Dr. Matheson A. Harris: I see many patients interested in upper eyelid blepharoplasty or eyelid lift, and brow lift surgery. Patients often ask, "Which is better? Scalpel versus electrocautery versus laser, for making the incisions and performing the surgery?" A scalpel is the oldest method still in use. It works great for making precise incisions, and causing minimal damage to the tissues along the incision. It does, however, cause the most bleeding and surgeons almost always have to use cautery, once they've made a cut with the scalpel to stop the bleeding.

Electrocautery is a fine, needle-tipped instrument, which uses pulses of electricity, to both cut, and cauterize the skin. This leads to precise cuts, with minimal, to no bleeding. The incisions can be made much quicker, and overall, surgery time is less. I feel it's also more precise, because the surgical field is free of blood, which makes seeing what you're doing much easier. There is some mild tissue damage, at the edges of the incisions, which can slightly delay healing. CO2 laser is also used to make skin incisions, and perform tissue dissection. The laser creates heat, which destroys the tissue as it cuts. It causes heat damage to the adjacent skin, as well, which can, again, lead to delayed healing.

All of these techniques when used by a competent surgeon can yield good results. A laser, however, is significantly more expensive to operate, does not improve healing or scarring, and is the least safe to use in the operating room. A recent study in the British Journal of Surgery showed that scarring and healing in patients whose incisions were made with electrocautery, was nearly identical to that with a blade.

Scalpel, Electrocautery, or Laser for Eyelid Surgery?

Dr. Matheson Harris discusses the different options used in Eyelid Surgery. He explains techniques using scalpel, electrocautery and laser and who is a candidate.