LAM FACIAL PLASTICS

Hello Dr. Lam,

So good of you to provide this forum and answer so many questions. Very informative.

I was looking through your very impressive photo gallery. I'm particularly interested in ways to reduce bad undereye wrinkles. Came across your photogallery for skin resurfacing, chemical peels. The last woman in the series, a blond lady, seems to have gottem tremendous results from her chemical peel, especially around the eyes. Can this be real? Are her results really the result of a chemical peel? Were there other treatments provided also? It just seems to good to be true. (Was she your patient? Was the photo air brushed, touched up?)

Thank you,
Annie

Undereye wrinkles are hard to manage. Remember that there are two components to wrinkling. The static wrinkles that develop over time and can be treated with laser, peels, or plasma; and the wrinkles that appear when you smile and laugh that are dynamic in nature that are treated with Botox.

Even if you treat the lower eyelid wrinkles with some sort of peel, you will have them recur without Botox. My analogy that I always use is if you iron the shirt (i.e., peel the skin), you need to stop wearing the shirt (Botox freezes the muscle) so that you don't have them redevelop as much.

That being said, effacement of lower eyelid wrinkles is not always consistent as my photos demonstrate. Of course, all the photos are my patients; and of course, they are not retouched.

Two more things: remember women in particular are obsessed with oftentimes wrinkle reduction or any tiny reduction to the point that they don't see it in a closeup mirror using at times magnification during makeup application. This is unrealistic. You will always have some wrinkles there. Also, as we age we have lower eyelid holllowness that can make the lower eyelid area look worse. Fat grafting is usually important to fix that problem. That can make that area look better.

Finally, I really don't do peels anymore since I am getting much better results with plasma skin resurfacing. (not perfect but better than with peels).
best,
sml

Hello again Dr. Lam,

Thank you for your informative answer.

Then - did the blondle lady I referred to only have a chemical peel or other procedures that eliminated the wrinkles under and around her eyes?

Also, can resurfacing (whether laser or chemical) sometimes make under eye skin worse, not better, i.e. more wrinkled, less elastic? Can a person's skin be too thin, fragile for any kind of resurfacing?

Finally, would resurfacing help lines/wrinkles that are barely visible when static (although, if you look closely you can see), but wrinkly/crinkly when smiling? For example, under the eyes and down the cheeks? I have very fine lines that get crinkly when smiling. I feel like a Jeckle/Hyde - one face when static, and an entirely different wrinkly/crinkly face when smiling. Can this be helped?

Thank you so much for your time and effort (and energy!).

Annie

Hi,
She had a chemical peel. Peels are safe in persons in my opinion up to and including Mediterranean descent but not really Asians and Hispanics and beyond (at least the types of deeper peels I am showing you.)

O/w most people are good candidates for peels, plasma, etc. I think if you treat the area which has very thin skin too deeply you can have a burn, which can then cause a problem. That is why I don't treat the lower eyelid skin as aggressively as I do the cheek, for example. Actually, a sefely performed peel or plasma can actually thicken the skin and improve the collagen over time.

If you are seeing only wrinkles during animation (movement) and not static (when not smiling), ALL you need is just Botox, which you should start now before the wrinkles become static when you will then also need a peel, laser, etc.
best,
sml

Hello Dr. Lam,

You've been so good to answer my questions. I hope you don't mind I sent you a private message.

Thanks so much and god bless...

Annie

Just answered it.
SML