title: Radiowave surgery versus CO laser for upper blepharoplasty incision: which modality produces the most aesthetic incision?
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cosmetic Facial Surgery, Richmond, Virginia 23235, USA. niamtu@niamtu.com
authors.forename: Joe
authors.initials: J
authors.lastname: Niamtu
mesh_terms: D019882:Blepharoplasty / Q000379:methods*; D006801:Humans; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use; D000078702:Radiofrequency Therapy