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Juan Carlos Jimenez, Jose Raul Montes, Joseph Maldonado; Aesthetic benefits of CO2 laser photorejuvenation treatment for malar mounds (festoons).. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):4735.
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To review the effectiveness of CO2 laser for malar mounds in patients undergoing lower eyelid blepharoplasty.
Retrospective medical chart review of patients that had lower eyelid blepharoplasty and received CO2 laser in an oculoplastic practice during the past 3 years. Outcome measures were improvement or resolution of malar mounds after CO2 laser treatment. Inclusion criteria were malar mounds in addition to periocular fat herniation. Exclusion criteria were any patient that has had lower lid blepharoplasty in the past. Age, sex, smoking status, medical history, type of skin (Fitzpatrick scale), degree of skin thickness and laser parameter were recorded. Pre and post operative pictures were compared by three independent observers to determine if CO2 laser was effective as a treatment for malar mounds.
Six patients (2 men and 4 women) with a mean age of 71 years old + 10 (standard deviation; range of 57 - 86 years old) that met the inclusion criteria underwent treatment with partial festoon resolution in 2 (33%) and complete festoon resolution in 4 (66%). Three (50%) patients had skin type IV, 2 (33%) had skin type III-IV and 1 (17%) had skin type IV-V. Four (66%) patients had medium skin thickness, 1 (17%) had large skin thickness and 1 (17%) had fine to medium skin thickness. Complications were scleral show in 3 (50%), hyperemia in 6 (100%) and hyperpigmentation in 1 (17%).
CO2 laser ablation is an effective and safe procedure for treatment of malar mounds. Ideal patients are those with fine to medium skin thickness and mild to moderate edema. The darker the skin the higher the risk for post inflammatory hyperpigmentation which is a common adverse event that can be prevented or treated with topical agents such as Hydroquinone 4% and anti-inflammatory drugs. Other adverse events such as erythema and scleral show are common and usually self limiting.
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