The main advantage of the laser over traditional stainless steel scalpels and scissors is that laser incisions tend to bleed less and thus the time it takes to perform most operations may be decreased slightly (because there's far more to most operations than simply controlling bleeding). With laser blepharoplasty, eyelid fat can be removed without first clamping to prevent bleeding, a step that may eliminate some slight discomfort.
The first laser to be used widely in blepharoplasty was the neo-dymium:YAG (Nd:YAG) laser, an instrument in which the laser power is transmitted through a fiberoptic coil to a probe that can be applied directly to the skin. Laser energy is used to simultaneously cut tissue and coagulate blood vessels. While this seemed to offer some potential advantages, many surgeons found otherwise.
Any time saved on surgery was lost to increased pre-operative set-up routines. The surgeon and staff were forced to wear goggles, which decreased their view of the overall surgical field as well as of the finer details.
Not to mention the matter of increased cost, which, of course, was passed on to the patient. Lasers are very expensive cutting tools.
Regarding surgical outcomes, though, there was no demonstrable advantage. Unbiased studies showed no difference in bruising or swelling in patients who underwent laser blepharoplasty on one side and surgical steel blepharoplasty on the other. The only noticeable difference was a more obvious scar on the side treated by the laser, although after three months the two sides looked identical.
Then came the modification that allowed the laser to be employed as a skin "resurfacing tool" designed to soften wrinkles. Almost immediately, intense interest in the possibility of replacing the traditional steel scalpel with this "new" high tech sensation emerged in the field of cosmetic surgery. Newspapers and television screens were overrun with reports (i.e, press releases from laser manufacturers and investors) proclaiming the merits of "laser face lift" and "laser rhinoplasty" and, of course, "laser blepharoplasty". To the public, at least, it seemed as if the entire field of facial plastic surgery had been reinvented and modernized overnight. "Laser mania" was off and running.
This "next-generation" laser was the same carbon dioxide (CO2) laser now used so frequently to perform skin resurfacing.
Use of the CO2 laser requires a number of extra safety precautions to prevent stray energy from causing injury to the eyes. Special non-reflective surgical instruments, patient eye shields, staff eyewear, and smoke evacuators must be employed. The surgical field must be draped with extra caution to prevent errant energy from causing unintended burns. Flammable agents must be kept away from the area, and a fire extinguisher must be present at all times. In contrast to the Nd:YAG instrument, the CO2 laser does not make contact with the tissue but must be held a short distance from the tissue with its cutting beam "aimed".
The steps of the blepharoplasty operation are otherwise almost identical whether or not a laser is used. Less bleeding may be noted during laser-assisted surgery, and surgical time may be decreased slightly.
Unfortunately, though, and contrary to some claims by vocal advocates, objective medical studies have failed to demonstrate any significant decrease in post-operative bruising or healing times. To the contrary, healing times may be increased when the CO2 laser is employed because the full edges of the incisions have been unnecessarily cauterized. Sutures must thus be left in days longer, and scars take weeks longer to establish their strength. Because the CO2 laser does not come in contact with the tissue but instead must be aimed from a slight distance, some laser incisions are less than smooth and skin removal may be not as accurate as with traditional techniques. Such factors can conspire to create scars that may end up wider and thicker than those achieved with "low-tech" tools. Because the heat of the laser may cause the orbital fat to temporarily shrink due to water evaporation, fat removal may be less precise. Because of the speed with which a laser can cut through tissue and the lack of direct tactile feedback while doing such cutting, the possibility of unintended collateral damage to the eye and eyelid during surgery may be magnified.
So, what is the big advantage to using the laser as a cutting tool in blepharoplasty?
There is no such advantage, at least not for the vast majority of patients. If a patient suffers from a severe bleeding tendency, the laser might possibly prove beneficial, but, really—such a patient probably shouldn't be undergoing cosmetic blepharoplasty to start.
Without a doubt, you will find some excellent surgeons who claim that their experiences are not consistent with this conclusion. Some of these opinions will be entirely scientifically and intellectually honest, but some, we suspect, may be at least partially influenced by a vested interest in protecting a substantial investment in both specialized equipment and previous marketing campaigns.
In the opinion of a number of highly-respected eyelid surgery specialists, however, the differences between laser and non-laser incisional blepharoplasty are so slight and insignificant that they don't really matter. To achieve a good result in blephaoplasty requires that a surgeon possess a thorough understanding of eyelid anatomy and adequate training and experience. Fancy though it may sound, the use of a laser is not an adequate substitute.
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