Background:
The ability of simultaneous cutting and hemostasis with low lateral
thermal injury makes CO 2 laser a useful tool in blepharoplasty.
Monopolar electrosurgery is another commonly used cutting tool that
improves the quality of hemostasis and cutting speed. This study aimed to
objectively and quantitatively assess the intraoperative and postoperative
outcomes of transconjunctival lower blepharoplasty using either a CO 2
laser or monopolar electrosurgery.

Methods:
Between August 2018 and March 2021, 78 patients who underwent
transconjunctival lower blepharoplasty were randomly assigned to the
CO 2 laser group and monopolar electrosurgery group. Patient related
parameters were recorded. Periorbital bruises were objectively and
quantitatively assessed using the ecchymosis evaluation score. Analyses
were performed using the independent sample t-test, and the chi-square
test.

Results:
Sex, age, local anesthesia injection volume, and fat removal volume were
not different between the groups. Patients’ subjective intraoperative heat
sensation was significantly higher in the monopolar electrosurgery group

than in the CO 2 laser group. The CO 2 laser group had a significantly lower
incidence of postoperative chemosis than the monopolar electrosurgery
group. All patients had uncomplicated wound healing, except three
(7.89%) patients in the monopolar electrosurgery group who developed
conjunctival granuloma. Operation time, intraoperative pain sensation,
intraoperative blood pressure, postoperative ecchymosis, conjunctivitis,
and patients’ esthetic satisfaction did not differ between the groups.

Conclusion:
Our findings revealed that CO 2 laser is a useful technique for reducing
intraoperative heat sensation and postoperative chemosis and may prevent
conjunctival wound complications.