Elsevier

Ophthalmology

Volume 108, Issue 3, March 2001, Pages 437-441
Ophthalmology

Lower eyelid CO2 laser rejuvenation: A randomized, prospective clinical study1,

Presented as a poster at the Annual meeting of the Association for Research in Vision and Ophthalmology, Ft. Lauderdale, Florida, May 2000.
https://doi.org/10.1016/S0161-6420(00)00593-5Get rights and content

Abstract

Purpose

The effect of transconjunctival blepharoplasty alone compared with transconjunctival blepharoplasty and CO2 laser skin resurfacing on lower lid bulging and wrinkles was examined.

Participants

Forty-four subjects, including 13 men and 31 women.

Methods

Subjects were prospectively randomly assigned into two groups: (1) transconjunctival blepharoplasty with immediate CO2 laser resurfacing or (2) transconjunctival blepharoplasty with CO2 laser resurfacing 2 months later. Standardized photographs were taken before and 2 months after each procedure. A trained, masked observer graded the photographs.

Main outcome measures

Bulging and wrinkles of the medial, central, and lateral portions of the lower lid were scored and compared at specified end points.

Results

Transconjunctival blepharoplasty alone resulted in an improvement in lower lid bulging in 92% of subjects, whereas lower lid wrinkling worsened in 46%. When transconjunctival blepharoplasty was performed with simultaneous CO2 laser resurfacing, or with CO2 laser resurfacing 2 months later, a statistically significant improvement in wrinkles occurred (chi square = 20.625; P < 0.0005). The timing of the procedures had no statistically significant effect on final outcome. No subject had lower lid retraction develop.

Conclusions

Transconjunctival blepharoplasty and adjunctive CO2 laser resurfacing represents an excellent alternative to transcutaneous lower blepharoplasty. The procedure addresses lower lid wrinkles, skin redundancy, and fat herniation without a scar and with little risk of lower lid retraction.

Section snippets

Methods

The primary outcome of this study was the ability of laser resurfacing of the lower lids, after transconjunctival blepharoplasty, to reduce lower lid wrinkles compared with transconjunctival blepharoplasty alone. Secondary outcomes were the effectiveness of transconjunctival blepharoplasty to reduce lower lid bulging and the importance of timing of the transconjunctival blepharoplasty and resurfacing on the ultimate improvement in lower lid bulging and wrinkles.

Institutional review board

Results

Of the 70 subjects enrolled in the study, 44 followed through to completion. Fifteen dropped out before surgery, and 11 others had inadequate follow-up. Thirteen men and 31 women completed the study, with 20 randomly assigned to the group undergoing simultaneous procedures, and 24 undergoing separate procedures. Three of this latter group opted to undergo transconjunctival blepharoplasty alone and not proceed with laser resurfacing. All subjects were subjectively pleased with their results.

Discussion

During much of the twentieth century, transcutaneous blepharoplasty was the standard approach to lower eyelid fat bulges and wrinkles. Unfortunately, this procedure often leads to complications associated with excessive skin excision and scarring of the middle lamella of the lid, specifically lower lid retraction, ectropion, and lateral canthal rounding.2, 6 Perkins et al2 found lateral canthal rounding in 5% of their series of 300 subjects who underwent subciliary incision blepharoplasty.

The

Historical image

Eyecup, ca 1830–80, Porcelain with Blue Transfer, Spode, England Gift of J. William Rosenthal

As recently as 50 years ago, nearly everyone had at least one eyecup in his or her medicine cabinet. These small cups were used to apply solutions to the eye, and are known as “eyecups,” “eyebaths,” and “eye wash cups.”

∗ Courtesy of the Museum of Vision, Foundation of the American Academy of Ophthalmology.

References (10)

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Supported in part by That Man May See, Inc, San Francisco, California, and an unrestricted departmental grant from Research to Prevent Blindness, Inc, New York, New York.

1

The authors have no commercial interest in any of the products discussed.

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