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Blepharoplasty Incisional Modalities: 4.0 Radiowave Surgery vs. CO2 Laser
Joseph Niamtu, III
Many modalities have been used for blepharoplasty incision, including scalpel, scissors, cautery, laser, and electrosurgery and radiowave surgery.
Incision with hemostasis has many advantages in the extremely vascular periorbital tissues. Bleeding in the surgical field presents many problems for the surgeon and the patient. Poor visualization is a negative thing in any procedure. Increased bleeding can translate into increased postoperative swelling, bruising, and pain and prolongs healing. Using a bloodless incisional modality mitigates all of the above for the patient and hastens the procedure for the surgeon.
Radiowave surgery should not be confused with electrosurgery as vast differences exist. 1–3 Standard electrosurgery was invented in 1928 and has changed little since. It operates at lower frequencies than radiowave surgery (about 1 million cycles per second), and the electrode tip provides the resistance for the circuit. This means that the electrode becomes heated and transfers this heat to the lateral tissues. This increased heat causes lateral tissue damage up to 650 m. This lateral tissue damage also translates into increased pain and swelling, delays healing, and produces a more significant scar.
Modern radiowave surgery is a patented technology (Ellman International, Oceanside, NY) that operates at 4.0 MHz. Multiple studies have shown this technology to have as little as 20 m of lateral tissue damage, which is commensurate with histologic studies of scalpel incision.4–6 4.0 MHz radiowave surgery can produce a bloodless incision with minimal lateral tissue damage. These attributes indicate its use in blepharoplasty surgery.
The CO2 laser operates at a wavelength of 10,600 nm and has an affinity for water. The skin is abundant with this target chromophore, and at a specified fluence the tissue is vaporized. Although CO2 laser produces a bloodless incision, it can generate lateral thermal damage up to 500 m. The eyelids, being very forgiving, can tolerate this without abnormal scarring, but other facial incisions are not generally made with the CO2 laser.
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82 J. Niamtu, III
Study
Thirty consecutive cosmetic blepharoplasty patients were treated by the author using 4.0 MHz radiowave surgery (Ellman International, Oceanside, NY) on one lid and a 0.2-mm CO2 handpiece at 8 watts (Lumenis Inc., Santa Clara, CA) on the other lid. Routine cosmetic blepharoplasty was performed by removing a predetermined skin ellipse, a 5-mm band of orbicularis oculi muscle, and reduction and recontouring of both upper periorbital fat pads. All incisions were closed with a running 6-0 nylon suture, which was removed a 5 days postop, and all patients were instructed in the same wound care.
Results
Of the 30 patients in the study, 23 presented for 1 year followed with digital photography. Digital photos were printed on high-quality paper, and the scars (patients eyes closed, brows raised) were evaluated by blind observers.The observers were experienced blepharoplasty surgeons and included a plastic surgeon, a facial plastic surgeon, an oculoplastic surgeon, an oral and maxillofacial surgeon, and a dermatologist. Observers were asked to score which eyelid scar was aesthetically superior or if they were both the same. Interestingly, 37% of the observers rated the radiowave surgery side as most aesthetic, 37% rated the CO2 laser side as most aesthetic, and 26% scored both sides as equal. Statistically there was no significant difference between the sides; therefore, in this study both modalities produced equally pleasing scars as rated by experienced observers.
Both 4.0 MHz radiowave and CO2 laser produce a bloodless incision with an aesthetic scar. Clinical advantages existing for the 4.0 MHz include affordability, portability, the ability to use in many other surgical applications, and the broad availability of customized electrode tips to suit hundreds of situations in multiple specialties. Advantages of the CO2 laser include the ability to resurface facial eyelids and skin with a single modality.
Figure 26.1. Both radiowave and CO2 laser provide simultaneous incision and hemostasis for cosmetic blepharoplasty surgery.
Chapter 26 Blepharoplasty Incisional Modalities: 4.0 Radiowave Surgery vs. CO2 Laser 83
Figure 26.2. A case from the study where both radiowave surgery and CO2 laser produced excellent postblepharoplasty scars. This patient’s left upper eyelid was treated with 4.0 MHz radiowave surgery and the her right upper lid was treated with CO2 laser.
References
1.Niamtu J. 4.0 MHz Radiowave surgery in cosmetic surgery. Australas J Cosmet Surg 2005;1(1):52–59.
2.Niamtu J III. Cosmetic Blephaoplasty. Atlas of Oral Maxillofacial Surg Clin N Am 2004;12:91–130.
3.Bosniak S, Cantisano-Zilkha. Radio-surgery: a 24 year history of scarless mole removal. Oculoplastic Orbital Reconstr Surg 2001;4(22):109–112.
4.Bridenstine JB. Use of ultra-high frequency electrosurgery (radiosurgery) for cosmetic surgical procedures. Dermatol Surg 1998;24:397–400.
5.Kalwarf KL, Kreici FR, Edison AR, Reinhardt RA. Lateral heat production secondary to electrosurgical incisions. Oral Surg Oral Med Oral Pathol 1983;55(4):344–348.
6.Olivar AC, Parouhar FA, Gillies CA, Servanski DR. Transmission electron microscopy: Evaluation of damage in human oviducts caused by different surgical instruments. Ann Clin Lab Sci 1999;29:281–285.