“Split-Face” Evaluation of Collagen Changes Induced By Periorbital Fractional CO2 Laser Resurfacing

Background Periorbital fractional CO2 laser resurfacing has been used for facial rejuvenation purposes. However, to the best of our knowledge, no study objectively assessed periorbital neoformation and remodeling of local cutaneous collagen, in a split-face model, from skin samples obtained during upper blepharoplasty. Objectives To objectively evaluate neoformation and remodeling of local cutaneous collagen after periorbital skin fractional CO2 laser resurfacing. Methods Prospective and comparative study in which 16 female subjects presenting with dermatochalasis and periorbital rhytids were evaluated. All subjects underwent unilateral periorbital fractional CO2 laser resurfacing 30 days prior to upper blepharoplasty. Quantification of types I and III collagen from laser treated and untreated eyelid skin samples obtained during upper blepharoplasty was assessed with histochemical analysis (Picrosirius Red staining). Laser resurfacing treatment was applied to the untreated side immediately after the upper blepharoplasty. Two blinded, independent physicians evaluated clinical improvement in pretreatment, 1 and 6-month post-treatment digital images. Results Histochemical analysis showed significant higher intensity in collagen types I (treated: 158.7 ± 5.3, untreated: 139.2 ± 5.0; p<0.0001) and III (treated: 105.1 ± 7.7, untreated: 104.1 ± 7.1; p< 0.0001) in the samples submitted to fractional CO2 laser treatment; a greater difference was detected in collagen type I. A significant improvement in periorbital rhytidosis was observed one month after laser resurfacing (23%); a greater improvement in the periorbital region was observed 6 months after laser resurfacing and upper blepharoplasty (43.67%). Conclusions Periorbital fractional CO2 laser resurfacing demonstrated to be an effective method to improve palpebral skin, with histochemical evidence of increase in collagen types I and III.