Our eyes are often the first area of the face to display the early signs of aging, mainly because eyelid skin is the thinnest in the body. Exposure to various environmental factors such as UV light, atmospheric pollution, and the oxidative stress phenomenon contribute to the deterioration of collagen and elastin fibers in the dermis with subsequent morphologic changes. Inevitably, these factors work in tandem with the intrinsic aging process to provoke cellular senescence and loss of skin tone manifested in the appearance of fine lines and wrinkles. This process is especially evident in the lower eyelids.
In this delicate area, the oculoplastic surgeon has two main therapeutic options for restoring a youthful skin complexion: resurfacing procedures or surgical resection of excess skin. Each alternative has pros and cons, and there is no one-size-fits-all approach. The best option will depend on age, skin type, degree of skin laxity, and severity of skin damage, among other factors.
Skin resurfacing: removing damaged skin to make room for new skin
Skin resurfacing treatments encompass various non-surgical procedures, including skin ablation with lasers and other energy-based devices, chemical peels, and microdermabrasion. Skin quality can also be improved with mesotherapy, but this fits outside the category of skin resurfacing and is outside the scope of our current blog.
The science behind these treatments indicates that we can restore skin morphology and improve its quality by removing the outer layers of damaged skin to stimulate new collagen and elastin formation. A tighter, smoother skin will replace aged and sun-damaged skin, giving the lower eyelids a more beautiful complexion. New skin will also have a youthful appearance with a noticeable improvement in wrinkles and fine lines.
A relative disadvantage of skin resurfacing treatments is their inherent risk of inducing changes in skin color, either hyperpigmentation or hypopigmentation, especially in people with darker skin tones. There is also a risk of scarring, infection, prolonged erythema (redness), and cyst formation (milia). Most of these complications can be prevented by careful patient selection, skin prepping with topical agents before the procedure, and employing an adequate technique. It is important, therefore, that the physician performing these treatments have expertise in managing such complications.
Skin resection: eliminating the excess to tighten eyelid skin
In patients with advanced skin damage and severe wrinkles, or when a darker skin tone contraindicates skin resurfacing, a straightforward surgical resection of excess skin is a great option to restore the youthful complexion of the lower eyelid region.
This operation, medically termed lower eyelid blepharoplasty, is usually performed in an outpatient surgical facility under local anesthesia. When the surgery is more complex, as in cases when lower lid bags are treated concomitantly, intravenous sedation or general anesthesia may be preferable. A conservative approach is essential in blepharoplasty since removing too much skin can easily result in complications such as lower eyelid retraction or ectropion. Most surgeons will perform a canthal tightening procedure to prevent this complication.
Whatever the procedure, select a specialist with ample experience.
After a thorough examination, your doctor will determine the best option to meet your expectations. Whether you choose a skin resurfacing procedure or surgical intervention to treat under-eye wrinkles, selecting a specialist with adequate training and substantial experience in eyelid rejuvenation is very important.
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