Is surgical blepharoplasty better than laser eyelid correction?

Surgical correction of the upper and lower eyelids, i.e. blepharoplasty, is one of the most frequently performed procedures in plastic surgery

In 2020, over 300,000 eyelid corrections were performed in the United States, ranking second in terms of the number of all aesthetic procedures performed in both women and men. These procedures are very popular in Poland, although precise data on them are lacking.

Who is eligible for surgical eyelid correction?

There are many surgical techniques used for eyelid correction. Each time, they should be tailored to the individual needs and anatomy of the patient. First, it is necessary to assess whether blepharoplasty is necessary and whether the patient is a good candidate for it. However, the most important thing is to check whether the patient’s expectations regarding the shape of the eyelids can be met by the surgeon through such a procedure. Patients should only be selected if they can derive real benefit from such an operation. For example, female patients often note that excess skin, which often reaches as far as the eyelashes, prevents them from applying full make-up. Indications for upper eyelid blepharoplasty include: drooping of loose eyelid skin and/or prominence of tissues associated with the occurrence of herniated orbital fat. As for age, no lower limit is set; however, in practice, patients usually present for consultations regarding blepharoplasty around the age of 40-50. This procedure is often combined with a brow lift.

Techniques of surgical eyelid correction

During lower eyelid blepharoplasty, it is possible to correct excessive laxity of the lower eyelid skin and so-called under-eye bags, i.e. the visible separation between the lower eyelid and the cheek. The incision line runs just below the lash line. From an anatomical point of view, smoothing out such a separation involves adding or removing tissue; therefore, in some cases, fibrous attachments are released, while in others, fat structures are shifted or removed. Both of these operations result in the face looking younger and more rested after full and proper recovery.

Laser blepharoplasty or classic: the difference between a surgical scalpel and a laser

A surgical scalpel and a laser during eyelid surgery (blepharoplasty) can be used for the same tasks: removing excess eyelid skin, tightening the excess orbicularis oculi muscle, and reducing excessive amounts of herniated fat pads. However, although the laser acts similarly to a surgical scalpel, it simultaneously seals blood vessels in addition to cutting, which consequently reduces bleeding. The literature does not demonstrate the superiority of either method or its influence on long-term results or patient satisfaction with the outcome. The final result is assessed approximately one year after surgery, as this is when the scar formation process is completed. It should be noted that in daily practice, operated patients see the effects of surgery much sooner.

Possible complications after eyelid surgery

Every surgical procedure carries a certain risk of complications for the patient. There are some temporary undesirable consequences that occur very frequently after eyelid surgery, namely: swelling and bruising. Other less common ones include: a sensation of sand under the eyes, transient incomplete closure related to swelling, tearing, and asymmetry. Among the complications, examples include: haematoma, wound dehiscence, and lower eyelid ectropion. Fortunately, these situations occur very rarely.

When does the laser have an advantage?

The main advantage of using a laser – compared to the classical method – stems first from the fact that operating with its help significantly reduces postoperative swelling and bruising, because the laser beam is simultaneously a cutting tool and seals blood vessels. This is significant, as many small blood vessels run in the eyelid area. For this reason, surgery performed on the upper eyelid very often causes bruising of both the upper and lower eyelids. Secondly, recovery for patients after surgery using a laser is faster.

Disadvantages of laser eyelid correction

Laser technology also has disadvantages. Its use carries a risk of thermal injury to surrounding tissues. Using a laser does not protect against complications associated with overly aggressive excision of excess eyelid skin, which can also occur when using a scalpel. In the case of the upper eyelid, this results in incomplete closure of the palpebral fissure, whereas in the case of the lower eyelid, it causes the previously mentioned ectropion. Although these complications are very rare, every patient should discuss the possibility of their occurrence with the doctor.

Recovery and recommendations after eyelid surgery

These are similar for both methods. Patients should adopt a conservative lifestyle, apply cold compresses, and use ointments or medications prescribed by the doctor. An important aspect is moisturising the scar on the eyelids after the postoperative wound has fully healed and protecting it from UV rays.

Is it worth combining surgical and laser treatment?

To improve the results of blepharoplasty, the classic surgical procedure can be combined with a laser treatment of the periorbital area. This method is gaining popularity. After performing surgical upper or lower blepharoplasty, a laser procedure is carried out. It involves the use of a CO2 or Er:YAG laser with parameters appropriately selected for the patient. The treatment area is the skin of the upper and lower eyelids. The aim of such treatment is to remove or reduce the amount of damaged collagen and stimulate the synthesis of new collagen along with tissue remodelling. This occurs through the combination of removing water molecules from tissues and laser-denatured collagen. This procedure additionally causes tightening of the eyelid skin, and when used at specific times and intervals after the surgery, it reduces the visibility of the postoperative scar. Rapidly developing laser technology is increasingly being implemented in plastic surgery procedures. Properly performed eyelid correction allows for very satisfactory results and patient satisfaction. As highlighted earlier, the use of a laser during blepharoplasty does not affect long-term results. However, combining blepharoplasty with simultaneous laser therapy of the eyelid area allows for an even greater rejuvenation effect than using the surgical procedure alone. It should be remembered that any tool or device is only as good as its operator.

Author of the text: Prof. Mateusz Koziej First published in the magazine estetyczny-portal.pl (23 September, 2022)