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Figure 8 Xanthelasma removal

ptosis, entropion and ectropion, and xanthelasma excision are discussed in this article. Reduced operation time, less bleeding, superior intraoperative visibility, less bruising and swelling, as well as less pain and discomfort, and a shorter healing period, are some of the benefits of using the laser as a surgical tool. Furthermore, the CO2

laser can be used in laser

resurfacing treatments for photodamaged skin and acne scars. The efficacy and safety have been demonstrated with this technique since its first introduction 20 years ago. Thermal ablation vaporises superficial layers of tissue providing the tissue rejuvenation.


Reduced operation time, less bleeding, superior

intraoperative visibility, less

bruising and swelling, as well as less pain and discomfort, and a

shorter healing period, are some of the benefits of using the laser as a surgical tool.

In the author’s clinic the use of the CO2 laser is not

limited to skin resurfacing, but is also used in laser- assisted blepharoplasty procedures (Figures 2–5) as a bloodless incisional modality is preferred. This treatment modality is easier, and better results can be achieved by using the CO2

laser in the majority of eyelid

surgeries such as ptosis, ectropion and entropion, and in xanthelasma (Figure 8). A 0.2 mm laser handpiece with an 8 W setting is used

in incisional surgeries. Additionally, the handpiece is used at normal focal length to incise the skin and orbicularis, as well as the septum, while for melting and reshaping of the fat tissue it is preferred to de-focus the laser in order to increase the spot size to shrink fat. Although the laser is excellent for small-vessel haemostasis, it is less valuable for larger-vessel haemorrhage, as the CO2

chromophore is water and

the small beam loses its ability to coagulate in a pool of blood. For lower-lid surgery, it is possible to use both the

transcutaneous or transconjunctival approach. If the latter is used, the conjunctiva and capsulopalpebral fascia are incised to access the prolapsed lower fat pads. The incision is made approximately 4 mm inferior to the lower tarsus from the canthus to the lacrimal punctum. A subciliary incision is made if the transcutaneous method is preferred. In some patients upper-lid blepharoplasty with lower-lid resurfacing is performed, providing very good results (Figures 3–4). However, it is essential to select patients carefully as laser resurfacing should not be performed if there is laxity at the lower eyelid, as this will increase the risk of post-surgical ectropion.

Conclusions The benefits of using the CO2

40 ❚ laser rather than a cold-steel scalpel in periocular surgeries such as blepharoplasty, November/December 2012 | References

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2. Coleman SR. Structural Fat Grafting. St. Lois MO: Quality Medical Publishing, 2004

3. Gosain AK, Klein MH, Sudhakar PV, Prost RW. A volumetric analysis of soft-tissue changes in the aging midface using high-resolution MRI: implications for facial rejuvenation. Plast Reconstr Surg 2005; 115(4): 1143–52

4. Reid RR, Said HK, Yu M, Haines GK 3rd, Few JW. Revisiting upper eyelid anatomy: introduction of the septal extension. Plast Reconstr Surg 2006; 117(1): 65–6

5. Erdogmus S, Govsa F. The arterial anatomy of the eyelid: importance for reconstructive and aesthetic surgery. J Plast Reconstr Aesthet Surg 2007; 60(3): 241–5

6. Biesman BS. Anatomy of the eyelid, forehead and temporal region. In: Biesman BS. ed, Lasers in Facial Aesthetic and Reconstructive Surgery. Philadelphia: Lippincott Williams and Wilkins, 1998

7. Fitzpatrick R, Geronemus R, Goldberg D, Kaminer M, Kilmer S, Ruiz-Esparza J (2003) Multicenter study of noninvasive radiofrequency for periorbital tissue

tightening. Lasers Surg Med 33(4): 232–42

8. Ross E, Naseef G, Skrobal M, Grevelink J, Anderson R. In vivo dermal collagen shrinkage and remodeling following CO2 laser resurfacing. Lasers Surg Med 1996; 18(suppl 8): 38

9. Janik JP, Markus JL, Al-Dujaili Z, Markus RF. Laser resurfacing. Semin Plast Surg 2007; 21(3): 139–46

10. Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser resurfacing: nonablative, fractional and ablative laser resurfacing. J Am Acad Dermatol 2008; 58(5): 719–37

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 Declaration of interest None  All figures ©Rengin Griffin

activation causes immediate tissue contraction and new collagen production to reduce wrinkles and tighten the skin. Patient


selection and preoperative

planning and postoperative care are essential for successful outcomes and unwanted side-effects. Despite the advances in

technology and the introduction of alternative methods for skin resurfacing, the CO2

laser continues to deliver the

most consistently effective improvement in skin tightening and wrinkle reduction, thus remaining the gold standard for skin resurfacing.

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