Newer fractional devices for eyelid rejuvenation may decrease downtime

Key Points

In the past, eyelid rejuvenation often required a long period of downtime, accompanied by some substantial risks. But that's not necessarily the case anymore.

Laser and radiofrequency treatments of the periorbital area and eyelid proper are not a novel idea, but the newer fractional devices provide an increase in safety and, as a result, have contributed to a subsequent increase in popularity of these procedures.

Laser resurfacing can address certain components of the periorbital area that are not remedied by blepharoplasty, such as fine lines and "crepiness." We also use it for patients who have already had a blepharoplasty and do not have enough redundancy for a second surgical procedure. Laser resurfacing is also good for those patients who are not satisfied with their surgery or who have visible surgical scars. Eyelid treatments with laser and radiofrequency have become an important adjunct to surgery in this area.

First things first

The most important step prior to beginning treatment of the periorbital area with any device is to become familiar with its specialized anatomy and the safety issues associated. First, the anatomy:

The upper eyelid is considered to be the portion of the skin below the eyebrow extending to the lash line, including all structures beneath to the conjunctiva. The lower eyelid extends from the lower lash line to the orbital rim.

The eyelid skin is different from the skin in other areas of the body. It measures 1 mm at its thickest point on the lid, which is at the point just inferior to the brow. The thinnest part of the lid measures a mere 0.3 mm in total thickness near the lash margin (Hwang et al. J Craniofac Surg. 2006). In addition, the orbicularis muscle lies directly beneath the skin, with little to no fat to act as protection. Performing resurfacing into this muscle is entirely possible, which then can result in scarring and ectropion. It is crucial to remember the thinness of the skin in this area when choosing your laser settings.

Protective measures

When performing laser or light procedures on any portion of the lid, the globe must be protected. Corneal shields should be placed prior to any procedure treating the eyelid proper. The most commonly used shields are stainless steel, as they do not conduct heat due to their buffing and electro-polishing. Another option is the plastic corneal shield. However, we do not use the plastic corneal shields due to the possibility of heating of the shield during the procedure.

Prior to insertion of the shield, anesthetic (proparacaine) drops are placed into the eye. The anesthetic effects are virtually instantaneous, so the shields can be inserted immediately. The rims of the shields should be checked for any sharp points prior to insertion. The easiest way to place the shields is to have the patient look down, then insert the upper edge of the shield beneath the upper eyelid. Then you should ask patient to look up and carefully put in the lower edge of the shield. Use your thumb to evert the lower lid to make it easier to insert. Once the shield is in place, it provides a smooth surface on which to track the laser handpiece, being careful not to place pressure on the globe itself.