Laser Eyelid Tissue Resurfacing 

  • Author: Adam J Cohen, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Aug 3, 2011
 

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]

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 skinLaser 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.[9, 10]

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Indications

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[11]
  • Superficial and fine rhytids (see the image below)Depigmentation seen periorbitally, periorally, andDepigmentation seen periorbitally, periorally, and on the forehead following carbon dioxide laser resurfacing.
  • Scars[12]
  • 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

Contraindications to carbon dioxide laser skin resurfacing include the following:

Absolute

  • 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

  • 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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Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Adam J Cohen, MD  Eyelid and Facial Aesthetic and Reconstructive Surgery, Diseases and Surgery of the Orbit and Lacrimal System, Cosmetic Laser Surgery

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

Disclosure: Nothing to disclose.

Coauthor(s)

Samer Alaiti, MD, RVT  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 is a member of the following medical societies: American Academy of Cosmetic Surgery, 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, and American Society of Lipo-Suction Surgery

Disclosure: Nothing to disclose.

Michael B Stevens, MD, PhD  Consulting Staff, Department of Plastic Surgery, Kaweah Delta Hospital

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen D Plager, MD, FACS  Chief, Department of Ophthalmology, Dominican Hospital; Assistant Clinical Professor, Department of Ophthalmology, Stanford University Hospital

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

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor 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, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Consulting fee Consulting

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

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, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

References

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

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

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

  4. 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. Oct 2000;106(5):1127-41; discussion 1142-5. [Medline].

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

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

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

  8. Felder DS. CO2 laser skin resurfacing in oculoplastic surgery. Curr Opin Ophthalmol. Oct 1996;7(5):32-7. [Medline].

  9. Trelles MA, Rigau J, Mellor TK, Garcia L. A clinical and histological comparison of flashscanning versus pulsed technology in carbon dioxide laser facial skin resurfacing. Dermatol Surg. Jan 1998;24(1):43-9. [Medline].

  10. 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. Feb 2009;35(2):222-8. [Medline].

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

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

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

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

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

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

  17. 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. Nov 1997;37(5 Pt 1):709-18. [Medline].

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

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

  20. 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. Jan 1998;24(1):25-9. [Medline].

  21. 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. Aug 2008;7(8):774-7. [Medline].

  22. 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. Mar 16 2009;41(3):185-188. [Medline].

  23. Sandel HD 4th, Perkins SW. CO2 laser resurfacing: still a good treatment. Aesthet Surg J. Jul-Aug 2008;28(4):456-62. [Medline].

  24. 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. Sep 1999;25(9):729-32. [Medline].

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

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

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

 
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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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