Fractional CO₂ laser vs. Fraxel laser for lower eyelid rejuvenation following transconjunctival lower blepharoplasty

Aim: Transconjunctival CO₂ laser lower blepharoplasty is considered to be a safe and reliable approach. A retrospective review of transconjunctival approached CO₂ laser lower blepharoplasty associated with fractional CO₂ laser ablation or fractioned non-ablative Fraxel laser resurfacing for lower eyelid rejuvenation is presented for comparison. Methods: From February 1996 to February 2016, 250 patients underwent CO₂ laser lower blepharoplasty with a male to female ratio of 1:7.5. The age ranged from 43 to 68 years (mean 52 years). A CO₂ laser was applied to make a transconjunctival lower blepharoplasty. Immediately after CO₂ laser lower blepharoplasty, 40 patients received fractional CO₂ laser and 40 patients took Fraxel laser for resurfacing. Results: Swelling occurred in all patients postoperatively. Complications related to transconjunctival CO₂ laser lower blepharoplasty were 6 (2.4%) patients with conjunctival chemosis, 5 (2.0%) with ecchymosis, and 3 (1.2%) with granulomas. The early complications (≤ 1 month) related to fractional CO₂ laser ablation were 40 (100%) patients with mild erythema, 40 (100%) with mild edema, 1 (2.5%) with hyperpigmentation, 1 (2.5%) with infection, and 1 (2.5%) with scarring. These problems resolved in all patients after 3 months. There was no complication after Fraxel laser right after lower blepharoplasty. The Fraxel group had short recovery time. However, there was no statistically significant difference between the two groups in final outcome (≥ 6 months). Conclusion: Transconjunctival CO₂ laser lower blepharoplasty associated with fractional CO₂ laser ablation or Fraxel laser resurfacing assisted the appearance around the periorbital regions.