Depending on the amount of excess skin in the lower eyelids, laser resurfacing can certainly be an excellent choice for treatment of this problem. Laser resurfacing does a wonderful job of tightening the lower eyelid skin and greatly improving crepe papery-type wrinkling, but if there is a significant amount of skin laxity in the lower eyelids, there will still be a significant amount of wrinkling despite aggressive laser resurfacing. In these circumstances, I recommend a lower eyelid skin pinch, which is a minor surgical procedure, but can be easily performed at Quintessa Medical Spa under local anesthesia. This technique is just as it sounds in that the lower eyelid skin is pinched to assess how much excess skin can safely be removed without putting any tension on the lower eyelids. This skin is then removed and the resulting incision is closed with sutures that are removed in three or four days. This can provide a very dramatic improvement in the lower eyelid skin laxity and the resulting scar virtually always heals extremely inconspicuously. A nonsurgical alternative for lower eyelid laxity that is brand new and very exciting is the Ultherapy treatment. This is a device that uses ultrasound to not only visualize the skin and underlying soft tissue, but also uses ultrasound pulses to target the deeper tissues where it heats up the collagen. This resulting heat causes new collagen deposition and resulting skin tightening. It can significantly improve lower eyelid wrinkling and laxity and is performed in a single setting with absolutely no downtime. Results are not as significant as surgery, but the big advantage is the noninvasive and no downtime aspects of Ultherapy. I recommend that you schedule a consultation at Quintessa Medical Spa to see if you are a candidate for this exciting new technology.