Aging around the eyes, as evidenced by wrinkles and dark circles, will occur to some degree in everyone. It is a perpetual process that starts to become evident after the age of 35. While formal eyelid surgery (blepharoplasty) may ultimately be needed, some may desire to consider non-surgical treatment options. While there are thousands of eye creams and potions, none can really make a significant periorbital rejuvenation change.
Laser resurfacing is the bridge between creams and blepharoplasty surgery. Traditionally, laser skin treatments have been avoided on the eyelids because the skin is very thin and the risk of causing a burn injury is very real. But laser resurfacing has changed over the past ten years with the use of more accurate depth control and fractional spacing of the laser pulses. Both approaches produce less skin damage and can virtually eliminate any risk of burns and scarring.
While there are advocates for every type of laser resurfacing device out there, there is not solid scientific evidence that fractional laser treatment produces a better or longer-lasting result than traditional non-fractional ablation. Fractional laser is certainly more popular currently but optimal laser energies and devices remain in a state of perpetual development and evolution.
Non-surgical eyelifts are currently done in my practice using the Sciton microlaser and fractional laser resurfacing peel. Typical treatment time is done in less than 10 minutes for both upper and lower eyelids. The laser is used to treat the entire upper and lower eyelids, going right up to the lashline.The eyelid skin is first treated by a topical anesthetic for 15 minutes and the eye is protected with a metal shield. The eyelid skin can be treated from a 4 to 15 micron depth. It is then treated with the fractional laser at 80 microns at 22% density. This results in some mild redness and swelling for several days. Whether it is two days or four or five days is depth dependent. How much downtime a patient can tolerate determines the best depth. Ideally, a series of laser treatments are done to get the best skin tightening and some wrinkle reduction. Treating a patient every 6 to 8 weeks over a 6 month period for a total of four treatment sessions is our current protocol.
Laser resurfacing of the eyelids is not new and has even been given branding names by certain practices. It has been touted that it achieves significant skin tightening with results that are comparable to a surgical eyelid lift…without any risks. The minimal to no risk part is true but comparing it to what can be accomplished with a blepharoplasty is an overstatement. It is a good compliment for the younger patient who does not yet need surgery and works well in conjunction with Botox injections. For the older patient with more skin excess, it provides some improvement but should clearly be viewed as a bridge to blepharoplasty and not a replacement for it.
Dr. Barry Eppley