Wendy Lee, M.D.
Fraxel™ has become increasingly popular over the past few years for use as a laser skin resurfacing device. The treatment is minimally invasive, requires very little downtime and can be applied to various regions of the body, including most commonly the face, but also the neck, chest, and hands.
Fraxel™ targets pigment and fine wrinkles of the skin. The treatments coagulate small islands of tissue leaving surrounding normal tissue that facilitates healing and allows new collagen formation. The energy (mJ) determines the depth of the treatment and the level determines the density of coverage. The net effect is that of improvement in overall skin tone, decrease in pigmentation, shrinkage of pore size and a decrease in fine wrinkles in the area treated.
Fraxel™ has more recently been used for treatment of the eyelids. Results and patient feedback reveal tightening of the skin of the lids, decreased wrinkling, thickening of the skin and a decrease in dark circles. This has become a promising alternative to a surgical blepharoplasty. As well it offers a more aggressive approach to treating the lids than topical creams.
Optimal results require a series of treatments, preferably 3-6, with treatments spaced at least one month apart to allow tissue healing and collagen formation. Most patients will notice an improvement even after the first treatment, but will continue to improve after additional treatments.
There are different approaches to treatment of the eyelids. This article will briefly discuss one approach which is used to treat the entire eyelid proper with use of corneal shields and application of the laser extending up to the lash line. Reliant Technologies makes two tip sizes, 7mm and 15mm, that connect to the handpiece. Some use only the large tip, but the advantage of using the small, extended tip is that small areas, such as the medial canthus can be reached and contoured around.
Prior to treatment, a consult with each patient should be performed to assess patient expectations. This will allow the physician to evaluate and examine each patient to determine if Fraxel™ of the eyelids is an appropriate treatment option. Past medical history should be known, notably whether the patient has a tendency to hyperpigment after trauma or procedures, whether they have a history of herpetic outbreaks on the face, or recent sun exposure, all of which may alert one to alter pre and post treatment plans.
Topical anesthetic is applied to the treatment area for 30-45 minutes. Care must be taken to avoid contact with the eye, as this can lead to chemical irritation and even corneal abrasions. After the topical anesthetic is removed, a thin layer of Vaseline is applied. Two drops of an anesthetic drop, such as proparacaine, are placed in each eye. Ensure that if the patient wears contacts, they are removed. Corneal shields are then gently placed. The laser is applied to the area with alternating horizontal and vertical passes for a total of up to 8 passes. Once the treatment is finished, the corneal shields are gently removed, the Vaseline is rinsed off and ice packs are applied.
The patient can expect to experience erythema and edema of the eyelids for at least 2 days. They should be instructed to apply ice packs off and on for the first 2 days, sleep with the head of the bed elevated and avoid heat inducing activities.
After the treatment, the patient should notice gradual improvement in the area treated. Most patients will experience tightening of the skin and decreased wrinkling. They may notice an abnormal sensation of the lids, such as a tingling sensation, that resolves with time. As mentioned above, most patients return for follow up treatments every month for 3 – 6 months.
For a more detailed description of the procedure, refer to the Reliant Technology website. The procedure is discussed in a webinar that was given in August 2007.