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A new technique for upper and lower eyelid blepharoplasty, combining the advantages of the transconjunctival approach with those of the CO2 laser, is described. The use of the CO2 laser as the only cutting tool eliminates many of the most common and the most serious complications of blepharoplasty attributable to hemorrhage and hematoma. The transconjunctival approach yields superior cosmetic results to those of the more commonly performed traditional techniques, which sometimes results in unacceptable lower eyelid scars and/or lower eyelid retraction. Patient rehabilitation to normal activity is rapid because of decreased bruising and swelling. The laser procedure is well suited to the office-based laser surgical practice, but requires a high degree of skill in CO2 laser excisional surgery. In the hands of the inexperienced operator, new and serious complications may occur.

Thirteen patients underwent blepharoplasty in a paired comparison study. A carbon dioxide laser was employed for one side while standard cold steel surgery and electrocautery was used on the contralateral side. In addition to reduced intraoperative time and bleeding, we found less postoperative ecchymosis and edema on the laser-treated side. Long-term follow-up showed no difference between the two sides when cosmetic end result and scars were compared.

Eight patients underwent carbon dioxide (CO2) laser blepharoplasty. The temperature of the upper eyelid conjunctiva was monitored and recorded during laser surgery. A minimal increase in temperature was noted. This study confirms the absence of thermal injury at a distal site from the laser application and the safety of the laser procedure.