39 Resurfacing Complications: Clinical Overview

Noninvasive and minimally invasive procedures including injectables and resurfacing continue their meteoric rise, by far outpacing the growth in surgical procedures. The “new normal” for us as surgeons means that periorbital rejuvenation is no longer solely surgical. For our patients, the noninvasive procedures offer convenience, faster recovery with less downtime, and, in general, less morbidity. At least the complications are perceived to be less in severity. The reality is that all operations and procedures, whether surgical or not, do carry risk of serious complications, including those threatening life and eyesight. Periorbital resurfacing is no exception. Whether the laser or peels, injudicious application or less-than-thorough pretreatment evaluation may lead to serious consequences, including skin burns, contractures, and lid retraction.

Prior to any resurfacing procedure, a thorough history and eyelid evaluation is essential, noting any history of previous eyelid procedures, dry eyes, or other conditions, which may affect the outcome of the procedure. Evaluation of lid position and lid tone, including the distraction and snap tests, must be undertaken. Preexisting malposition or poor lid tone will only be worsened by the resurfacing and should be concomitantly dealt with.

As the eyelid skin is far thinner than the adjacent skin, especially that of the brow, laser settings and peel concentrations must be adjusted accordingly. All laser devices have recommended settings according to skin thickness and must be calibrated prior to each case. The energy levels, patterns, and number of passes must be adjusted for each patient based on the condition of the eyelid and the skin.

Peels, whether glycolic acid based, trichloroacetic acid (TCA), phenol, or croton oil, must be diluted sufficiently for eyelid application. Our preference is to only apply 20% TCA and 0.1% croton oil to the eyelids while limiting the number of “passes” based on skin quality, skin excess, and, of course, experience.

Combining surgery with peels requires special caution. Surgical procedures where middle lamellar modification and skin excision is undertaken and then followed by a peel or laser resurfacing are best combined with canthal anchoring to minimize the risk of lid retraction. Needless to add, the skin excision must be conservative if it is followed by resurfacing of any kind.

Stay updated, free articles. Join our Telegram channel

Join