Why do I still have wrinkles after blepharoplasty?

True or False? Blepharoplasty rids the eyelids of wrinkles.

False!

Many of us have the expectations that, after blepharoplasty, the eyelids will look smooth and wrinkle-free. If that is our expectation from blepharoplasty, then we will be sorely disappointed, because blepharoplasty only removes skin. If we have excess skin, causing heavy hooding, then blepharoplasty will reduce the hooding over our lash line and take years off our eyes. However, wrinkles in the leftover skin folds before surgery will still be present after surgery.

Wrinkles are a “texture” problem and not due to excess skin. They form because, over time, we naturally lose collagen, elastin, and hyaluronic acid, the components in our dermis that give the skin its firmness, rebound and plump, respectively. UV radiation and other external factors that cause oxidative stress to the skin accelerate or exacerbate these degradations. Blepharoplasty does not by any means restore these components or prevent external injuries to the skin and thus cannot reverse wrinkles.

If that is the case, what gets rid of these wrinkles?

Any intervention that increases collagen, elastin and hyaluronic acid in the skin improve wrinkles.

There are multitudes of modalities that stimulate or remodel collagen, including laser, microneedling, radiofrequency, chemical peel and biostimulant. Of these modalities, the gold standard to retexturize the skin is laser. I certainly do no recommend chemical peel near the eyes for obvious reasons (i.e., chemical burn to the cornea.) Microneedling with or without radiofrequency and biostimulant may be performed to the lower eyelids, but they are not commonly performed interventions for the upper eyelids, as most providers are understandably cautious with applying needle or heat directly over the eye, again for obvious concerns. Laser resurfacing is most effective for addressing the wrinkles of the eyelids because it treats the underlying causes of wrinkles and it may be performed safely to the eyelids with proper shielding and appropriate parameters, technique, and postoperative care.

Together, blepharoplasty and laser resurfacing provide the best rejuvenation of the eyelids structurally and texturally.