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Laser Eyelid Tissue Resurfacing

  • Author: Adam J Cohen, MD; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Feb 09, 2016
 

Background

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.

Laser tissue resurfacing. Female patient with skin Laser tissue resurfacing. Female patient with skin and muscle laxity, photoaging, and dermatochalasis.
Same patient as in image above underwent combined Same patient as in image above underwent combined upper and lower laser blepharoplasty, perioral and periorbital carbon dioxide laser resurfacing, SMAS facelift, and full-face blue peel. This photograph was taken 6 months after the procedure.
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Pathophysiology

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

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Indications

Indications for carbon dioxide laser skin resurfacing include the following:

  • Verruca vulgaris/plana
  • Junctional and compound nevi
  • Lentigo simplex
  • Small syringomas
  • Epidermal melasma
  • Superficial and fine rhytids (see the image below)
    Depigmentation seen periorbitally, periorally, and Depigmentation seen periorbitally, periorally, and on the forehead following carbon dioxide laser resurfacing.
  • Scars [14]
  • Dermatoheliosis
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Relevant Anatomy

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.

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Contraindications

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
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Contributor Information and Disclosures
Author

Adam J Cohen, MD Assistant Professor of Ophthalmology, Section Director of Oculoplastic and Reconstructive Surgery, Rush Medical College of Rush University Medical Center

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: BioD, Poferious<br/>Serve(d) as a speaker or a member of a speakers bureau for: IOP<br/>Received income in an amount equal to or greater than $250 from: IOP for speaking.

Coauthor(s)

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.

Specialty Editor Board

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.

Chief Editor

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.

Additional Contributors

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.

References
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Depigmentation seen periorbitally, periorally, and on the forehead following carbon dioxide laser resurfacing.
Laser tissue resurfacing. Female patient with skin and muscle laxity, photoaging, and dermatochalasis.
Same patient as in image above underwent combined upper and lower laser blepharoplasty, perioral and periorbital carbon dioxide laser resurfacing, SMAS facelift, and full-face blue peel. This photograph was taken 6 months after the procedure.
 
 
 
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