Laser blepharoplasty and periorbital laser skin resurfacing.

Standard blepharoplasty was developed in the early 1990s by minute descriptions of new anatomic details and surgical procedures derived from endoscopic surgery and by the introduction of lasers as cutting and ablative instruments. The combination of these innovations with deep frontotemporal and mid-facial lifting has added a new dimension to periorbital rejuvenation. This contribution deals with the role of lasers within the scope of expanded periorbital surgery. Indications and surgical techniques of standard and extended laser-assisted blepharoplasties are described. For upper lid blepharoplasty, the CO(2) laser is compared as a cutting instrument to the radiosurgical microelectrode needle. In performing a lower lid blepharoplasty different options are given to choose a minimal invasive transconjunctival approach in combination with laser skin resurfacing or to perform a standard transcutaneous dissection but using the laser for cutting only. With increasing anatomic and surgical knowledge as well as refinements of instruments, it has become evident that the surgeon must define clear positions when to take advantage of these new procedures. Therefore, pros and cons of standard and laser-assisted blepharoplasties will be discussed.