Background. In this study, a new type of Er:YAG laser, emitting irradiation with variable pulse duration, has been used for blepharoplasty and skin resurfacing in periocular region.

More than 40 patients have been treated with second generation Er:YAG laser (Fotona Fidelis) for blepharoplasty and skin resurfacing. A focused laser beam (diameter 0.4 mm) with very short pulse width (100 µs), that is significantly below the thermal relaxation time of skin, leads to a precise cut with no observable thermal effect on surrounding tissue. The depth of the cut is approximately 1–2 mm, precision comparable to a surgical scalpel. The high repetition rate of consecutive laser pulses (50 Hz at 120 mJ energy) accounts for accumulation of thermal load in tissue, and thus leads to complete hemostasis of the cut tissue. Due to improved cutting abilities of the Er:YAG laser, excision of orbital fat is also performed with one pass of the laser beam. By changing the laser parameters to short pulses (300 µs), energy 500 mJ, spot diameter 5 mm and repetition rate 12–15 Hz, skin resurfacing was performed. No special pretreatment therapy was used. Anesthesia: 2% Xylocain inj. subcutaneously. Non adhesive dressing for 24 hours was applied after surgery.

Epithelisation was complete after ten days. Redness persists up to 5 weeks. Discomfort of patients was mild. Cosmetic results are satisfying.

Conclusions. New generation of Er:YAG laser offers a possibility to cut and coagulate the tissue simultaneously, and by changing the parameters to ablate the tissue with heating influence on skin collagen.