Blepharoplasty: laser or cold steel?

Blepharoplasty of the upper and/or lower eyelids can restore a youthful appearance to the aging face. This is a minimally invasive procedure that can be accomplished with little bleeding and a small incision. Laser-assisted blepharoplasty was pioneered in 1980, with the technique simplified after the subsequent introduction of the pulsed carbon dioxide laser. Laser-assistance helps mitigate bleeding during blepharoplasty. In ideal circumstances, the laser can be used as a multipurpose device that simultaneously offers cutting, cautery and blunt dissection capabilities. However, there is little experimental evidence confirming the superiority of laser-assisted blepharoplasty over more traditional scalpel surgery. For some procedures cold-steel may be preferable, and some surgeons prefer to use a knife for initial incisions and then laser for its coagulative properties. Patient factors and physician skill should guide the selection of the ideal blepharoplasty technique.