A Multi-Modal Approach to Addressing Aging Lower Eyelid Skin

The skin of the lower eyelids can exhibit the following features with age:

• A loose redundancy resulting in bunching near the eyelash line at rest
• Fine lines and wrinkles extending down to the cheek
• Hyperpigmentation, which can sometimes be worse in the tear trough region

A multi-modal approach to help address the above features should try to both maximize effectiveness and minimize risks. One example of such an approach is:

1. Lower eyelid skin pinch
2. Laser skin resurfacing
3. Nanofat with or without platelet-rich-plasma (PRP) injections

It is important to seek a consultation with a fellowship-trained, double board-certified facial plastic surgeon if you have questions about your lower eyelids.

The Lower Eyelids are Composed of Multiple Layers of Mostly Thin Tissue

It is composed of:

• Skin
• Muscles
• Conjunctiva
• Fat
• Connective tissue.

It is among the thinnest tissues in the face.

The Lower Eyelids Serve Important Functions

This part of facial anatomy serves important functions, contributing to:

• Eyelid closure
• Tear distribution across the eye

The risks of treating this part of the face  include, but are not limited to, the following:

• Scaring
• Infection
• Damage to the eye
• Incomplete eye closure

The skin is relatively thin and functionally important. As a result, interventions on the skin of the lower eyelids should be more gentle than on other parts of the face. Therefore, improvements of the skin in this area should be expected to be less dramatic than in other areas of the face.

A Multi-Modal Approach Can Increase Effectiveness and Reduce Risks

Each of the above procedures can help address aging of the skin in this area through a different mechanism:

1. Lower eyelid skin pinch. Some patients demonstrate redundant skin immediately inferior to the eyelash line. A small amount of this skin is pinched immediately inferior to the lower eyelid eyelash line, extending just past the lateral edge of the eyelid and into a natural fold. The purpose of a skin pinch procedure is to reduce some of the skin bunching that can occur near the eyelash line with rest. Importantly, the muscle controlling the lower eyelid will always contribute to bunching of the tissue in this location when contracting (e.g. speaking, smiling, eyelid closure).
2. Skin resurfacing, which can include lasers, chemical peels, and/or dermabrasion The purpose of these procedures is to ablate a certain depth of skin – usually micrometers – and allow it to heal with the intention of improving the organization of collagen fibers in the skin. Dr. Harmon utilizes a fractional ablative CO2 laser, which delivers laser energy in microcolumns to the skin. Untreated skin is left between these microcolumns. This untreated skin supplies cells and signaling molecules to improve the healing process.
3. Injection of Nanofat and/or PRP. Nanofat involves harvesting fat from the patient’s body, processing it into a thin liquid with components including stem cells, and injecting it immediately under the skin in the lower eyelids. PRP involves drawing blood from the patient and isolating platelets from the blood and injecting them under the skin as well. While neither are Food and Drug Administration (FDA) approved treatments for skin, they both use products from the patient’s own body for treatment. The purpose of injecting one or both of these materials in the skin of the lower eyelids is to help improve skin quality by delivering a concentration of the patient’s own stem cells and signaling molecular to areas of injection.

A Consultation With a Fellowship-Trained, Double Board-Certified Facial Plastic Surgeon is Advised

A consultation with an experienced, qualified facial plastic surgeon is advised to determine whether patients are candidates for one or more of the above procedures. The procedures can be performed together or separately. And while many patients are satisfied with one laser treatment session, more than one laser treatment may be required for optimal effect. Finally, some patients demonstrate other changes to the lower eyelids such as bags caused by protruding (i.e. pseudo herniated) fat. A full lower blepharoplasty can be performed on these patients who are candidates.