Comparison of Carbon Dioxide Laser to Baker's Phenol Solution to Correct Rhytids of the Lower Eyelids

Introduction:

Fine rhytids of the lower eyelids have been treated by chemical peels and more recently by carbon dioxide (CO₂) lasers. Although histologic studies indicate that both methods of treatment penetrate through the papillary dermis to the reticular dermis, CO₂ lasers have been postulated to produce better long-term results in the improvement of rhytids and in skin laxity secondary to the thermal effect of the laser that causes collagen synthesis and reorganization. The purpose of this study was to compare the outcomes in lower eyelids between the CO₂ laser and Baker's phenol solution by analyzing both patient response and the clinician's impression of progress.

Materials and Methods:

Seven patients were enrolled in this study, which was conducted at the Facial Plastic and Cosmetic Surgical Center. The patients underwent a 50% phenol peel of the left lower eyelid. The right lower eyelid was treated by a Luxar NovaPulse CO₂ laser. After treatment, patients were evaluated at 1–3 days, 1 week, 3 weeks, and at 3 months. At each evaluation period, patients filled out a questionnaire comparing swelling, erythema, pain, discomfort, and itching for each eyelid. The clinicians rated the amount of swelling, erythema, crusting/peeling, and reepithelialization of each eye. At 3 months, a subjective evaluation was done.

Results:

Fifty-seven percent of patients complained of more swelling on the laser side initially; however, at 3 weeks, 57% of patients complained of more swelling on the phenol side. At 3 months, all swelling resolved. Initially, erythema was greater on the laser side in 57% of patients. At 3 months, it was present equally, except in those patients who had used Catrix postoperatively on the phenol side; in these cases, swelling was markedly decreased. Pain was worse on the laser side but resolved for all patients after 3 weeks. Reepithelialization occurred within 7 days on the laser side, whereas it took up to 3 weeks before there was an absence of crusting/peeling on the phenol side.

At 3 months, all but one patient felt there was no difference between the two treatments in the correction of fine rhytids; however, four of the seven patients noted that the laser side was smoother to the touch. Five patients would choose the laser over the phenol. One patient was noted to have better correction of the bagginess of her lower lid on the laser side.

Discussion:

For treatment of fine rhytids, there was little difference in the two methods of treatment. However, the CO₂ laser seemed to better correct lower lid bagginess. The majority of the patients preferred the laser over the chemical peel.