Study: Plasma Exeresis Is an Acceptable Alternative to Surgical Blepharoplasty

Male doctor doing cataract surgery in operating room
Researchers support the application of a noninvasive technique.

Upper blepharoplasty is one of the most common plastic surgeries used to treat dermatochalasis, according to the study’s investigators. However, some patients may be reluctant to undergo surgery because they fear that they won’t be happy with the results or that the procedure will leave scars. For these patients, plasma exeresis is a favorable alternative to surgical blepharoplasty, according to a study published in the Journal of Cosmetic Dermatology. However, researchers caution that patient satisfaction may vary.

The investigators say the nonsurgical plasma treatment is minimally invasive and has a relatively low impact on patients’ quality of life. During the procedure, a handpiece produces ionized energy from the air gap that causes superficial tissue to heat without any direct contact. Controlled and limited thermal damage transforms solid tissue into a gaseous state and creates mild coagulation that increases collagenosis and contracts local epidermal and dermal skin.

Little research has been conducted on defining protocols for or quality of life after upper eyelid blepharoplasty using plasma, according to researchers. To assess patient satisfaction and better understand the symptoms patients experience after the procedure, investigators conducted a prospective study. Both male and female patients were included in the study and all had been diagnosed with upper eyelid dermatochalasis without any other eyelid diseases. Patients younger than 18 years old, those who were pregnant, or had a cognitive deficit, or Fitzpatrick skin types V or VI, or who wore a cardiac pacemaker were excluded.

The study included 16 patients who consented to have upper eyelid blepharoplasty using plasma technology. Females made up 87.5% of the patients. Patient satisfaction, symptoms, and quality of life were assessed using 2 questionnaires at follow-up days 7 and 30. Answers to the questionnaire were correlated with age, Fitzpatrick skin type, and quantity of eyelid skin treated with plasma.

Physical appearance was the most relevant factor impacting quality of life during the first week postoperative. Regarding satisfaction with results, most patients expressed a higher level of satisfaction at day 7 follow-up analysis (P =.038). Less impact on quality of life and higher satisfaction were associated with eyelid treated areas (P =.044 and P =.036) and Fitzpatrick skin type (P =.043) at 7 and 30 days after the procedure, respectively. Eyelid edema and itching were the symptoms most reported at 7 and 30 days, respectively. 

While no hypopigmentation was noted after the procedure, 2 patients presented with hyperpigmentation at their day 7 follow up. Of those, 1 resolved without intervention by follow-up day 30. A month after treatment, a new case of hyperpigmentation was observed. Researchers decided to treat both patients with Tyrosinase inhibitors for 3 weeks, resolving mild skin hyperpigmentation. All 3 patients were Fitzpatrick skin type III.

Regarding quality of life after the procedure, most patients had no complaints besides the need to wear sunglasses, a hat, or scarf the first week after the procedure. Most patients (75%) said that they were willing to have the same procedure again if necessary. However, most patients (75%) expressed this opinion more certainly in the first week than at 1-month postoperative. 

“We suggest expectations with satisfactory results were greater at earlier follow-up periods, but were not aligned with the final outcomes delivered later and a good satisfaction degree was not reached,” the study says.

Researchers identified several limitations with their study, including that follow-up was limited and they believe that plasma treatment with additional sessions could have resulted in better patient satisfaction. Second, although patients noted some side effects after treatment, the use of subcutaneous anesthetic injection is likely to have caused local symptoms during the first week follow-up and sunscreen may have caused local symptoms in the later postoperative period.

Ferreira FC, de Oliveira Sathler CSC, Hida IY, et al. Upper eyelid blepharoplasty using plasma exeresis: evaluation of outcomes, satisfaction and symptoms after procedure. J Cosmet Dermatol. Published online November 30, 2020. doi: 10.1111/jocd.13868