Blepharoplasty – high tech or low tech – laser or scalpel
The development of Aesthetic lasers in the mid 1990’s revolutionized the field of blepharoplasty and facial and eyelid rejuvenation. Most experts in plastic surgery today agree that the laser had its most dramatic impact on the ability of surgeons to rejuvenate the mid-face region, that is the eyelid and peri-ocular (around the eyes) region of the face.
Initially, laser resurfacing of the eyelids and peri-ocular region produced stunning wrinkle removal and smoothing of skin. Although this procedure is still popular in selected patients, prolonged recovery times and the tendency for hypopigmentation or lightening of the treated skin has dampened enthusiasm for this procedure. Laser resurfacing remains a very effective technique for lighter skinned individuals who can afford the 2-week down time. Botox® with its striking effect of correcting crow’s feet and virtually no down time has surpassed laser resurfacing in popularity for correction of peri-ocular wrinkles. However, the new ActiveFX CO2 laser has all of the advantages with few disadvantages of the old CO2 laser, and peri-ocular Active FX peel is currently the choice for surface rejuvenation of the eyelid.
The major controversial argument about eyelid rejuvenation however, remains whether a surgical steel scalpel or the laser should be used for the incisions required for blepharoplasty, the eyelid tuck or eyelid rejuvenation procedure.
Blepharoplasty involves making an incision on the upper eyelid and removing the excess skin or hooding that hangs down over the eyelid as we age. This procedure is called an upper blepharoplasty. The incision can be made with either a scalpel or a laser.
The lower blepharoplasty is done to remove eyelid bags, puffiness and excess skin from the lower eyelids. An additional procedure called an arcus marginalis release can be done during the lower blepharoplasty procedure to remove dark circles under the eyes (also called the naso-jugal fold)– but this is not a part of the routine blepharoplasty.
The lower blepharoplasty may be done through an incision on the outer skin of the eyelid with a scalpel or through a laser or scalpel incision through the inner pink tissue on the inside of the eyelid called the conjunctiva, thus a transconjunctival blepharoplasty. The advantage of the transconjunctival blepharoplasty is that the supporting muscles of the eyelid are not cut through and the natural shape of the eyelid is preserved. Often when the outer eyelid incision is used the weakening of the muscles caused by the incision causes the eyelid to turn down into a sad eyed or “hound dog eyes”. Typically a laser is not used when the outside lower eyelid incision is used.
The proponents of the laser blepharoplasty cite the following advantages:
· Less bleeding
· Better visibility of vital structures
· Faster surgery
· Less bruising and swelling
· Equal scar
Proponents of the scalpel blepharoplasty cite the following:
· The laser requires special training and precautions
· The laser is expensive
· Healing time is slower
If you are planning on having a blepharoplasty done you should ask your surgeon which technique he/she uses and why.
The most important issue is for you to seek consultation with a board certified surgeon who has a lot of experience in eyelid surgery. Ask to see his/her results and talk to other patients who have had experience with this doctor.
Ultimately it is most important that you feel comfortable with and trust the doctor you choose.
Personally I use the laser for all of my blepharoplasty operations and have for over 10 years. I prefer the clean bloodless field that allows me to see and avoid injuring all of the vital structures that are exposed during the operation. I also like the speed of the laser, 15 minutes for an upper blepharoplasty with the laser compared to 45min with the scalpel. Upper and lower blepharoplasty can be done in less than an hour with the laser, yet some surgeons take as long as 1 ½ to 2 hours with the scalpel.
The most important issue in blepharoplasty is preserving the shape of the lower eyelid. I always do a transconjunctival blepharoplasty to preserve the natural shape of the lower eyelid and avoid the sad eyed or “hound dog look. Contact me for further information, or read Save Your Face on how to find a good doctor, Chapter 10.
Dr Seckel