Your Questions

Q: Dr. Eppley, I have a few wrinkles and extra skin on my lower eyelids that I would like to get rid of.  I don’t think I need any blepharoplasty surgery and have read about lasers and chemical peels. Which of these two lasts the longest or do they both last a comparable amount of time? Which is most natural looking result or is there no difference? Which is least likely to excessively tighten skin? I am curious as to why laser resurfacing is so popular over chemical peels. Which has the least downtime?

A: There is no evidence that either method,  laser vs TCA chemical peel, is more effective or long-lasting on lower eyelid skin rejuvenation. Laser do have a higher risk of hypopigmentation. Both are commonly used and it is a matter of comfort and experience as to which method plastic surgeons use.

It is likely you may also benefit by a pinch lower blepharoplasty with a TCA peel but I would have to look at your lids to answer that question. This is a favorite method of mine for the lower eyelids because it works very well with a very small amount down time. It is also the most minimalist method to guarantee that lower lid skin would be tightened to some degree.

Lasers are more popular than peels today for a variety of reasons. First they are more ‘high-tech’ and with that comes the assumption that they produce better results. In addition, their high cost and the need for the manufacturers to sell them drives a lot of more visible marketing efforts.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I’m interested in learing more about dermabrasion or micropeeling. Can this be done on the eyelids? (above and below) Will this help reduce the beginnings of a fold in the top eye crease? I live two hours away. If you can answer these two questions about this procedure would help me determine if I should come in for a consultation.

A: By the way your question is phrased, it appears that you seek a non-surgical solution to the appearance of wrinkles on the eyelids. There are a variety of skin resurfacing methods that are commonly used on all other areas of the face so it is reasonable to ask about their use on the eyelids.

The eyelids represent skin that is very unique from that of the rest of the face. It is different primarily because it is so thin. Being thin makes it very sensitive with higher risks of scarring if the skin resurfacing method is not carefully selected and performed.

Microdermabrasion (superficial) and dermabrasion (deep) are not effective (microdermabrasion) or safe (dermabrasion) skin resiurfacing methods for use on the eyelids. Traditional laser resurfacing is not either for the same reason that dermabrasion should not be used, it penetrates too deep.

The use of laser micropeeling and chemical peels, however, are both effective and safe methods for the eyelids. Laser micropeeling at the depth of 20 microns or less, TCA (trichloroacetic acid) chemical peels of 15%, 25% and 35% as well as the newer Vi chemical peel are all potential choices. Which one of these is best for your eyelids will require an actual consultation to determine.

Another very effective option is the combination of ‘mini-blepharoplasties’ with chemical peeling. The actual removal of a small amount of excess skin and then tightening the rest can be a very effective eyelid wrinkle-reducer.

Dr. Barry Eppley

Indianapolis, Indiana

Q: I have some acne scarring on my face that I`d really like to get rid of. I have a rolling icepick scar and I want to know if a deep chemical peel would help. It isn`t very deep. One maybe two layers deep. Help! What should I do?

A: To understand whether any form of skin treatment or resurfacing will reduce a specific scar, it is important to appreciate the depth of the scar compared to the thickness of skin. Then one can look at the treatment method and see if it can go to the level of the depth of the scar.

Let us, for the sake of this discussion, assume that facial skin thickness is 1mm or 1000 microns. (some areas of the face are thicker and some areas are thinner, but let’s use this simplistic number as it is easier to understand) The top epithelium usually occupies about 5% or so, around 50 to 75 microns. This is the part of the skin that peels and sloughs off and is easily regenerated. The rest of the skin, 95%, is a thicker collagen called dermis. It is into the dermis that all visible scars really go. Most visible scars are at least several 100 microns (100 to 500 microns) Pitted or icepick acne scars will usually go much deeper than even that level.

Microdermabrasion, for example, removes only 2 to 4 microns of skin. This is why it is not an effective scar treatment, it simple can’t go deep enough. Microlaser peels, or superficial laser peels, remove skin from 10 to 50 microns. They have a minor effect but it will take a lot of treatments to have any visible scar reduction. Deeper CO2 laser peels do go down 200 to 400 microns which is why they can be more effective for scar reduction. But a laser peel can not go too deep (greater than 400 microns or so) or it will be a source of its own scarring.

Chemical peels, even deep ones, do not reach these laser depths. This is why a chemical peel, of any sort, is not an effective scar treatment.

 Dr. Barry Eppley