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Page 2 of 10 Pirakitikulr et al. Plast Aesthet Res 2020;7:67 I http://dx.doi.org/10.20517/2347-9264.2020.77

Table 1. Properties of lasers used for periorbital skin resurfacing
Ablative Non-ablative
Er: YAG Er:YSGG Er:Glass Nd:YAG Alex Ruby PDL KTP IPL
CO 2
Wavelength (nm) 10,600 2,940 2,790 1,540 1,064 755 694 585-595 532 500-1200
Fractional x x x x x x x x x
Depth (mm) 2.0 1.0 1.0 1.4 1.0 0.7 0.7 1.2 0.8
Chromophore Hemoglobin x x x x x x x x
Melanin x x x x
Water x x x x

Emission Continuous x x x x
Long-Pulsed x x x x x x x x x
Q-switched x x x
Picosecond x x

IPL: intense pulsed light; KTP: potassium titanyl phosphate; PDL: pulsed dye laser

function of the eyelids, thereby causing damage to the ocular surface. Initially, periorbital scars are most
often managed conservatively with mechanical massage or medically with topical and intralesional
[1]
corticosteroids and antimetabolites such as 5-fluorouracil . Lasers can be used as an alternative or
[2]
in combination with some of these therapies . Lasers can help soften scar tissue through controlled
[3,4]
thermal damage to the skin to promote collagen remodeling . In addition, lasers can aid in topical drug
delivery by increasing skin permeability, which helps distribute and increase the penetrance of topically
[4]
applied medications . By selectively targeting specific chromophores, lasers can also be used to address
dyspigmentation . Complications are rare with proper preoperative assessment and technique, but the
[5]
susceptibility of the eye to laser damage warrants special precautions. In this review, we present a general
approach to treating periorbital scars with laser. Recommendations are based on the authors’ clinical
practice and a review of the PubMed-indexed literature published within the last 30 years. Sources include
systematic reviews, meta-analyses, and clinical trials, which are cited accordingly throughout the text.

PRINCIPLES OF PERI-OCULAR LASER SKIN RESURFACING
[6,7]
A wide range of lasers has been used to treat the periorbital tissue [Table 1] . Lasers used for skin
resurfacing are defined by their lasing medium and emission wavelength, and further categorized based
on whether the superficial epidermis is removed during treatment. Ablative lasers, which include CO ,
2
Erbium:YAG, and Erbium:yttrium-scandium-gallium-garnet (Er:YSGG) lasers, were the first lasers to
come to market and target both the dermis and the overlying epidermis. These lasers can be very effective;
however, they also carry a greater risk of causing scarring and hyperpigmentation, particularly in patients
with higher Fitzpatrick skin types. In contrast, non-ablative lasers do not cause thermal damage to the
overlying epidermis. Examples include Erbium:glass, diode, Nd:YAG, alexandrite, ruby, pulsed dye (PDL),
and potassium titanyl phosphate.

Both ablative and non-ablative lasers can be fractionated. Fractionation divides a single laser beam into
thousands of microscopic beams of light that generate columns of treated tissue and leave intervening skin
untouched. This allows treatment depth to be safely increased and creates deeper channels for topical drug
[8]
delivery, as discussed below . With the thermal energy distributed over a larger surface area, there is also
a lower risk of overtreatment . While maintaining similar efficacy, fractionation has made ablative lasers
[9]
in particular much safer because, by leaving small areas of tissue untreated, areas of ablated epidermis re-
epithelialize more rapidly .
[10]
TM
Other light-based therapies such as intense pulsed light (IPL) or BroadBand Light (BBL) emit a spectrum
of light rather than a single wavelength. These are also used for non-ablative skin treatment in the