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Histological Analysis

Geva E. Mannor, MD, MPH; Robert G. Phelps, MD; Alan H. Friedman, MD; Murray Meltzer, MD

Arch Ophthalmol. 1999;117:913-916.

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 I 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.

From the Departments of Ophthalmology (Drs Mannor, Friedman, and Meltzer), Dermatology (Dr Phelps), and Pathology (Drs Phelps and Friedman), Mount Sinai Medical Center; and Surgical Service, Bronx Veterans Administration Hospital (Dr Mannor), New York, NY.

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