Recent Advances In Cosmetic Eyelid And Facial Surgery

    Some of the more recent advances, despite an improved understanding of periorbital aging, have not prevailed, but were attempts to simplify surgery and/or reduce complications. In 1985, Bosniak and Sachs described lipolytic diathermy as a technique for fat pad 'sculpting' in cosmetic blepharoplasty. The attempt here was to reduce the volume and appearance of the eyelid fat by thermal melting without the need for an eyelid incision. The procedure did not catch on with any great success, but it paved the way for other methods and agents that would reduce the volume of fat that was perceived as a cause of periorbital aging. Putterman described scalpel-YAG laser blepharoplasty in 1990 which was early in the 'laser era.' The hope of a more precise and advantageous 'laser' solution to cold steel for incisions has not come to fruition. Rapid-absorbing gut sutures were also introduced for skin closure around the same time. The attempt to replace the painstaking chore of removing sutures has been more satisfactorily solved by using capable clinical assistants, rather than materials that were at times inflammatory, caused wound irregularities, and were less dependable.


    Baker and associates first described carbon dioxide (C02) laser blepharoplasty in 1984. This technique involved skin and fat excision using continuous energy laser output, which was the only power mode available at the time. The work of Baylis and colleagues and their multiple courses, exhibits, and presentations were responsible for popularizing and reintroducing the oculoplastic community to the benefits of transconjunctival blepharoplasty. David, was the first, in 1988, to describe the use of the C02 laser for transconjunctival lower eyelid fat excision. The potential of non-incisional surgery that could potentially address some of the issues not dealt with by traditional surgery led to the expansion of applications of laser energy, and for the next ten years remained a major focus. These developments were fueled in part by industry greed and the knowledge of the explosive growth of cosmetic surgery, and the possibility that these procedures could expand into non-surgical practice. Many were convinced that laser technology would soon replace the need for any significant surgical intervention in the majority of patients. Despite the fact that this has not occurred, the insights gained have been invaluable.