Fractional CO₂ laser vs. Fraxel laser for lower eyelid rejuvenation following transconjunctival lower blepharoplasty

Abstract

Aim: Transconjunctival CO₂ laser lower blepharoplasty is considered to be a safe and reliable approach. A retrospective review of transconjunctival approached CO₂ laser lower blepharoplasty associated with fractional CO₂ laser ablation or fractioned non-ablative Fraxel laser resurfacing for lower eyelid rejuvenation is presented for comparison.

Methods: From February 1996 to February 2016, 250 patients underwent CO₂ laser lower blepharoplasty with a male to female ratio of 1:7.5. The age ranged from 43 to 68 years (mean 52 years). A CO₂ laser was applied to make a transconjunctival lower blepharoplasty. Immediately after CO₂ laser lower blepharoplasty, 40 patients received fractional CO₂ laser and 40 patients took Fraxel laser for resurfacing.

Results: Swelling occurred in all patients postoperatively. Complications related to transconjunctival CO₂ laser lower blepharoplasty were 6 (2.4%) patients with conjunctival chemosis, 5 (2.0%) with ecchymosis, and 3 (1.2%) with granulomas. The early complications (≤ 1 month) related to fractional CO₂ laser ablation were 40 (100%) patients with mild erythema, 40 (100%) with mild edema, 1 (2.5%) with hyperpigmentation, 1 (2.5%) with infection, and 1 (2.5%) with scarring. These problems resolved in all patients after 3 months. There was no complication after Fraxel laser right after lower blepharoplasty. The Fraxel group had short recovery time. However, there was no statistically significant difference between the two groups in final outcome (≥ 6 months).

Conclusion: Transconjunctival CO₂ laser lower blepharoplasty associated with fractional CO₂ laser ablation or Fraxel laser resurfacing assisted the appearance around the periorbital regions.

Keywords

Transconjunctival lower blepharoplasty / fractional CO₂ laser / Fraxel laser / ablative resurfacing

References

[1] Jelks GW.Preoperative evaluation of the blepharoplasty patient. Bypassing the pitfalls.Clin Plast Surg1993;20:213-23; discussion 224

[2] Zarem HA.Expanded applications for transconjunctival lower lid blepharoplasty.Plast Reconstr Surg1991;88;215-20

[3] David LM.CO₂ laser blepharoplasty: a comparison to cold steel and electrocautery.J Dermatol Surg Oncol1987;13:110-4

[4] Morrow DM.CO₂ laser blepharoplasty. A comparison with cold-steel surgery.J Dermatol Surg Oncol1992;18:307-13

[5] Lask G.Laser may be faster and better than scalpel for blepharoplasty.Skin Allergy News1992;23:20

[6] Trelles MA,Sala P.Surgical removal of lower eyelid fat using the carbon dioxide laser.Am J Cosmet Surg1992;9:149-52

[7] Westfall CT,Nunery WR,Yaremchuk MJ.Operative complications of the transconjunctival inferior fornix approach.Ophthalmology1991;98:1525-8

[8] Chernoff G,Zair E.SilkTouch: a new technology for skin resurfacing in aesthetic surgery.J Clin Laser Med Surg1995;13:97-100

[9] Fulton JE Jr.Dermabrasion, chemabrasion, and laserabrasion. Historical perspectives, modern dermabrasion techniques, and future trends.Dermatol Surg1996;22;619-28

[10] Waldorf HA,Geronemus RG.Skin resurfacing of fine to deep rhytides using a char-free carbon dioxide laser in 47 patients.Dermatol Surg1995;21:940-6

[11] Lowe NJ,Griffin ME,Lowe P.Skin resurfacing with the Ultrapulse carbon dioxide laser. Observations on 100 patients.Dermatol Surg1995;21:1025-9

[12] Cotton J,Gorin R,Hanke CW.Histologic evaluation of preauricular and postauricular human skin after high-energy, short-pulse carbon dioxide laser.Arch Dermatol1996;132;425-8

[13] Chang CJ.Combining the CO₂ laser and the endoscope to remove soft tissue masses from the forehead area.Photomed Laser Surg2005;23:509-12

[14] Li YH,Wei HC.A Chinese experience of fractional ultrapulsed CO₂ laser for skin rejuvenation.J Cosmet Laser Ther2010;12:250-5

[15] Wolfort FG. Aesthetic blepharoplasty. 1st ed. Boston: Little, Brown and Company; 1995.

[16] Baker SS,Small RG.Carbon Dioxide Laser Blepharoplasty.Ophthalmology1984;91:238-44

[17] Baker SS.Carbon Dioxide Laser Upper Lid Blepharoplasty.Am J Cosmet Surg1992;9:141-5

[18] Baker SS. The Ultrapulsed CO₂ Laser as Cutting Tool: Upper Blepharoplasty &Lid Ptosis. Syllabus of the American Society for Aesthetic Plastic Surgery, Inc: endorsed course “New Horizons in Aesthetic Laser Surgery: Practical Use of the UltraPulse CO₂ Laser for Facial Rejuveration”. San Francisco, California, 1995.

[19] David LM.Carbon dioxide laser blepharoplasty: conjunctival temperature during surgery.J Dermatol Surg Oncol1989;15:421-3

[20] Mittelman H.Carbon dioxide laser blepharoplasty--advantages and disadvantages.Ann Plast Surg1990;24:1-6

[21] Seckei BR. Personal approach to blepharoplasty and skin-musle flap with the CO₂ laser. Syllabus of the American Society for Aesthetic Plastic Surgery, Inc. endorsed course “New Horizons in Aesthetic Laser Surgery; Practical Use of the UltraPulse CO₂ Laser for Facial Rejuvenation”. San Francisco, California, 1995.

[22] Fitzpatrick RE. CO₂ laser Surgery. In: Goldman MP, Fitzpatrick RE, editors. Cutaneous laser surgery: The art and science of selective photothermolysis. St. Loui, Mosby-Yearbook, Inc. 1994;198-258.

[23] Scarano A,Brucoli M,Carinci F.Upper eyelid blepharoplasty with voltaic arc dermabrasion.J Craniofac Surg2018;29:2263-6

[24] Grubbs, C Bowen. Mycobacterium abscessus infection following home dermabrasion.Cutis2019;104:79-80

[25] Manstein D,Sink RK,Anderson RR.Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury.Lasers Surg Med2004;34:426-38

[26] Chan NP,Yeung CK,Chan HH.The use of non-ablative fractional resurfacing in Asian acne scar patients.Lasers Surg Med2010;42:710-5

[27] Trelles MA,Martín-Vázquez MJ.Assessment of the efficacy of nonablative long-pulsed 1064-nm Nd:YAG laser treatment of wrinkles compared at 2, 4, and 6 months.Facial Plast Surg2005;21:145-53

[28] Carraway JH.The prevention and treatment of lower lid ectropion following blepharoplasty.Plast Reconstr Surg1990;85:971-81

[29] Alster TS.Treatment of complications of laser skin resurfacing.Arch Facial Plast Surg2000;2:279-84

[30] Ramsdell WM.Fractional CO₂ laser resurfacing complications.Semin Plast Surg2012;26:137-40 PMCID:PMC3580977

[31] Chang CJ. Laser skin resurfacing in Asian patients. In: Pu L, Chen YR, Li QF, et al, editors. Aesthetic Plastic Surgery in Asians: Principles and Techniques. Thieme Medical Pub, 2015.