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Eye rejuvenation grows up


Monopolar radiofrequency energy, fractional resurfacing and plasma skin resurfacing have all been demonstrated to be effective for the treatment of eyelid skin. Each approach has strengths and weaknesses. One expert discusses maximizing outcomes by matching the device or treatment to the patient's individual needs, and fully understanding the limits of each modality.

Key Points

Las Vegas - Technology-based facial rejuvenation has evolved into a complex discipline. Newer devices often offer more effective cosmetic outcomes with less downtime than would typically be associated with ablative skin resurfacing. The key to achieving optimal treatment outcomes is appropriately matching the type of energy and depth of delivery with the aesthetic goal and patient expectations, according to Brian S. Biesman, M.D., F.A.C.S.

"Whether I use Thermage®, Fraxel (Reliant), or plasma resurfacing technologies, it is paramount to carefully match the device used with the desired cosmetic outcome. As the aggressiveness of treatment increases, so does the length of the recovery period and the degree of clinical improvement," says Dr. Biesman, assistant clinical professor, departments of ophthalmology, otolaryngology and dermatology, Vanderbilt University Medical Center, Nashville, Tenn.

Dr. Biesman tells Dermatology Times that he has developed treatment applications for the eyelids with Thermage®, fractional resurfacing and plasma resurfacing devices to rejuvenate the eyelid and periorbital skin. He adds that Thermage® is totally noninvasive and has no associated downtime.

In contrast, fractional resurfacing treatments can produce substantial effects on superficial wrinkles and dyschromia but are associated with a recovery period lasting from two to seven days, depending on the aggressiveness of treatment. Makeup may typically be applied within one to two days, while the remainder of the recovery period involves resolution of swelling. Four to five fractional resurfacing treatments are typically required to achieve optimal results.

Plasma skin resurfacing

Plasma skin resurfacing of the eyelids can involve a single treatment and, in some cases, may produce more dramatic changes than monopolar RF or fractional resurfacing treatments.

However, patients must be prepared for seven to 10 days of downtime followed by erythema that can last 12 weeks or more.

"Those patients that require a little bit of skin tightening and not much pigmentary change are probably best suited for the Thermage® eyelid procedure. I usually suggest fractional resurfacing for those with fine wrinkling and mild laxity," Dr. Biesman says.

"In patients with more advanced wrinkling, photoaging and discoloration, I usually recommend plasma skin resurfacing, as they need a more aggressive treatment," he says. "There is clearly overlap, but the plasma device is generally associated with both more dramatic results and the longest downtime. I typically recommend it for those patients who have the greatest degree of change and really need the greatest amount of improvement."

Special treatment tips

Dr. Biesman helped to design special treatment tips for the Thermage® and the Fraxel devices, as well as special protocols for their use for safe treatment of the eyelids.

Dr. Biesman performs eyelid treatments with the Rhytec plasma skin resurfacing device using existing technology, but has evaluated several different treatment protocols. He says that preliminary results are very promising, with very good efficacy from the standpoint of discoloration and skin tightening.

"Over time, I would anticipate enhancement of our treatment techniques with all of these devices. As we achieve a better understanding of each device's capabilities and nuances, the versatility and safety of these devices should improve," he says.


According to Dr. Biesman, the fine-tuning and the precise application of these devices to specific lesions account for their flexibility.

He says the Fraxel laser could be used to treat those patients who need to see a lot of change. The trick is to use a little higher energy and/or higher treatment density. He adds that it is only a matter of time until these exact parameters are set, but they still must be determined.

"I believe that with any of these treatments, it is crucial that patients understand from the start what they can expect from the outcome. In general, I am very conservative when it comes to patient counseling. It is always better to under promise and over deliver than vice versa," Dr. Biesman says.

Disclosure: Research support for these studies was provided by Thermage®, Reliant and Rhytec.

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