Noninvasive periocular rejuvenation achievable with fractional laser procedure

Key Points

Dr. Ancona, director, Centro Medico Juva, Milan, introduced the technique in 2007, which she performs using the SmartXide Dot fractional CO₂ laser (DEKA). In a published paper, Dr. Ancona and Bruce Katz, M.D., reported results from one year of follow-up in a series of 100 patients (Ancona D, Katz BE. J Drugs Dermatol. 2010;9(1):16-21).

Dr. Ancona also recently presented findings from up to two years of follow-up in a prospective study enrolling 200 patients presenting with periocular wrinkles, tissue laxity, photoaged skin and moderate dermatochalasis. Patients received an average of two laser treatments (range, one to four) spaced three to four weeks apart.

According to results of the follow-up study, the procedure was well tolerated, and post-treatment sequelae (erythema and edema) persisted for three to four days, although downtime was generally limited to 24 hours. Outcome assessments were based on masked observers' review of standardized digital photographs and included ratings of upper-eyebrow elevation (measurement of the change in perpendicular distance from the pupil to the brow midpoint) along with skin changes (rhytids and tightening).

The results showed that after three months, the majority of patients benefited with greater than 25 percent improvement in skin texture and laxity along with eyebrow elevation of at least 1 mm to 2 mm, and there was good persistence of the benefits at last follow-up.

"Changes around the eyes are often amongst the first perceived signs of facial aging, and so blepharoplasty has become a popular procedure for re-establishing a more youthful appearance," Dr. Ancona says. "Although the fractional CO₂ laser treatment is not a replacement for blepharoplasty, it represents a useful noninvasive alternative associated with high patient satisfaction because of its outcomes and benefits of minimal morbidity and downtime."

The 200 patients represented a consecutive group treated since December 2007, and included 170 women and 30 men. Patients with recent sun exposure or who had undergone chemical peeling, another laser treatment, botulinum toxin injections or isotretinoin treatment within the previous six months were excluded. The study population had an average age of 45 years and skin types I to IV.

"While the mechanism for the eyebrow elevation achieved with this procedure is unknown, we postulate it is the result of treatment-induced changes in skin-tightening vectors as a result of new collagen formation. However, our experience indicates that the magnitude of benefit obtained depends on skin quality and patient age," Dr. Ancona says.

"The procedure seems to work best with average people who are 45 years old without severe photodamage or dermatochalasisdermatochalasis who may have a better neocollagenesis response.

"I am not advocating this treatment as a replacement for blepharoplasty, but an effective nonsurgical alternative for periorbital rejuvenation," she says.

How it's done

The laser procedure is performed after pretreatment with a topical anesthetic and with the eyes covered by a metal shield. The laser parameters used include a power range of 10 to 14 watts, pitch of 500 to 900 microns, and pulse duration of 500 to 1,000 ms.

"A low power is used for the initial treatment and then it can be adjusted upward at subsequent sessions, although there is some variation in the initial setting based on eyelid skin thickness and the patient's willingness to accept longer downtime," Dr. Ancona says. "This approach has been successful in achieving excellent tolerability and minimal downtime, which differs from other reports describing three to five days of downtime following fractional CO₂ resurfacing."

Treatment encompasses the lower and upper eyelids along with the crow's feet area using a single laser pass with no pulse stacking. Post-treatment care involves only application of a topical antibiotic ointment for three to four days.