A treatment that combines fat removal in combination with laser skin resurfacing may be the key to eliminating the puffy, wrinkled lower eyelids that appear as we age.
A UCSF study, which appears in the March issue of the journal Ophthalmology, examined two procedures currently used to improve the appearance of the lower eyelid - removal of fat bags by making an incision on the inside surface of the eyelid and CO2 laser resurfacing of the eyelid skin to reduce excess skin and fine wrinkles.
"We found that almost 50 percent of people who had fat removal alone had an increase in the wrinkles of the lower lid, despite a smoothing of their fat bags," said Susan Carter, MD, UCSF assistant professor of ophthalmology. "The patients that underwent both fat removal and laser resurfacing had a dramatic improvement in fat bags as well as wrinkles."
Patients enrolled in the study had both procedures performed at once or had the fat removed first, followed by the skin resurfacing two months later. The variance in timing allowed researchers to determine whether the issue of timing of the laser resurfacing had any effect on results. The timing of the procedures did not have a statistically significant effect on the outcome, said Carter.
When fat removal (transconjunctival blepharoplasty) was combined with simultaneous laser resurfacing, 20 of 20 patients had improvement of lower eyelid bulging, and 18 of 20 had improved appearance of lower lid wrinkles. Of the 21 patients that underwent fat removal followed by laser resurfacing two months later, slightly more than 70 percent had an improved appearance in their lower lid wrinkles, again demonstrating a statistically significant effect of laser resurfacing in reducing wrinkles when combined with fat removal, explained Stuart Seiff, MD, professor in the UCSF department of ophthalmology and co-investigator on the study.
After four months, of the 41 patients that underwent fat removal and laser resurfacing, 100 percent of patients had an improved appearance in the bulging of the lower lid and 83 percent had improvement in lower lid wrinkles, whether the procedures were performed separately or simultaneously.
In some patients, transconjunctival blepharoplasty has replaced an older surgical procedure called transcutaneous blepharoplasty. The primary advantage of the newer procedure is that the incision made to remove the fat is on the inside surface of the eyelid and no visible scar is created. This results in a reduced likelihood that the eyelid will be pulled downward or away from the eye by scar tissue, which can cause dryness of the eye. The persistence of lower lid wrinkling has been perceived as a weakness of this newer approach to fat removal, said Carter. She explained that lower eyelid resurfacing performed in conjunction with the procedure appears to address that concern.
The study was funded by That Man May See, Inc., the official support foundation of the Beckman Vision Center at UCSF. Additional investigators include Phillip H. Choo, MD, assistant professor of clinical ophthalmology at UC Davis and Prashanth Vallabhanath, MD, UCSF clinical instructor of ophthalmology.
Materials provided by University Of California, San Francisco. Note: Content may be edited for style and length.
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