title: Lower eyelid ablative fractional resurfacing: a new technique to treat skin laxity and photoaging.
abstract: OBJECTIVE
  The authors describe and validate a new technique of one-session, multiple-pass, low spot density, fractional ablative CO2 resurfacing in order to treat lower eyelid skin laxity and photoaging.
  
  
  METHODS
  The investigation was conducted on 25 patients. The YouLaser CO2 (Quanta System s.p.a., Italy), a 10600-nm CO2 ablative fractional laser system, was used to treat the lower eyelids at a pulse energy of 25 to 35 J, with a pulse duration of 1 ms, 200 microm spot size and a density of 100 laser spots/cm2 for every passage. Each patient had 1 session only, and 1 to 3 passes per area, after application of topical anesthesia. Two blinded physicians assessed eyelid tightening from photographs of 25 patients using a 4-point evaluation scale (1 = 1-25%, 2 = 26-50%, 3 = 51-75%, and 4 = 76-100%. The grades of the 2 evaluating physicians were analyzed using t-test and Kruskal-Wallis analysis of variance. The same evaluation scale was used to assess patient satisfaction in a questionnaire.
  
  
  RESULTS
  The median grades of the 2 physicians for all patients did not differ significantly (p = .88) from one another, and the Kruskal-Wallis assessment (p = 0.0011) indicated unbiased grading among the physicians. All patients achieved a degree of eyelid tightening; 8% achieved 1% to 25% improvement, 24% achieved 25% to 50%, 40% achieved 50% to 75%, and 28% achieved 75% to 100%. Results of patient questionnaires were similar to that of the physicians' evaluation: 4% achieved 1% to 25% improvement, 28% achieved 25% to 50%, 48% achieved 50% to 75%, and 20% achieved 75% to 100%.
  
  
  CONCLUSIONS
  The fractioned form of CO2 laser delivery offers very good results with short downtime and easy patient recuperation. The new technique allowed the operator to control skin contraction immediately after laser skin exposure. Using high energy and lower laser spot density permits a control of the amount of contraction simply by the number of passes. Increasing this variable progressively increased skin damage and consequently the contraction.
authors: G. B. Bietti Eye Foundation, Rome, Italy. pmezzana@gmail.com
authors: P
authors: P
authors: Mezzana
authors: F
authors: F
authors: Scarinci
authors: A
authors: A
authors: Costantino
authors: N
authors: N
authors: Marabottini
authors: M
authors: M
authors: Valeriani
mesh_terms: D000328:Adult; D019882:Blepharoplasty; D015331:Cohort Studies; D005143:Eyelids; D005260:Female; D006801:Humans; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use*; D008875:Middle Aged; D015595:Skin Aging; D016896:Treatment Outcome