Patient Satisfaction and Management of Postoperative Complications Following Ablative Carbon Dioxide Laser Resurfacing of the Lower Eyelids

Abstract

Purpose: To describe postoperative management following ablative carbon dioxide laser resurfacing of the lower eyelids. Methods: A retrospective review of patients who consecutively underwent bilateral lower eyelid ablative carbon dioxide laser resurfacing by a single experienced oculoplastic surgeon over a 6-year period was conducted. Patient satisfaction, aesthetic outcomes, and postoperative complications were evaluated as adjunctive or monotherapy. Results: Among 424 patients included in the study, most were female (n = 356, 84.0%) and Caucasian (n = 404, 95.3%), with Fitzpatrick skin types II-III (n = 381, 89.9%). Mean age was 62.8 years (standard deviation: 9.7 years). Most (n = 324, 76.4%) underwent fractional ablative carbon dioxide laser resurfacing of the lower eyelids, whereas 91 (21.5%) received traditional laser resurfacing and 9 (2.1%) had both fractional and traditional laser resurfacing during the same session. At the time of lower eyelid laser resurfacing, most patients also underwent concurrent procedures, including upper (n = 321, 75.7%) and lower blepharoplasty (n = 348, 82.1%); a small proportion of patients (n = 39, 9.2%) did not undergo any concurrent surgical procedure. In addition to ablative laser resurfacing of the lower eyelids, 25 (5.9%) had upper eyelid laser resurfacing, 60 (14.2%) had full-face laser resurfacing, 55 (13.0%) had neck laser resurfacing, and 42 (9.9%) had additional treatment of solar lentigines or dyschromias on the face. Median follow-up duration was 3.9 months (interquartile range: 2.0–11.0 months). In the immediate postoperative period, 22 patients (5.2%) developed contact dermatitis from topical antibiotic eye drops and/or ointment prescribed postblepharoplasty. Postinflammatory hyperpigmentation was observed in 40 patients (9.4%) despite topical prophylaxis; all were eventually successfully treated with a combination of topical nonprescription and prescription creams and/or oral tranexamic acid. A localized herpetic outbreak occurred in 3 (0.7%) who underwent full-face laser resurfacing and 1 (0.2%) who underwent periocular laser resurfacing only; all were successfully treated with oral antiviral therapy. Two (0.5%) developed culture-proven atypical mycobacterial infection of the resurfaced lower eyelid skin and were treated with combination antibiotic therapy for several months until resolution. A small scar was noted in 4 patients (0.9%), which resolved after local corticosteroid injections. No patient developed persistent scarring or ectropion. Patient satisfaction was overall high, with 363 (85.6%) very satisfied and 48 (11.3%) satisfied with the aesthetic outcome of lower eyelid laser resurfacing. Conclusions: Ablative carbon dioxide laser resurfacing of the lower eyelids can be a useful tool in the armamentarium of the experienced oculoplastic surgeon, with excellent aesthetic results, high patient satisfaction, and low complication rates as adjunctive or monotherapy. Proper and timely management of postoperative complications is essential to maximizing successful cosmetic outcomes.

role of fractional carbon dioxide laser resurfacing in post-operative transconjunctival lower eyelid blepharoplasty

“…There was a 72.5% reduction in the appearance of the wrinkles. However, the study by Kim et al, 9 Reported that patient satisfaction was overall high, with 363 (85.6%) very satisfied and 48 (11.3%) satisfied with the aesthetic outcome of lower eyelid laser resurfacing. They concluded that Ablative carbon dioxide laser resurfacing of the lower eyelids can be a useful tool in the armamentarium of the experienced oculoplastic surgeon, with excellent aesthetic results, high patient satisfaction, and low complication rates as adjunctive or monotherapy.…”

“…Also, Griffin et al, 8 reported that all cases had lower lid dermatochalasis the studied groups were comparable as regard preoperative complain. Kim et al, 9 stated that all cases had bilateral lower eyelid puffiness. In the current study regarding complications, we found that in group (A) there was 2(20.0%) had incomplete correction while in group (B) 4(40%) had Increased periocular wrinkles.…”

Factors influencing the length of the recovery period after blepharoplasty: a review of the latest data

“…On the other hand, fractionated CO2 laser resurfacing was comparable to traditional ablative resurfacing, but had lower risk of complications and shorter recovery time. 82,83 A study by Kim et al 84 with fractional ablative CO2 laser resurfacing revealed low risk of infections, mainly viral. The most common complication was inflammatory hyperpigmentation, which occurred in about 10% of patients but could be easily treated locally.…”

Laser‐assisted blepharoplasty: An innovative safe and effective technique

“…The first laser‐assisted blepharoplasty procedure was developed by Baket in 1980, but despite initial excitement and a relevant side effect—excessive thermal damage that results in scars—the practice was never widely adopted 15–16 . It was only possible to resolve this issue in the early 1990s with the development of new high energy pulsed carbon dioxide (CO 2 ) lasers; these innovations enabled medical professionals to coagulate and cut tissues with minimal thermal injury while achieving consistent results 17,18 …”

“…[15][16] It was only possible to resolve this issue in the early 1990s with the development of new high energy pulsed carbon dioxide (CO 2 ) lasers; these innovations enabled medical professionals to coagulate and cut tissues with minimal thermal injury while achieving consistent results. 17,18 The aim of this study was to evaluate the efficacy and safety of a new CO 2 laser-assisted blepharoplasty technique applied to the upper and lower eyelids.…”