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Treatment of the Lower Eyelid with the CO2 Laser: Transconjunctival or Transcutaneous Approach?

Purpose: To compare the effects of CO2 laser transcutaneous blepharoplasty with CO2 laser transconjunctival blepharoplasty with simultaneous resurfacing for the treatment of lower lid dermatochalasis. Methods: Thirteen men and 23 women, between 42 and 67 years of age, participated in this study. Patients were divided into two groups: (1) CO2 laser transconjunctival blepharoplasty with resurfacing or (2) CO2 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. Results: 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. Conclusion: 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.