The periorbital zone is an exclusive part of the face and requires a special approach for correction. The architectonics and anatomy of tissues in this area is associated with a limited choice of procedures and high risks of complications. Clinical studies of the effectiveness of the laser for the correction of wrinkles in the periorbital region, in particular the lower eyelid, open up new opportunities for cosmetologists in the field of non-surgical eyelid surgery.
Find out in our article on estet-portal.com what results can be achieved using a laser as an independent method and its advantages over other methods.
CO2 laser clinical trial methodology
The study involved patients who had age-related changes in the skin of the upper eyelid Hestern I, according to the classification. During the procedure, local anesthesia was used – lidocaine and tetracaine.
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Over 18 years, more than 260 lower eyelid resurfacing procedures have been performed using CO2 laser alone, without skin incisions, in patients classified as Hester I. Most patients − 90.8% were women. Related procedures: endoscopic forehead lift (brow lift) 41%, upper blepharoplasty 38.4%, facelift 29.6% and fillers (autologous or not) − 27.3%.
Features of blepharoplasty for correction of the eastern section of the eyes
Mean surgical time for the CO2 laser procedure was 5 minutes per side. Most patients needed one CO2 laser treatment to improve the condition of the eyelid. CO2 laser treatment can also be indicated for Hester II – Classification IV for patients who have medical or personal contraindications to other procedures: transconjunctival blepharoplasty or endoscopic mid-thirds lift.
These patients were not included in the study in order to obtain the most accurate results.
Contraindications, complications and results of CO2 laser application
There were only two contraindications to treatment of lower eyelid dermatochalasis with CO2 laser in the study. The first was for Asian patients, due to the difficulty in treating skin hyperpigmentation after laser therapy.
The second contraindication was − the presence of scallops (scallops (also called "zygomatic garlands") develop when the muscles under the eye — in particular the orbicularis muscle that closes the eye — begin to weaken and degenerate), as this implies deterioration of the periocular musculature, which should be aimed at improving the aesthetic profile of the patient.
Protocol for complex correction of the periorbital area
The result of the CO2 laser treatment was an improvement in the eyelid area, with a reduction in the ratio of the epidermis/dermis complex, resulting in a lower eyelid area with much less wrinkles and a much younger appearance. The results were evaluated up to 6 months after the procedure with regular physical examination and photographic documentation. These events were carried out by a dermatologist-cosmetologist or a plastic surgeon.
The main postoperative complication is transient erythema. Minor complication – these are milia, hyperpigmentation, allergic reactions, acne activation. These complications of lower eyelid laser therapy were observed in 5% to 15% of cases. It is important to explain this postoperative aspect to the patient.
There was no difference in complications when switching laser equipment because the study used a fractional laser in a non-fractional position (ablative mode).
Wrinkle recurrence: management tactics
The doctor observed the recurrence of wrinkles in the lower eyelid area 6 months after the procedure. It is necessary to wait for the complete disappearance of postoperative edema in order to accurately assess the result. Stimulation of mimic wrinkles in the periorbital region is the main factor in the formation of wrinkles in this area. When wrinkle recurrence was diagnosed, patients were evaluated for potential botulinum toxin therapy to stop the causative factor or for a new CO2 laser session if there were deep wrinkles, which occur in less than 10% of relapse cases.
Clinicians do not consider the recurrence of wrinkles as a failure of laser correction, as there was always an improvement in the eyelids and lacrimal cavity after the procedure. None of the patients after laser therapy had indications for percutaneous blepharoplasty.
Overview of primary and secondary melium removal methods
Advantages of CO2 laser as an independent method
In Hester I cases where aging and wrinkling is limited to the skin of the lower eyelid, CO2 laser offers an excellent approach to correcting age-related changes and can be performed alone or in combination with others, under local anesthesia or sedation, in depending on the need and the condition of the patient.
Originally approved for the correction of facial wrinkles, hyaluronic acid and fillers are now widely used for periorbital augmentation, although their use in this space is considered off-label. However, their use may be associated with undesirable effects, including edema, which may prompt patients to seek additional procedures to improve appearance.
Even though loss of soft tissue thickness is certainly present in tear trough deformity, flattening a cavity in this area by filling in the deformity may result in an unnatural appearance and swelling.
This can give the midface a puffy appearance, which can worsen over time if the filler itself is osmotically active. On the other hand, using your own fat cells as a filler can lead to unpredictable results and requires several surgical steps. CO2 laser still offers a clear advantage among these correction techniques, improve skin texture and eliminate adjacent periorbital wrinkles.
Correction of the area around the eyes: professional subtleties
However, it is important to emphasize that the CO2 laser − it is a medical procedure that can lead to associated complications such as scarring or ectropion. Currently, during a clinical study, complications are, in most cases, associated with individual manifestations of allergic skin reactions with a rapid and satisfactory resolution.
According to the long-term results of the study, it is necessary to observe post-procedure care, which includes cosmetic eyelid skin care products based on aloe vera, glycolic and retinoic acids in order to prevent the appearance of hyperpigmentation and maintain neocollagenesis stimulation.
Secrets of Successful Lower Eyelid Correction with HA Fillers
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