 3-4 times over several months to achieve the best result.
Recently we have introduced the ActiveFX® Laser , the latest technological break through in non-surgical facial laser skin rejuvenation and wrinkle removal. This technique uses the revolutionary ActiveFX® CO2 Lyte® laser which is a component of the Ultrapulse® Encore® laser made by Lumenis®.
The ActiveFX® Laser exfoliates or removes dead skin, wrinkles, fine lines, pigment, skin irregularities, and tightens skin with only 3-4 days of facial skin pinkness, even less in some people. The ActiveFX provides deep exfoliation, the crucial first step of the 6-step facial rejuvenation program and the beginning phase of any wrinkle removal program. You can have the procedure done on Thursday and return to work on Tuesday, thus you only miss one or two days of work. The procedure is done in the office and takes 15 to 20 minutes. We give patients a pill before hand for relaxation and apply a topical anesthetic to numb the skin so discomfort is minimal. No injections, needles, or other anesthesia is required.
Recently we have been using an additional treatment called Gentlewaves® immediately after the ActiveFX® laser wrinkle removal treatment and this treatment has reduced the pinkness and down time to 4-5 days! The Gentlewaves® is a safe LED (Light Emitting Diode the red blinking light on your TV remote) which soothes the skin after the ActiveFX® wrinkle removal treatment and significantly reduces pinkness and down time.

The benefit of the ActiveFX® laser skin peel for wrinkle removal over other superficial laser and IPL non ablative treatments also called photo facial treatments is that you get deep skin exfoliation and immediate skin tightening as well as wrinkle removal.
The ActiveFX® Laserlyte Peel® is also excellent for eyelid rejuvenation, and can improve or remove eyelid wrinkles and fine lines and tighten eyelid skin and can be done in combination with a laser transconjunctival blepharoplasty for a much improved blepharoplasty result for true total eyelid rejuvenation.

The ActiveFX® laser skin rejuvenation uses a gentle de-powered CO2 laser beam which is scanned over the skin in random fashion so that heat build up is minimized, thus redness or pinkness is lessened and recovery time is much quicker. Unlike the Erbium laser, the ActiveFX® laser Peel produces skin tightening as well as wrinkle removal, two crucial components for effective, real facial skin rejuvenation.
The ActiveFX® LaserlytePeel® is a revolutionary new advance in wrinkle removal therapy, facial skin rejuvenation and non-surgical facial rejuvenation.
The application of the ActiveFX Laser peel following laser laser transconjunctival blepharoplasty is a major advance in eyelid rejuvenation and the treatment of facial and eyelid wrinkles and eyelid aging changes.
To learn more contact me or read Save Your Face.

Dr Brooke Seckel

Boston, MA

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Traditional scalpel blepharoplasty is a plastic surgery operation which involves cutting and removing skin and fat from the lower eyelid to remove excess skin and fat and to remove eyelid bags and dark circles under the eyes. This is also sometimes referred to as an operation called eyelid plasty. While this plastic surgery operation does remove skin and fat, the technique also creates a scar on the lower eyelid and weakens the support of the lower eyelid and can result in the lower eyelid turning down into a sad eyed look also called an ectropion or “hound dog eyes.”

In addition, the scalpel blepharoplasty does nothing to address the skin aging changes of the lower eyelid such as wrinkles, “crepiness”, brown spots and other superficial skin aging changes. Also, dark circles under the eyes, also called the tear trough deformity, cannot be removed unless a special technique called arcus marginalis release with fat repositioning is done.

A newer more modern technique called the transconjunctival blepharoplasty avoids the eyelid skin incision by making the incision on the inside pink portion of the lower eyelid, called the conjunctiva with a laser. The transconjunctival incision avoids a scar on the eyelid and avoids cutting through the eyelid muscle, thus the crucial lower eyelid support is not violated and the beautiful eyelid shape is preserved. This approach avoids the sad eyed look, ectropion, and hound dog eyes. The laser seals blood vessels as the incision is made thus there is less bleeding, less bruising and quicker recovery. The laser transconjunctival blepharoplasty also provides the opportunity to correct dark circles under the eyes.

To correct the skin aging changes on the outside of the lower eyelid an exciting new laser technique with the ActiveFX laser made by Lumenis, is done to remove the wrinkles, brown spots and skin aging changes and create smooth fresh new lower eyelid skin. Unlike the older laser skin resurfacing techniques, the new ActiveFX Laserlyte Peel® is a superficial peel, about 70 microns compared to 150-200 microns for the older laser resurfacing. The new Laserlyte Peel® is done with the Lumenis® CO2 Lyte® laser which is especially designed to deliver a gentler laser peel to the eyelid skin. Wrinkles are removed, the skin is tightened, and the eyelid skin rejuvenated and recovery time from the peel is only 4-5 days, less than the recovery time from the blepharoplasty. This is a revolutionary improvement over the older laser resurfacing technique that left the eyelid red for 6-8 weeks and could cause an ectropian. It is still very important to check for eyelid laxity before any eyelid surgery by pulling down on the lower eyelid and making sure the eyelid snaps back against the eyeball quickly. If the eyelid is slow to snap back, the ligaments are lax and must be tightened before any lower eyelid surgery by using a technique called a canthoplasty or canthopexy.

The laser transconjunctival lower eyelid blepharoplasty with Laserlyte Peel® is a revolutionary new eyelid rejuvenation or eyelid lift technique which produces total eyelid rejuvenation with minimal down time, something that cannot be achieved with scalpel blepharoplasty alone. This approch allows for the correction of bags and dark circles under the eyes. More importantly the sad eyed look or ectropion can be avoided. After the blepharoplasty has healed, Botox can be used to prevent the crows feet from recurring. To learn more read Save Your Face or contact me.

Dr. Brooke Seckel

Boston, Massachusetts

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Newer, modern blepharoplasty technique involves using a laser to make the transconjunctival incision. The benefit of the laser is less bleeding, quicker surgery, quicker recovery, and usually less bruising.

Even with these advanced new techniques, however, one problem is that the skin of the lower eyelid still looks old after blepharoplasty surgery. The surgery can remove bags, tighten skin and improve eyelid aging changes, but the aged skin, “crepiness”, wrinkles, and brown spots are left behind and the rejuvenated eyelid skin still looks old. In the past, laser resurfacing was done to the eyelid skin to freshen the skin. Although laser resurfacing can create new smooth skin, down time after laser resurfacing is prolonged and redness can last up to 3 months. In addition with laser resurfacing of the eyelid, there is risk of ectropion or sad eyed look because the eyelid can be pulled downward by the laser tightening of the skin.

A new, exciting, revolutionary technique using a new laser peel called the ActiveFX laser Peel peel allows for a superficial skin refreshing peel of the eyelid skin without the risks and downtime associated with laser resurfacing of the eyelid. The new Laserlyte® peel uses a new feature of the Lumenis® Ultrapulse® Encore® laser called the ActiveFX or CO2Lyte® which is designed to perform a superficial 70 micron peel of the skin to remove wrinkles, pigment and tighten skin without the risks of traditional laser resurfacing.

The down time after a Laserlyte® peel is a remarkable 4-7 days! This is within the normal downtime of a blepharoplasty alone. The laser has been modified to use a smaller treatment area and a different scanning mechanism so that old skin is vaporized and gently tightened using much less laser energy. Thus the irritation of the eyelid is less and recovery time is shorter.

This is a very significant new development in eyelid rejuvenation surgery and in my opinion will significantly change the way blepharoplasty is done and will enable plastic surgeons to perform true eylid rejuvenation, including skin renewal, with minimal down time and avoid the complications associated with old style laser resurfacing of the lower eyelid. To learn more read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

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Patients who seek blepharoplasty often complain of a tired look. The most common complaint I hear is that “people say I look tired when I am not”. The goal is to remove the tired look, the eyelid bags, the dark circles and tighten skin. Blepharoplasty alone does not remove wrinkles. Wrinkle removal requires resurfacing of the skin by one of many different new techniques.
The most common blepharoplasty technique done by most surgeons today involves making an incision on the outside of the lower eyelid with a scalpel in order to remove excess fat and skin.One very common problem following the scalpel blepharoplasty operation however is that the operation can change the shape of the eyelid. In some cases, after surgery the outer portion of the lower eyelid turns down revealing too much of the white portion of the eye. Technically this is called scleral show, and if it is extreme it is called ectropion and can damage the eye. Plastic surgeons refer to this complication as “hound dog eyes” or “sad eyed look”
Fortunately, the sad eyed look or hound dog eyes can be avoided by a newer blepharoplasty technique called the transconjunctival blepharoplasty.
The problem with the standard “old style” scalpel blepharoplasty technique is that when the surgeon cuts through the muscle which supports the lower eyelid the support for the eyelid is often lost. In addition, the scarring produced by the surgery tends to pull the eyelid down. If the patient has a lax lower eyelid to begin with, the situation is made much worse.
The transconjunctival blepharoplasty is done very differently from the scalpel blepharoplasty and avoids injury to the supporting eyelid muscle. The conjunctiva is the pink part of the eyelid on the inside. In transconjunctival blepharoplasty the small incision for a blepharoplasty is made with a laser through the conjunctiva on the inside of the lower eyelid and avoids damage to the supporting muscle. The fat is removed or repositioned from the inside and the lid tightened and an arcus marginalis release performed to correct dark circles. Laser blepharoplasty, that is using the laser to make the transconcunctival incision and tighten the skin and muscle, is becoming much more common today as blepharoplasty techniques continue to improve.
The benefit of the transconjunctival laser blepharoplasty is:

1. There is no visible scar on the outside of the lower eyelid
2. The eyelid shape is not changed
3. Healing time and recovery is usually quicker
4. Bruising is often less
5. The sad eyed look or hound dog eyes is avoided
If you have a lower eyelid that is lax or loose or if your outer lower eyelid turns down, there is a serious risk that you may have the sad eyed look or hound dog eyes or worse if you have an old style scalpel blepharoplasty with the incision on the outer eyelid. Very few plastic surgeons use the transconjunctival laser blepharoplasty technique. If you would like to read more about this technique and total eyelid rejuvenation visit saveyourface.com. Contact me for further questions about this article or read Save Your Face.

Dr Seckel

Boston, Massachusetts

A newer approach called a transconjunctival lower eyelid blepharoplasty is done through a small incision on the inside of the lower eyelid. No scar or mark is left on the outside of the eyelid thus there is no visible evidence that the surgery has been done.

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Other advantages of this approach are that the lower eyelid muscle and supporting structures are not cut through form the outside. This technique preserves the support of the eyelid and avoids the sad eyed look or “hound dog eyes”, technically called an ectropion, which is an often-occurring “stigma” of a blepharoplasty operation.

I do the transconjunctival blepharoplasty using the laser, which has the advantage of less bleeding, less bruising, and quicker recovery from surgery.

Contact me or read Save Your Face to learn more about the latest facial and eyelid rejuvenation techniques.

Dr. Seckel

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However the prolonged and difficult recovery following laser facial skin rejuvenation with both the older CO2 and Erbium lasers prevents most people from considering this technique.

The New Laserlyte Peel™ is the latest revolutionary technological break through in laser skin peeling technology and non-surgical laser facial skin rejuvenation. This technique uses fractional micro ablative laser technology to vaporise small areas of damaged skin but leaves intact skin bridges between the laser treated spots. This exciting new method provides high tech deep facial skin exfoliation for removal of wrinkles and sun damage, stimulation of new collagen production, and tightening of facial skin, with minimal down time and recovery.

Ablative CO2 and Erbium laser beams at at specific energy settings and fractional overlap are used to provide deep skin exfoliation or removal of dead skin, wrinkles, fine lines, crow’s feet, pigment, skin irregularities, and tightens skin with only 5-7 days of facial skin pinkness. This is accomplished by leaving intact skin bridges for rapid regrowth of new skin cells in 4-6 days as opposed to 2 weeks with other laser resurfacing methods. You can have the procedure done on Thursday and return to work on Wednesday, thus you only miss 2 -3 days of work. The procedure does not require injections or anesthesia, but I do apply a topical anesthetic cream to the face for my patient’s comfor

The benefit of the New Laserlyte Peel™, wrinkle removal and skin tightening method over other superficial laser and superficial chemical skin peels is that you get immediate skin tightening as well as wrinkle removal and stimulation of new collagen production to replace the skin collagen damaged by years of aging and photo damage.

The Laserlyte Peel™ is also excellent for eyelid rejuvenation, and can improve or remove eyelid wrinkles, crow’s feet, and fine lines and tighten eyelid skin much more safely than can be done with traditional laser resurfacing methods. The Laserlyte Peel can be done in combination with a laser transconjunctival blepharoplasty for a much improved blepharoplasty result for true total eyelid rejuvenation.

The Laserlyte Peel is a revolutionary new method for laser skin peel or deep exfoliation which provides effective facial skin rejuvenation and non-surgical facial rejuvenation by removing facial skin wrinkles, tightening facial skin, and restoring new collagen in the skin with minimal down time.

To learn more about the Laserlyte Peel or other non-surgical or surgical facial rejuvenation techniques, Contact me or read Save Your Face.

Dr Seckel

Boston, Massachusetts

In addition, the scalpel blepharoplasty does nothing to address the skin aging changes of the lower eyelid such as wrinkles, crow’s feet, “crepiness”, brown spots and other superficial skin aging changes. Also, dark circles cannot be removed unless a special technique called arcus marginalis release with fat repositioning is done.

A newer more modern technique called the transconjunctival blepharoplasty avoids the eyelid skin incision by making the incision on the inside pink portion of the lower eyelid, called the conjunctiva with a laser.

Contact Dr Seckel

The transconjunctival incision avoids a scar on the eyelid and avoids cutting through the eyelid muscle, thus the crucial lower eyelid support is not violated and the beautiful eyelid shape is preserved. This approach avoids the sad eyed look, ectropion, and hound dog eyes. The laser seals blood vessels as the incision is made thus there is less bleeding, less bruising and quicker recovery.

To correct the skin aging changes on the outside of the lower eyelid an exciting new laser technique called the ActiveFX Laser Peel is done to remove the eyelid wrinkles, brown spots and skin aging changes and create smooth fresh new lower eyelid skin. Unlike the older laser skin resurfacing techniques, the new ActiveFX Peel is a superficial peel, about 70 microns compared to 150-200 microns for the older laser resurfacing. The new ActiveFX Peel is done with the Lumenis® CO2 Lyte® laser which is especially designed to deliver a gentler laser peel to the eyelid skin. Wrinkles are removed, the skin is tightened, and the eyelid skin rejuvenated and recovery time from the peel is only 5-7 days, less than the recovery time from the blepharoplasty. This is a revolutionary improvement over the older laser resurfacing technique that left the eyelid red for 6-8 weeks and could cause an ectropian. It is still very important to check for eyelid laxity before any blepharoplasty by pulling down on the lower eyelid and making sure the eyelid snaps back against the eyeball quickly. If the eyelid is slow to snap back, the ligaments are lax and must be tightened before any lower eyelid surgery by using a technique called a canthoplasty or canthopexy.

The laser transconjunctival lower eyelid blepharoplasty with ActiveFX Laser Peel is a revolutionary new eyelid rejuvenation or eyelid lift technique which produces total eyelid rejuvenation with minimal down time, something that cannot be achieved with scalpel blepharoplasty alone. More importantly the sad eyed look or ectropion can be avoided. After the blepharoplasty has healed, Botox can be used to prevent the crows feet from recurring.

Contact me, or read Save Your Face for the latest information on new advances in facial and eyelid rejuvenation.

Dr Seckel

Contact Dr Seckel

The benefit of a transconjunctival approach, that is making the incision on the inside of the eyelid as opposed to the traditional technique of making an incision on the outside of the eyelid, helps preserve the natural shape of the lower eyelid and avoid the sad eyed or hound dog look after surgery.

Newer blepharoplasty technique involves using a laser to make the transconjunctival incision. The benefit of the laser is less bleeding, quicker surgery, quicker recovery, and usually less bruising.

Even with these advanced new techniques, however, one problem is that the skin of the lower eyelid still looks old after blepharoplasty surgery. The surgery can remove bags, tighten skin and improve eyelid aging changes, but the aged skin, “crepiness”, wrinkles, and brown spots are left behind and the rejuvenated eyelid skin still looks old. In the past, laser resurfacing was done to the eyelid skin to freshen the skin. Although laser resurfacing can create new smooth skin, down time after laser resurfacing is prolonged and redness can last up to 3 months. In addition with laser resurfacing of the eyelid, there is risk of ectropion or sad eyed look because the eyelid can be pulled downward by the laser tightening of the skin.

An exciting new technique using a new laser peel called the ActiveFX laser peel allows for a superficial skin refreshing peel of the eyelid skin without the risks and downtime associated with laser resurfacing of the eyelid. The new ActiveFX laser peel uses a new feature of the Lumenis® Ultrapulse® Encore® laser called CO2Lyte® which is designed to perform a superficial 70 micron peel of the skin to remove wrinkles, pigment and tighten skin without the risks of traditional laser resurfacing.

The down time after a Laserlyte Peel® is a remarkable 5-7 days! This is equal to or less than the downtime of a blepharoplasty alone. The laser has been modified to use a smaller treatment area and a different scanning mechanism so that old skin is vaporized and gently tightened using much less laser energy. Thus the irritation of the eyelid is less and recovery time is shorter.

This is a very significant new development in eyelid rejuvenation surgery and in my opinion will significantly change the way blepharoplasty is done and will enable plastic surgeons to perform total eyelid rejuvenation including skin renewal, with minimal down time and avoid the complications associated with old style laser resurfacing of the lower eyelid.

Contact me or read Save Your Face to learn more about this procedure

Dr Seckel.

A newer technique using a laser incision on the inside of the lower eyelid allows the surgeon to shrink or tighten the lower eyelid tissues from the inside, avoiding the need for a visible incision on the outside of the eyelid. No eyelid tissue or skin is cut away.

Contact Dr Seckel

This technique preserves the integrity of the lower eyelid skin and muscle, preserves the support of the lower eyelid and prevents the “sad eyed” or hound dog appearance of the lower eyelid which can occur after traditional incisional eyelid blepharoplasty surgery in which the skin is cut and removed.

This technique is called a transconjunctival laser lower eyelid blepharoplasty with muscle/septum tightening. This procedure also accomplishes skin tightening of the lower eyelid. Following the blepharoplasty if excess skin and or wrinkles or crow’s feet are still noticeable the laser can be used to resurface the lower eyelid skin and create fresh new lower eyelid skin. To prevent recurrence of the wrinkles and crow’s feet Botox® injections can be used after surgery.

In an article published in the journal Plastic and Reconstructive Surgery a study of 196 laser blepharoplasties using the laser blepharoplasty with laser muscle/septum tightening showed excellent cosmetic results with no occurrence of eyelid malposition or sad eyed look. (Laser blepharoplasty with transconjunctival orbicularis muscle/septum tightening and periocular skin resurfacing: a safe and advantageous technique. Seckel, et al. Plast Reconstr Surg. 2000; 106(5): 1127-41)

The newer laser blepharoplasty technique for the lower eyelid, which avoids an external incision and removal of eyelid skin, is an advance that produces an excellent cosmetic result and avoids malposition of the lower eyelid.

Contact me or by phone at 617-262-2208 to learn more about this procedure, or visit us online.

While blepharoplasty alone can achieve satisfactory eyelid rejuvenation for many people, the standard blepharoplasty alone cannot remove dark circles under the eyes.

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In fact, many people complain that after they have had a blepharoplasty on the lower eyelids, they notice that the dark circles under their eyelids are worse than before they had eyelid surgery.

A newer blepharoplasty technique, which includes a procedure called an arcus marginalis release with fat repositioning, can correct the dark circles under the eyelids for many people. This plastic surgery operation can be done as a part of the transconjunctival blepharoplasty, a standard incisional blepharoplasty or a laser blepharoplasty. The blepharoplasty operation alone does not provide wrinkle removal, for that botox and/or laser skin rejuvenation using the revolutionary new ActiveFX laser peel is necessary. Blepharoplasty can however achieve some degree of skin tightening

The dark circle is caused by the fact that a small ligament called the arcus marginalis tethers the dark circle to the bone of the eye socket. As the lower eyelid ages and becomes lax, and the fat supporting the eyeball begins to push out against the lax lid, the lower eyelid skin begins to fall or sag down towards the cheek.

Because the dark circle is tethered and cannot sag along with the lower eyelid skin, the sagging lower eyelid skin falls over the dark circle. This creates a shadow in the dark circle and makes the dark circle darker and more noticeable.

In some patients, a blepharoplasty can make the dark circle worse, especially if too much fat is removed during the eyelid surgery.

To correct the dark circles under the eye, a newer blepharoplasty technique that includes release of the arcus marginalis is done. When the arcus marginalis is released the dark circle is free to move downward with the lax lower eyelid skin and the shadow causing the dark circle is lessened.

Because the eyelid skin of the dark circle is thinner a depression is created which helps create the shadow. To compensate for the thin skin of the dark circle, after the arcus marginalis release is done, fat is placed beneath the dark circle to plump up the dark circle and lessen the shadow of the dark circle.

I call the combination of a transconjunctival blepharoplasty with arcus marginalis release, fat grafting, and the ActiveFX laser peel, total eyelid rejuvenation, something that was impossible to achieve before the advent of laser surgery. This new modern blepharoplasty technique for the first time allows me to remove dark circles under the eyes and achieve a truly refreshed younger eyelid look.

Contact me by email or by phone at 617-262-2208 to learn more about this procedure, or read Save Your Face.

Dr Seckel