Laser Eyelid Tissue Resurfacing

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Lower eyelid aging results in prominent adipose tissue, skin redundancy, increased rhytids, and laxity.

The traditional technique includes a subciliary incision with removal of fat, skin, and hypertrophied orbicularis muscle and canthal tightening. This approach can result in ectropion, retraction, and canthal angle blunting in 5-20% of patients. ^[1]

The transconjunctival approach allows for fat rearrangement, debulking, and arcus marginalis release, leading to improved eyelid contour. This approach does not address dermatochalasis, rhytids, or skin texture. The use of the carbon dioxide laser for resurfacing has been used successfully to reduce these findings. ^{[1, 2, 3, 4, 5, 6, 7, 8, 9, 10]}

The images below depict a patient who underwent combined upper and lower laser blepharoplasty, perioral and periorbital carbon dioxide laser resurfacing, SMAS facelift, and full-face blue peel.

Lasers target water-containing tissue. Treatment with lasers results in tissue vaporization. ^{[11, 12]}

Indications for carbon dioxide laser skin resurfacing include the following:

Seborrheic keratosis

Verruca vulgaris/plana

Junctional and compound nevi

Lentigo simplex

Small syringomas

Epidermal melasma

Dermatochalasis ^[13]

Superficial and fine rhytids (see the image below)

Scars ^[14]

Dermatoheliosis

Extensive knowledge of skin microanatomy, histology, and physiology is essential before proceeding with resurfacing procedures. Familiarity with relative facial skin thickness (ie, thin, medium, thick) is necessary to limit overtreatment and potential complications.

Absolute contraindications to carbon dioxide laser skin resurfacing are as follows:

Active bacterial, viral, or fungal infections

Oral isotretinoin use within the previous 6 months

Tendency for keloid or hypertrophic scar formation

Ectropion

Unrealistic expectations

Uncooperative patient

Relative contraindications to carbon dioxide laser skin resurfacing are as follows:

Poor general health

Continued ultraviolet exposure

Prior radiation to area of proposed treatment

Fitzpatrick skin phototypes V-VI

Reticular dermis-level resurfacing procedure within the preceding 2-3 months

Unwillingness to accept the possibility of postoperative erythema or hypopigmentation

Significant eyelid laxity

Excessively thin or thick skin

Collagen vascular disease, HIV, or hepatitis C infection

Carter SR, Seiff SR, Choo PH, Vallabhanath P. Lower eyelid CO(2) laser rejuvenation: a randomized, prospective clinical study. Ophthalmology. 2001 Mar. 108(3):437-41. [Medline].

Griffin RY, Sarici A, Ozkan S. Treatment of the lower eyelid with the CO2 laser: transconjunctival or transcutaneous approach?. Orbit. 2007 Mar. 26(1):23-8. [Medline].

Goldbaum AM, Woog JJ. The CO2 laser in oculoplastic surgery. Surv Ophthalmol. 1997 Nov-Dec. 42(3):255-67. [Medline].

Seckel BR, Kovanda CJ, Cetrulo CL Jr, Passmore AK, Meneses PG, White T. Laser blepharoplasty with transconjunctival orbicularis muscle/septum tightening and periocular skin resurfacing: a safe and advantageous technique. Plast Reconstr Surg. 2000 Oct. 106(5):1127-41; discussion 1142-5. [Medline].

Harris DM, Fried D, Reinisch L, et al. Eyelid resurfacing. Lasers Surg Med. 1999. 25(2):107-22. [Medline].

Griffin RY, Sarici A, Ozkan S. Treatment of the lower eyelid with the CO2 laser: transconjunctival or transcutaneous approach?. Orbit. 2007 Mar. 26(1):23-8. [Medline].

Alster TS. Cutaneous laser resurfacing: what’s hot. Cosmetic Dermatol. 1999 October. 18-23.

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Balzani A, Chilgar RM, Nicoli M, Sapountzis S, Lazzeri D, Cervelli V, et al. Novel approach with fractional ultrapulse CO2 laser for the treatment of upper eyelid dermatochalasis and periorbital rejuvenation. Lasers Med Sci. 2013 Nov. 28 (6):1483-7. [Medline].

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Berlin AL, Hussain M, Phelps R, Goldberg DJ. A prospective study of fractional scanned nonsequential carbon dioxide laser resurfacing: a clinical and histopathologic evaluation. Dermatol Surg. 2009 Feb. 35(2):222-8. [Medline].

Alster TS, Bellew SG. Improvement of dermatochalasis and periorbital rhytides with a high-energy pulsed CO2 laser: a retrospective study. Dermatol Surg. 2004 Apr. 30(4 Pt 1):483-7; discussion 487. [Medline].

Walgrave SE, Ortiz AE, MacFalls HT, et al. Evaluation of a novel fractional resurfacing device for treatment of acne scarring. Lasers Surg Med. 2009 Feb. 41(2):122-7. [Medline].

Walia S, Alster TS. Cutaneous CO2 laser resurfacing infection rate with and without prophylactic antibiotics. Dermatol Surg. 1999 Nov. 25(11):857-61. [Medline].

Fife DJ, Fitzpatrick RE, Zachary CB. Complications of fractional CO2 laser resurfacing: four cases. Lasers Surg Med. 2009 Mar. 41 (3):179-84. [Medline].

Horton S, Alster TS. Preoperative and postoperative considerations for carbon dioxide laser resurfacing. Cutis. 1999 Dec. 64(6):399-406. [Medline].

Ho C, Nguyen Q, Lowe NJ, Griffin ME, Lask G. Laser resurfacing in pigmented skin. Dermatol Surg. 1995 Dec. 21(12):1035-7. [Medline].

Railan D, Kilmer S. Ablative treatment of photoaging. Dermatol Ther. 2005 May-Jun. 18(3):227-41. [Medline].

Ross EV, Grossman MC, Duke D, Grevelink JM. Long-term results after CO2 laser skin resurfacing: a comparison of scanned and pulsed systems. J Am Acad Dermatol. 1997 Nov. 37(5 Pt 1):709-18. [Medline].

Sullivan SA, Dailey RA. Complications of laser resurfacing and their management. Ophthal Plast Reconstr Surg. 2000 Nov. 16(6):417-26. [Medline].

Carter SR, Stewart JM, Khan J, et al. Infection after blepharoplasty with and without carbon dioxide laser resurfacing. Ophthalmology. 2003 Jul. 110(7):1430-2. [Medline].

Trelles MA, Mordon S, Svaasand LO, Mellor TK, Rigau J, Garcia L. The origin and role of erythema after carbon dioxide laser resurfacing. A clinical and histological study. Dermatol Surg. 1998 Jan. 24(1):25-9. [Medline].

Tan KL, Kurniawati C, Gold MH. Low risk of postinflammatory hyperpigmentation in skin types 4 and 5 after treatment with fractional CO2 laser device. J Drugs Dermatol. 2008 Aug. 7(8):774-7. [Medline].

Avram MM, Tope WD, Yu T, Szachowicz E, Nelson JS. Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing. Lasers Surg Med. 2009 Mar 16. 41(3):185-188. [Medline]. [Full Text].

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Fulton JE, Rahimi AD, Helton P, Dahlberg K, Kelly AG. Disappointing results following resurfacing of facial skin with CO2 lasers for prophylaxis of keratoses and cancers. Dermatol Surg. 1999 Sep. 25(9):729-32. [Medline].

Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol. 2008 May. 58(5):719-37; quiz 738-40. [Medline].

Griffin RY, Sarici A, Ozkan S. Treatment of the lower eyelid with the CO2 laser: transconjunctival or transcutaneous approach?. Orbit. 2007 Mar. 26(1):23-8. [Medline].

Kilmer SL. Laser treatment of tattoos. Dermatol Clin. 1997 Jul. 15(3):409-17. [Medline].

Adam J Cohen, MD Physician/CEO, Eyelid and Facial Plastic Surgery and MediSpa

Adam J Cohen, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Mimedx.

Samer Alaiti, MD, RVT, RPVI, FACP Clinical Associate Professor, Department of Dermatology, Keck School of Medicine of the University of Southern California; Medical Director, Miracle Mile Medical Center for Dermatology and Cosmetic Surgery, Inc

Samer Alaiti, MD, RVT, RPVI, FACP is a member of the following medical societies: American Academy of Dermatology, American College of Phlebology, American College of Physicians-American Society of Internal Medicine, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery

Disclosure: Nothing to disclose.

Michael B Stevens, MD, PhD, MD, PhD 

Michael B Stevens, MD, PhD, MD, PhD is a member of the following medical societies: American College of Surgeons, California Medical Association, Lipoplasty Society of North America, Lipoplasty Society of North America

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Stephen D Plager, MD 

Stephen D Plager, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Cataract and Refractive Surgery, California Medical Association

Disclosure: Nothing to disclose.

Laser Eyelid Tissue Resurfacing

Research & References of Laser Eyelid Tissue Resurfacing|A&C Accounting And Tax Services
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