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CO2 laser or Colorado needle?

Article-CO2 laser or Colorado needle?

San Diego — The coagulation benefits of using the CO2 laser over cold steel for upper and lower eyelid blepharoplasty have been confirmed, yet there isn't anything magical about the CO2 laser in this type of surgery that the Colorado needle and an electrocautery device cannot achieve, according to Cameron K. Rokhsar, M.D., of The New York Aesthetic Center, and assistant professor of dermatology, Mount Sinai School of Medicine.

Recent literature concludes that most cosmetic surgeons prefer the CO2 laser over cold steel for blepharoplasty due to shorter healing times and less bruising and swelling as a result of its ability to seal blood vessels and lymphatics. While its effectiveness cannot be disputed, there may be no reason as to why a surgeon cannot use the Colorado needle and electrocautery in the CO2 laser's place for both upper and lower eyelid blepharoplasty. In the first ever head-to-head study of the two modalities comparing their healing parameters, the study found that there is no difference in the end result.

Speaking here at the American Academy of Cosmetic Surgeons Annual Scientific meeting, Dr. Rokhsar elaborated on data that brings into question why the CO2 laser is thought to be the superior tool for blepharoplasty. In his study, 12 patients underwent upper eyelid blepharoplasty and two had lower eyelid blepharoplasty completed for cosmetic reasons. In a randomly designed protocol, the initial incision was made with a scalpel in each eye, while the CO2 laser followed in one eye and the other eye received the procedure through the Colorado needle and electrocautery.

When assessing patients postoperatively at days one, three, seven, 14 and 30, using a scale of one to 10 in terms of ecchymosis, bruising, edema, erythema and pain, the study found there was no significant statistical difference in the healing parameters at each visit comparing the CO2 laser's results and those completed by the Colorado needle and electrocautery, according to the patient and the blinded evaluator. The time it took to operate on each eyelid was also similar using either device. At day 30, 25 percent of patients noted the eyelids to have healed the same, 33 percent reported the CO2 side to have healed better, and 42 percent reported that the Colorado needle side healed better.

"The Colorado needle and electrocautery, in essence, have similar properties because as you're cutting you're coagulating," Dr. Rokhsar says. "This study shows there is no difference between this approach and the CO2 laser's healing benefits."

Beyond healing Although the Colorado needle and electrocautery approach mirrors the CO2 laser's healing effects on blepharoplasty, there are several other benefits the surgeon should consider when considering the alternative. First and foremost, the Colorado needle offers a cost savings the CO2 cannot.

"Almost all surgeons have an electrocautery device that is easily hooked to the Colorado needle, which is far less expensive than the CO2 laser," Dr. Rokhsar says. "The Colorado needle is much easier to maneuver than the CO2 laser, which is very bulky. Additionally, if you're using a free beam you have no tactile sensation. The Colorado needle approach allows you to feel as you're performing the blepharoplasty."

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