title: Mid-infrared laser orbital septal tightening: ex vivo dosimetry study and pilot clinical study.
abstract: OBJECTIVE
  Blepharoplasty is one of the most commonly performed facial aesthetic surgeries. While myriad techniques exist to improve the appearance of the lower eyelids, there is no clear consensus on the optimal management of the orbital septum.
  
  
  OBJECTIVE
  To evaluate the safety and feasibility of the use of the holmium:yttrium aluminum garnet (Ho:YAG) laser for orbital septal tightening, and to determine whether modest use of this laser would provide some degree of clinical efficacy.
  
  
  METHODS
  Direct laser irradiation of ex vivo bovine tissue was used to determine appropriate laser dosimetry using infrared thermal imaging and optical coherence tomography before conducting a pilot clinical study in 5 patients. Laser irradiation of the lower eyelid orbital septum was performed through a transconjunctival approach. Standardized preoperative and postoperative photographs were taken for each patient and evaluated by 6 unbiased aesthetic surgeons.
  
  
  METHODS
  Use of the Ho:YAG laser for orbital septal tightening.
  
  
  METHODS
  To determine appropriate laser dosimetry, infrared thermal imaging and optical coherence tomography were used to monitor temperature and tissue shape changes of ex vivo bovine tissue that was subjected to direct laser irradiation. For the clinical study, preoperative and postoperative photographs were evaluated by 6 surgeons on a 10-point Likert scale.
  
  
  RESULTS
  Optical coherence tomography demonstrated that laser irradiation of bovine tissue to a temperature range of 60°C to 80°C resulted in an increase in thickness of up to 2-fold. There were no complications or adverse cosmetic outcomes in the patient study. Patient satisfaction with the results of surgery averaged 7 on a 10-point Likert scale. For 3 patients, 3 (50%) of the evaluators believed there was a mild improvement in appearance of the lower eyelids after surgery. The remaining patients were thought to have no significant changes.
  
  
  CONCLUSIONS
  Transconjunctival Ho:YAG laser blepharoplasty is a safe procedure that may ameliorate mild pseudoherniation of lower eyelid orbital fat and is a first step toward the development of percutaneous techniques.
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine.
authors.forename: Eugene A
authors.initials: EA
authors.lastname: Chu
authors.affiliation: Beckman Laser Institute, University of California, Irvine.
authors.forename: Michael
authors.initials: M
authors.lastname: Li
authors.affiliation: Beckman Laser Institute, University of California, Irvine.
authors.forename: Frances B
authors.initials: FB
authors.lastname: Lazarow
authors.affiliation: Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine School of Medicine, Irvine2Beckman Laser Institute, University of California, Irvine.
authors.forename: Brian J F
authors.initials: BJ
authors.lastname: Wong
mesh_terms: D000328:Adult; D019882:Blepharoplasty / Q000379:methods*; D005260:Female; D049673:History, 20th Century; D006801:Humans; D066298:In Vitro Techniques; D007259:Infrared Rays; D053685:Laser Therapy / Q000379:methods*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D009915:Orbit / Q000601:surgery*; D017060:Patient Satisfaction; D010865:Pilot Projects; D011874:Radiometry; D041623:Tomography, Optical Coherence