Joe Niamtu1. 1. Cosmetic Facial Surgery, Richmond, Virginia 23235, USA. niamtu@niamtu.com
Abstract
INTRODUCTION: For years, traditional upper blepharoplasty incisions have been made with scalpel and or scissors. Although effective, increased intraoperative bleeding can be problematic. Bleeding slows the surgery; obscures the surgical field; and can lead to increased swelling, bruising, and pain. Bloodless modalities for upper blepharoplasty include radiowave surgery, electrocautery, and CO(2) laser technology. These modalities provide a virtually dry and bloodless surgical field, which translates into faster surgery as well as decreased postoperative bleeding, bruising, and pain. PURPOSE: The purpose of this study was to determine which modality (CO(2) laser vs. 4.0-MHz radiowave surgery) produced the most aesthetic postoperative upper blepharoplasty scar at 1 year in a consecutive cohort of patients operated by the same surgeon. A search of the literature does not show a similar study in Caucasian patients. The mechanics and physics of CO(2) laser and 4.0-MHz radiowave surgery are also discussed. MATERIALS AND METHODS: Thirty consecutive patients underwent upper eyelid blepharoplasty for cosmetic purposes performed by the author. In all patients one upper eyelid was treated (skin, muscle, and fat) with a 4.0-MHz radiowave surgery unit (Surgitron, Ellman International) set at 12 W on the cut/coag mode, and the contralateral side was treated with an ultrapulse CO(2) laser (Encore, Lumenis Inc.) using a 0.8-mm handpiece on the continuous wave setting at 8 W. Six blepharoplasty-experienced, blinded observers consisting of doctors from five different cosmetic specialties evaluated standardized digital images of each patient taken 1 year after surgery. The photographs were randomized, and the blinded examiners were asked to choose the side that had the most esthetic postoperative incision. RESULTS: Of the 30 consecutive patients, 23 completed the required 1-year follow-up. Surgeons evaluating these patients scored the radiowave surgery side to look best in 37% of the cases (43/115), the CO(2) laser side was scored to look better in 37% (42/115), and both sides to be to be equally aesthetic in 26% of the cases. CONCLUSION: Both 4.0-MHz radiowave surgery and CO(2) laser incision produce simultaneous incision and coagulation. Both modalities restrict blood loss in the average four lid blepharoplasty surgery to less than 1 cm(3) of blood and decrease operative time. In this study, qualified blinded surgeons judging 12-month postblepharoplasty photos of incisional scars were unable to differentiate a statistically significant difference between the two modalities and the aesthetic quality of the scars. This represents the first study of its type in the literature utilizing Caucasian patients.
INTRODUCTION: For years, traditional upper blepharoplasty incisions have been made with scalpel and or scissors. Although effective, increased intraoperative bleeding can be problematic. Bleeding slows the surgery; obscures the surgical field; and can lead to increased swelling, bruising, and pain. Bloodless modalities for upper blepharoplasty include radiowave surgery, electrocautery, and CO(2) laser technology. These modalities provide a virtually dry and bloodless surgical field, which translates into faster surgery as well as decreased postoperative bleeding, bruising, and pain. PURPOSE: The purpose of this study was to determine which modality (CO(2) laser vs. 4.0-MHz radiowave surgery) produced the most aesthetic postoperative upper blepharoplasty scar at 1 year in a consecutive cohort of patients operated by the same surgeon. A search of the literature does not show a similar study in Caucasian patients. The mechanics and physics of CO(2) laser and 4.0-MHz radiowave surgery are also discussed. MATERIALS AND METHODS: Thirty consecutive patients underwent upper eyelid blepharoplasty for cosmetic purposes performed by the author. In all patients one upper eyelid was treated (skin, muscle, and fat) with a 4.0-MHz radiowave surgery unit (Surgitron, Ellman International) set at 12 W on the cut/coag mode, and the contralateral side was treated with an ultrapulse CO(2) laser (Encore, Lumenis Inc.) using a 0.8-mm handpiece on the continuous wave setting at 8 W. Six blepharoplasty-experienced, blinded observers consisting of doctors from five different cosmetic specialties evaluated standardized digital images of each patient taken 1 year after surgery. The photographs were randomized, and the blinded examiners were asked to choose the side that had the most esthetic postoperative incision. RESULTS: Of the 30 consecutive patients, 23 completed the required 1-year follow-up. Surgeons evaluating these patients scored the radiowave surgery side to look best in 37% of the cases (43/115), the CO(2) laser side was scored to look better in 37% (42/115), and both sides to be to be equally aesthetic in 26% of the cases. CONCLUSION: Both 4.0-MHz radiowave surgery and CO(2) laser incision produce simultaneous incision and coagulation. Both modalities restrict blood loss in the average four lid blepharoplasty surgery to less than 1 cm(3) of blood and decrease operative time. In this study, qualified blinded surgeons judging 12-month postblepharoplasty photos of incisional scars were unable to differentiate a statistically significant difference between the two modalities and the aesthetic quality of the scars. This represents the first study of its type in the literature utilizing Caucasian patients.