Eyelid healing after carbon dioxide laser skin resurfacing. Histological analysis

Objective: To clarify in vivo healing of eyelid skin after carbon dioxide (CO₂) laser resurfacing. Design: Patients requesting upper eyelid blepharoplasty consented to undergo previous CO₂ laser skin resurfacing of the upper eyelid skin segments to be excised at various time intervals. After blepharoplasty, the skin specimens were analyzed histopathologically by 2 masked pathologists. Patients: Eight patients with Fitzpatrick skin types 1 and II. Intervention: Upper eyelid CO₂ laser resurfacing 1,2, 4, or 12 weeks before planned upper eyelid blepharoplasty. Main Outcome Measures: Epidermis: thickness, polarity, contour, and constituents. Dermis: repair zone thickness, vascular and inflammatory pattern, collagen deposition, and elastic fiber changes. Results: The epidermis regenerated within 7 to 10 days. By 3 months, the epidermis revealed flattening of the rete peg pattern with restoration of polarity, keratinocytes, and melanocytes. The 3-month dermis demonstrated a fibrotic repair zone (500-700 μm), new elastic fibers, and telangiectatic capillaries. Conclusions: Eyelids heal similarly to other skin regions treated by CO₂ laser resurfacing. This cutaneous healing is analogous to that previously reported with use of chemical peels. Histological changes may explain the skin smoothing and wrinkle reduction seen clinically.