Plastic Aesthetic and Laser Surgery, Hygeia hospital, Athens, Greece
KeywordsUpper and lower laser blepharoplastyLaser skin incisionsPeriorbital skin resurfacingPost laser erythemaPost laser hyperpigmentation
Observations on patients’ recovery after application of CO2 laser in blepharoplasty made us conduct a study, and an evaluation scale for the scar was created (Table 3.1).
Scale for patient evaluation of upper eyelid scar quality
Patient completely satisfied; does not notice scar
Patient satisfied; notices scar or slight hyperpigmentation
Patient concerned; makeup coverage necessary; revision not required
Patient dissatisfied; revision required
A questionnaire was given to two groups of blepharoplasty patients that underwent incision by scalpel and laser (80 patients of similar skin type in each group). The results are shown in Table 3.2.
Scar quality of upper eyelid incisions according to patients’ subjective evaluation
The vast majority of the patients who had undergone a conventional incision evaluated the result of the scar as excellent or good, and scar revision was performed in only one case. On the contrary, only half of the patients with laser skin incisions were satisfied with the outcome of their scar. The main concern of this group was dehiscence and/or hyperpigmentation of the scar. More than 20% required scar revision, which was performed for the vast majority at the lateral edge of the incision and lateral to the lateral canthus skin. This occurred because the approximated edges of the incision had a coagulated zone of tissue due to the charring effect of the laser beam with its concomitant effects on tissue viability attributable to the heat conduction induced by the laser. Of course, this fact could be attributed to laser parameters and specific laser technology; however, several different protocols used gave us the same impression.
On the other hand, the location of corrections at the lateral part of the lateral canthus is due to the different thickness and quality of skin in that anatomical region, compared with the skin of the intraorbital part of the eyelid.
Following these observations, we discontinued the use of laser for skin incisions, and since 2002 have been performed only by blade.
3.1 Laser-Assisted Upper Blepharoplasty
The detailed technique will be presented in Chap. 4; however, some attention has to be focused on what was applied in the past and what is applied nowadays, regarding the use of laser in different surgical steps.
As previously described, the use of laser for skin incision was abandoned.
Despite the fact that it is an excellent tool for bloodless incisions, very fast, precise, and user-friendly in the operating theater, we should not avoid to point out that the heat conduction induced by laser during surgery plays a significant role in the healing process of the scar. The CO2 laser produces a zone of irreversible thermal injury (coagulation zone) along the wound edge, an observation that has been correlated with the well-recognized delay in the rate of laser wound healing, postoperative wound dehiscence, and less satisfying scarring (Fig. 3.1).
Poor quality of scarring following laser incisions in upper blepharoplasty by other surgeon, more prominent in (L) upper eyelid. Patient underwent revision of scar with cold steel scar excision and resuturing
Therefore, skin incisions should be performed by blade. However, once the initial incisions have been completed, the use of the laser to perform the remainder of the dissection is widely applied.