CO2 laser blepharoplasty: Fractional periocular resurfacing tackles wrinkles, saves time and discomfort

Key Points

Colorado Springs, Colo. - Combining CO₂ laser blepharoplasty with fractional laser resurfacing of the periorbital area allows physicians to give their patients the best of both technologies, an expert says.

In the blepharoplasty area, "The advantage is that the laser seals the blood vessels as it cuts. So, I'm able to do these blepharoplasties in half the time it took with a scalpel," says Howard Conn, M.D., an oculoplastic surgeon in private practice, Irvine, Calif. He has been performing CO₂ laser blepharoplasties - for which he uses a continuous- wave laser (UltraPulse, Lumenis) using a 0.2 mm spot size - since the early 1990s.

"The decreased operating time CO₂ laser blepharoplasty provides has extended my ability to practice, because I don't spend much time stopping the bleeding," Dr. Conn tells Dermatology Times.

Within 24 hours, he says, patients typically can function, apply makeup and return to work.

Disadvantages of laser blepharoplasty include the need for safety precautions, such as corneal protectors, water-soaked towels and sponges, a smoke evacuator and protective eyewear for surgeons and staff members.

At the same time, the success of CO₂ laser blepharoplasties rests largely upon the surgeon's ability to adapt to laser technology.

Equipment cost can be another barrier. However, Dr. Conn says, "Some of the fractional laser systems now are coming out with a continuous-wave handpiece."

For patients with periocular rhytids, blepharoplasty might not be enough, Dr. Conn says, offering the example of a patient he treated in the late 1980s with traditional blepharoplasty.

"I was happy with this patient's results. But she said, 'What about the wrinkles?' At the time there was nothing I was comfortable recommending to get rid of periocular wrinkles," he says.

UltraPulse CO₂

That changed, however, with the arrival of the UltraPulse CO₂ laser, which uses a stamping technology to ablate the skin's full surface, he says.

"I used that laser for periocular resurfacing in conjunction with blepharoplasty up until this past year, when Fraxel Re:pair (Reliant) became available," Dr. Conn says.

The UltraPulse treatment required five to seven days' downtime for patients' skin to re-epithelialize. That's acceptable for patients undergoing traditional blepharoplasties, because these procedures require sutures during this period, he says.

And at the time, he says the combination of traditional blepharoplasty and full-face laser skin resurfacing provided very good results.

"The problem with full-face resurfacing was the aggravation factor - if we were lucky, the patients would heal in a week. And I would be going in on weekends and making house calls" to get patients through this process, Dr. Conn says.

Fraxel

When the original Fraxel laser debuted, he says, it was very effective for mild-to-moderate sun damage.

The Re:pair system improves upon its predecessor's performance in the periocular region, Dr. Conn says.

"In contrast to the original Fraxel, which is erbium laser, it's an ablative CO₂ laser," he says.

And because the Re:pair laser is fractionated, he says, epithelial cells can fill in the "holes" in the treatment spots within 48 hours.

Compared to UltraPulse resurfacing, he says the Re:pair laser creates no skip areas or overlap, offers the ability to fine tune treatment depth and density and results in more skin tightening.