Primary goal: Blunting of wrinkles by tightening within the dermal layer of the skin
Secondary goals: Alteration of skin texture, generation of new collagen
Anesthesia: From none to mild oral sedation to nerve block by injection
Operative technique: Skin resurfacing is a non-surgical (although destructive) technique often performed in conjunction with plastic surgery on the eyes:
• Chemical Peel: Following skin preparation and cleansing, the selected chemical is applied using Q-tips.
• Laser resurfacing: The beam of the laser is directed over the tissue to be treated in one or a series of "passes".
Variations:
• Chemical Peel: Different chemicals may be used alone or in combination. The more destructive the chemical, the deeper the level of wounding and the more pronounced the final effect. Minimal chemical peeling may be accomplished using alpha hydroxy acids. Deeper peels are accomplished by using increasing concentrations of trichloroacetic acid ("TCA") or phenol.
• Laser resurfacing: Either the carbon dioxide (stronger) or erbium:YAG (weaker) lasers may be used, or the two may be used in combination. Newer and less destructive (non-ablative) lasers cause less tissue damage but also less effect.
Advantages: Cosmetic eyelid surgery is designed to remove extra tissue and strengthen weakened structure. Skin creasing is due to damage within the skin rather than excess tissue and is thus not helped by "cutting surgery." Resurfacing procedures are designed to create a controlled "injury" into the dermis of the skin, which, in the process of healing, leads to a reduction in wrinkling.
Limitations: If blepharoplasty is indicated in a patient for the removal of more than tiny amounts of excess eyelid skin and/or fat, attempting to avoid eyelid surgery by using heavy-handed laser or chemical resurfacing instead will not often yield a satisfactory result. Fine wrinkles such as those around the eyes often return rapidly once any swelling from the procedure has fully disappeared
Care and recovery: Except with the most mild of chemical peels, care and recovery is more extensive and prolonged than for blepharoplasty alone. With aggressive treatments (phenol-based chemical peels, carbon dioxide laser resurfacing), the eyes may appear truly "hideous" for several weeks and bad for months more. Redness and blotchy skin pigmentation may resolve only gradually and create a cosmetic problem for 6-18 months.
Risks and complications: Complications include prolonged and extreme skin redness and tenderness, hyperpigmentation, permanent blotchy pigmentation, worsening of pre-existing acne, herpes and other types of infection, hypopigmentation, and scarring. More aggressive techniques (phenol-based peels) may leave the "texture" of the skin with a somewhat waxy look. The phenol used in deep chemical peels is highly toxic. If the skin of the lower eyelid is excessively tightened by deep resurfacing, ectropion (eversion) or retraction (pulling down) of the lid may occur. While rare, severe injury to the eye has been reported.
Comments: Resurfacing techniques tend to benefit "static" wrinkles rather than "dynamic" wrinkling caused by underlying muscular pull (for example, crowsfeet). Trichloroacetic acid (TCA) peels offer a safe method for treating wrinkles and improving skin quality on and around the eyelids.
