Treatment of the lower eyelid with the CO2 laser: transconjunctival or transcutaneous approach?

To compare the effects of CO(2) laser transcutaneous blepharoplasty with CO(2) laser transconjunctival blepharoplasty with simultaneous resurfacing for the treatment of lower lid dermatochalasis.

Thirteen men and 23 women, between 42 and 67 years of age, participated in this study. Patients were divided into two groups: (1) CO(2) laser transconjunctival blepharoplasty with resurfacing or (2) CO(2) laser transcutaneous blepharoplasty by the skin-muscle approach without resurfacing. The two operative techniques were compared with regard to the patient's satisfaction, complications and effectiveness on lower lid bulging and wrinkles.

Transconjunctival blepharoplasty with simultaneous laser resurfacing yielded satisfactory results with improvement of the lower lid bulging in 92% of the 20 subjects. Persistent erythema was seen in only 5% and hiperpigmentation in 10% of this group, but 80% of the patients complained of long postoperative care. On the other hand, with the transcutaneous approach, lower lid bulging was perfect in 98% of the 16 subjects; although the rate of complications such as lateral canthal rounding (3.2%) and ectropion (6.25%) was higher, the patients had no problems with the period of postoperative care. Fourteen of 16 subjects in this group also demonstrated a better appearance of the lower lid wrinkles.

Although transconjunctival blepharoplasty with laser resurfacing is now the most common surgical procedure for lower eyelid dermatochalasis and orbital fat herniation, postoperative care after laser resurfacing can be a problem in a certain group of patients. Transcutaneous blepharoplasty via the skin-muscle approach may be preferable in certain cases because of the short recovery period.