Dual-laser blepharoplasty offers better eyelid results

Atlanta?A 6-year study confirms the safety of dual-laser blepharoplasty for aesthetic rejuvenation of the upper and lower eyelids. Describing a series of 320 blepharoplasties, Harley Freiberger, MD, a dermatologic cosmetic surgeon in Los Angeles, reported that no permanent complications were observed, and that lesions healed rapidly and patients were quickly able to return to normal activity.

At a meeting of the American Society for Dermatologic Surgery in Atlanta, Dr. Freiberger described his study, which included a series of 320 blepharoplasties (156 upper and 164 transconjunctival lower lid procedures) performed on 183 patients between 1998 and 2004. This is the largest series of patients to have been presented.

Dual-laser blepharoplasty, using the CO₂ laser and erbium:YAG (Er:YAG) laser, was introduced in 1998. Over the past few years, Dr. Freiberger, director of Advanced Cosmetic Laser Surgery at the New Me Institute in Los Angeles, has modified this procedure with the addition of a diamond scalpel, which optimizes the technique. The CO₂ laser and diamond scalpel are used for upper lid and transconjunctival lower lid incisions, while the Er:YAG laser is used for resurfacing of eyelid skin.

"What makes this instrument unique is that as the diamond blade cuts, the CO₂ laser beam is transmitted through the diamond blade. The surgeon can use 'incisional photocoagulation' to dissect tissue while sealing blood vessels," Dr. Freiberger said.

By cutting and coagulating at the same time, the surgeon works in a relatively dry operative field, allowing better visual and tactile control of precise incisions. Total operative time for both lower eyelids is usually less than an hour.

The two-laser technique for transconjunctival lower blepharoplasty requires no cutaneous incision that could leave a scar, and no sutures are needed to close the internal laser incision, Dr. Freiberger said.

One recovery period

"Concomitant Er:YAG laser resurfacing is a safe and effective method of reducing periorbital rhytids and requires only one period for patient recovery from blepharoplasty and skin rejuvenation," he added.

In the cases on which Dr. Freiberger reported, he used a continuous-wave CO₂ laser or a diamond laser scalpel (Clinicon, Carlsbad, CA) for all skin, muscle, fat, and conjunctival incisions of the upper and lower eyelids. On the upper eyelids, skin-muscle flap dissection and orbicularis oculi re-approximation was completed prior to skin closure. Following the eyelid procedure, all patients then underwent Er:YAG (short pulse, variable pulse, or combined Er:YAG/CO₂) laser resurfacing of upper and lower lid skin, and 34 patients had full-face resurfacing. No patients in the series required lower eyelid skin incisions. There was no occurrence of permanent complications such as ectropion, unacceptable scarring, or corneal injury. Minor sequelae were infrequent or correctable; these included dyschromia, temporary ectropion, and asymmetry. In some cases inadequate results required revision.