Q: I have under eye bags and wrinkles. I am unsure which approach to take to remove/reduce them: fraxal laser, or blepharoplasty? I would be grateful for your recommendations.

Dr A’s Answer: Fraxel and other laser procedures are designed to improve the quality of the skin while only subtly altering the shape. The shape of the lower eyelid is mostly related to the shape of the bone and fat and how it sits relative to the eye itself. In your case, I see that you have a shape issue, not so much a quality of skin issue. You have what are called “tear-troughs”. These are the sunken circular areas below the “bags”. The treatment for this is filling of the tear-trough area and reshaping of the fat. To some extent this can be done non-surgically, but for best and most permanent results you would want to look at surgical options like tear-trough implant surgery.