Ablative treatments smooth roughened skin, periorbital rhytids, remove pigmented lesions and minimise acne scarring. Dr Peter Crouch discusses the latest advances and the tried-and-tested methods

Until the development of laser skin resurfacing in the 1980s, mechanical abrasion and chemical peeling agents were the mainstay of treatments targeting acne scarring, wrinkles and tired, aged skin. Controlled ablation promised the prospect of restoring a more youthful, radiant appearance. Non-ablative remodelling of existing tissue is only one method of stimulating positive change and is the key strategy with IPL and radiofrequency treatments and has been outlined in previous articles in this series. The approach with most non-ablative treatments is to provide a controlled thermal stimulus sufficient to denature and contract collagen while avoiding surrounding tissue damage. Most non-ablative procedures utilise thermal (heat) energy for immediate tissue contraction (short-lasting), followed over the next few months by collagen remodelling and regeneration (longer-lasting).

Ablation literally means destruction, and there are several approaches for removing unwanted tissue and to promote increased tissue turnover as part of healing. Depending on the depth of ablation, skin resurfacing, smoothing of periorbital rhytids, removal of pigmented lesions and minimisation of acne scarring are all possible outcomes of expertly delivered skin ablation. In the months following ablative treatment, the body’s natural healing processes produce new replacement tissue, resulting in healthier, more even, smoother skin and a more youthful appearance.

The ideal tissue-ablation device would cause little pain and discomfort, have little or no downtime, be affordable, show demonstrable results after each session and cause no unwanted side-effects. As tissue ablation can effectively remove unwanted targets and the ablation is more related to tissue water content and is relatively more indiscriminate, ablative techniques rely more on targeting precisely where the treatment beam ablates rather than using the wavelength of the treatment beam to discern one target from another based on pigmentation—that is, a specific chromophore, or the presence of, for example, haemoglobin. Because the wavelengths often used for ablation specifically target tissue water, the fluence often determines, fairly precisely, the exact depth of ablation.

What Is Blepharoplasty?

Blepharoplasty refers to eyelid surgery and is designed to remove the excess fat, along with skin and muscle, from the upper and lower eyelids. It is the second most common aesthetic procedure performed by plastic surgeons.

What Are the Goals of Blepharoplasty?

A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance. In some patients the procedure will improve vision by removing the excessive skin of the upper eyelids, which can hang down and interfere with peripheral vision.

How Is the Procedure Performed?

Eyelid surgery is usually performed using local anesthesia and light intravenous sedation. It is commonly done in a doctor’s office, outpatient surgical center or, in some cases, in a hospital. The procedure is most often performed on an outpatient basis.

Are There Scars From the Blepharoplasty Procedure?

Scars are a result of any surgical procedure. The incisions made to accomplish the goals of the procedure are barely visible after several months as they are placed within the normal creases and folds of the upper and lower eyelids. In patients who only need removal of fat from the lower eyelids, the incision can be made on the inside of the eyelid, and will therefore result in an invisible scar.

Will the Fine Wrinkles Around My Eyes Go Away After Blepharoplasty? What About My Sagging Eyebrows and Dark Circles Under My Eyes?

The blepharoplasty procedure will not eradicate the wrinkles around the eyes (crow s feet) nor will it elevate droopy eyebrow. There are other procedures designed for these purposes. Dark circles under the eyes may improve a bit if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.

Can Anyone Have a Blepharoplasty?

The best patients are those who are healthy, psychologically stable and well motivated. Some medical conditions may increase the risk of blepharoplasty surgery such as thyroid disease, high blood pressure and patients who do not make sufficient tears to keep their eyes well lubricated.

What Are the Risks Involved With This Procedure?

Fortunately, when performed by a competent plastic surgeon, complications are infrequent and minor. All patients will experience some bruising and swelling for a few days after the surgery. In addition, a temporary problem with closure of the eyelids is usually seen. Some may have temporary blurring of their vision, usually due to the ointments applied to the incisions post operatively. In rare instances, the lower eyelid may be pulled down causing an ectropion. If this does not resolve on its own, further surgery may be necessary. The theoretical complications of any surgical procedure, such as bleeding, infection, wound disruption and heavy scarring are also possible, but rare.

Other Opportunity to Consider

Some of the surgeons may offer skin resurfacing around you eyes and mouth with an Erbium (Er:YAG) laser. You should seriously consider this option as your overal looks will benefit dramatically from this treatment. You may shed several years and improve (tighten) the texture of your facial skin.  Laser skin resurfacing (LSR) typically require 5-7 days of downtime, when your skin will be red and peeling. However, since Blepharoplasty requires the same, you will not even notice it.