A defocused CO2 laser beam facilitates hemostasis by physically altering the delivery of energy to the tissue. By pulling the handpiece away from the focal point, the surgeon increases the laser spot size, which significantly lowers the energy density. This shift transitions the laser from a cutting instrument into a coagulating tool, using thermal energy to seal small blood vessels at the incision edges.
By increasing the spot size and lowering energy density, the laser acts as a hemostatic tool rather than a scalpel. This allows for a "dry" surgical field and reduces postoperative bruising without the need for separate electrocautery devices.
The Mechanism of Action
Changing the Energy Profile
To achieve hemostasis, the surgeon intentionally defocuses the laser beam.
This action spreads the same amount of laser energy over a larger surface area. Consequently, the energy density drops below the threshold required for tissue vaporization (cutting).
The Thermal Effect
Instead of vaporizing the tissue, the defocused beam delivers a controlled thermal effect.
This heat is applied directly to the incision edges. It causes immediate shrinkage and sealing of small blood vessels, effectively stopping bleeding before it begins.
Clinical Benefits in Blepharoplasty
Achieving Near-Absolute Hemostasis
The primary goal of this technique is to create a bloodless operating environment.
Surgeons use the defocused beam to target vessels specifically at the wound edge. This results in near-absolute hemostasis, ensuring the surgeon has a clear, unobstructed view of the delicate anatomy around the eyelid.
Streamlining the Procedure
Using the laser for both cutting (focused) and coagulation (defocused) increases surgical efficiency.
It eliminates the need for additional equipment such as electrocautery units. The surgeon can manage bleeding using the same instrument simply by adjusting the working distance.
Improving Patient Recovery
The benefits of this technique extend beyond the operating room.
Because the vessels are sealed immediately and trauma is minimized, patients experience a decrease in the severity of postoperative bruising. This contributes to a faster and more aesthetic recovery process.
Operational Trade-offs
Loss of Cutting Ability
The primary trade-off when defocusing the beam is the immediate cessation of incision capability.
The lower energy density required for coagulation is insufficient for cutting tissue. The surgeon must constantly toggle between a focused mode for incision and a defocused mode for hemostasis, requiring active manipulation of the handpiece distance.
Management of Thermal Spread
While the thermal effect is desired for coagulation, it must be precise.
The surgeon relies on the defocused beam to generate heat, but this heat must be targeted solely at the vessels to avoid unnecessary thermal damage to adjacent skin or muscle tissue.
Making the Right Choice for Your Goal
To maximize the efficacy of laser-assisted blepharoplasty, the surgeon must dynamically manage the laser's focal point based on the immediate tissue interaction required.
- If your primary focus is tissue vaporization: Maintain a focused beam with high energy density to create clean incisions.
- If your primary focus is bleeding control: Increase the spot size (defocus) to lower energy density and induce coagulation.
- If your primary focus is patient recovery: Utilize the defocused mode on incision edges to minimize blood leakage and reduce postoperative ecchymosis (bruising).
Mastery of the CO2 laser lies in the fluid transition between cutting and coagulating simply by altering the distance to the tissue.
Summary Table:
| Feature | Focused Beam (Incision) | Defocused Beam (Hemostasis) |
|---|---|---|
| Energy Density | High | Low |
| Spot Size | Minimum | Enlarged |
| Tissue Effect | Vaporization / Cutting | Coagulation / Sealing |
| Clinical Goal | Sharp, clean dissection | Bloodless field & reduced bruising |
| Control Method | Handpiece at focal point | Handpiece pulled away from tissue |
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References
- Paolo Bonan, Giuseppe Rampino. Laser‐assisted blepharoplasty: An innovative safe and effective technique. DOI: 10.1111/srt.13351
This article is also based on technical information from Belislaser Knowledge Base .
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