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Laxity and wrinkles of the lower eyelid skin are common manifestations of photoaging. They often appear earlier on the eyelids than on adjacent facial skin. The pulsed CO2 laser has been shown to tighten loose skin and reduce wrinkles in the periorbital region. Previous studies suggested that the improvements were due to tissue-heating effects that vaporized intracellular water and ablated upper-layer tissue, denatured underlying tissue, and induced collagen shrinkage in lower layers. Post treatment skin tightening was attributed to new collagen synthesis in the lower layers as the treated tissue healed. Adverse effects of pulsed CO2 laser treatment include edema, persistent erythema, burning, crusting, late or permanent hypopigmentation, hyperpigmentation, prolonged recovery time, acne flares, scars, herpes simplex virus infection, ectropion/scleral show, dermatitis, and milia development. The severity of these effects may be reduced if treatment is limited to a single pass. This investigation examines the hypothesis that fractional ErYag laser treatment of the periorbital region is safe and efficacious compared to full field treatment. Improvements in wrinkle scores were both clinically and statistically significant by both techniques. Five of seven periorbital areas were improved by more than 1.8 Fitzpatrick grades for each of the techniques. Adverse effects were limited to edema and erythema/flaking, both of which resolved significantly more rapidly with the fractional technique. Pain scores between the two techniques did not differ significantly.

Periorbital Rejuvenation: Ablative Full Field Er:Yagvs. Fractional Er:Yag Laser Resurfacing