The American Journal of Cosmetic Surgery

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.

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.

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.

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.

Traditional liposuction cannulas and ultrasonic liposuction cannulas have had the feature of relative rigidity in common. Herein we introduce a new design that allows a patient's entrance wound to act as a fulcrum, enabling the surgeon's guiding hand to redirect cannulas with long, flexible shafts and highly reinforced swan necks. The nonultrasonic version of this cannula system includes a highly beveled tip adjacent to a triport (Accellerator III) set of openings. The new cannulas easily penetrate fibrous fat, reach fat deposits distant from the entrance wounds, and curve within the subcutaneous tissue below the dermal envelope, thereby reducing the need to move a patient's body position intraoperatively. A novel Teflon entrance wound insert that resembles the shape of a calla lily aids in the use of the system, thereby reducing cannula friction inside the insert and maximizing friction via projections on the outside of the insert. This friction outside of the insert maintains the insert's position in the wound during cannula backstroke.

Reinforced swan-neck, flexible shaft, triport bevel cannulas (RSFSTBCs) have been used successfully in hundreds of liposuctions performed by one of us (P.J.W.). P.J.W. has also used the Capistrano cannula tip with success. Capistrano cannulas and RSFSTBCs of 2.5 mm and 3.5 mm diameter were compared in 12 patients (eight female and four male) on contralateral but otherwise identical fat deposits.

No adverse effects were noted with either system; no indentations, inordinate bruising, seromas, or infections occurred. The reinforced swan-neck cannulas penetrated tissue with greater ease, and the flexible shafts allowed the operator to arc the cannulas to greater distances within the body. Thus the operator could reach more areas with fewer entrance wounds and less movement of patients on the operating table. Novel cannula motions occurred as a result of using the patient's entrance wound as a fulcrum and redirecting the distal shaft and tip of the cannula with an opposing hand.

The long, flexible shafts of the RSFSTBC system allow for a reduction in the need for cannula entrance wounds. The beveled tip provides for ease of penetration, even in fibrous tissues. The reinforced swan neck, in combination with the flexible shaft, enables the use of both mildly and highly arced cannula paths via several mechanisms.

Although lymphatic drainage of the lower extremities is well understood and liposuction-assisted lypectomy has been in existence almost 25 years, this study was undertaken to determine if liposculpture of the lower extremities causes significant damage to the lymphatics.

One patient with bitrochanteric lipodystrophy was selected for the study. Radioisotopic lymphography was performed. Dynamic images were obtained of the distal limbs for 15 to 20 minutes at 3 and 6 hours after injection. Liposculpture was performed on one side and ultrasonic liposculpture on the opposite side using tumescent anesthesia. Four months after the surgery, radioisotopic lymphography was repeated.

There were no relevant changes from the preoperative study. Lymphographs done early, late, and at 4 months show no abnormalities. There was no evidence of organic block or dermal reflux.