Association of Early Fractional Carbon Dioxide Laser Treatment With Lower-Eyelid Incision Scar Maturation and Positional Stability After Orbital Floor Fracture Repair

Early scar remodeling after transcutaneous orbital floor fracture repair may influence both scar appearance and lower-eyelid position. We retrospectively evaluated 262 patients who underwent transcutaneous repair of unilateral orbital floor fractures between March 2024 and April 2025; 128 received early fractional carbon dioxide (CO2) laser treatment and 134 served as controls. Laser treatment was initiated 19 to 36 days postoperatively, after complete epithelialization, and delivered in 2 to 3 sessions at ~4-week intervals. Scar maturation was assessed by the Scar Cosmesis Assessment and Rating (SCAR) score and maximum scar width, whereas lower-eyelid position was quantified by the interocular difference in margin reflex distance 2 (ΔMRD2) and inferior scleral show. Generalized estimating equations showed significant group-by-time interactions for SCAR score, scar width, and ΔMRD2. After multivariable adjustment, early laser treatment was independently associated with a lower 6-month SCAR score (β = -0.605, 95% CI -0.919 to -0.291; P < 0.001), smaller ΔMRD2 (β = -0.121 mm, 95% CI -0.196 to -0.046; P = 0.002), and less inferior scleral show (β = -0.068 mm, 95% CI -0.122 to -0.014; P = 0.014). Higher 6-month SCAR scores remained independently associated with greater ΔMRD2 (β = 0.034 mm per point, 95% CI 0.004-0.064; P = 0.025). Lower-eyelid malposition and adverse-event rates did not differ significantly between groups. Early fractional CO2 laser treatment was associated with more favorable scar maturation and reduced lower-eyelid positional displacement after orbital floor fracture repair.