CO2 Laser Blepharoplasty Improves Early Postoperative Outcomes Compared With Conventional Techniques: A Systematic Review and Meta-Analysis

Purpose: Blepharoplasty is one of the most commonly performed cosmetic surgical procedures worldwide. Carbon dioxide (CO 2 ) laser-assisted blepharoplasty has been proposed as an alternative to conventional cold-steel techniques, with potential advantages in hemostasis and postoperative recovery. However, the comparative evidence remains limited and has not been systematically synthesized. This study aimed to evaluate the comparative efficacy and safety of CO 2 laser versus conventional scalpel blepharoplasty. Methods: A systematic review and meta-analysis were conducted in accordance with the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase, Scopus, and the Cochrane Central Register of Controlled Trials were searched from inception to November 2025. Comparative studies comparing CO 2 laser blepharoplasty with conventional scalpel blepharoplasty were included. For binary paired outcomes, odds ratios (OR) were computed from discordant-pair counts in split-face studies using a McNemar-type approach with Haldane–Anscombe correction. A DerSimonian–Laird random-effects model was used for all pooled analyses. Results: Four comparative studies involving 133 patients were included. Three employed a split-face design in which the CO 2 laser was used on one eyelid and the conventional scalpel with electrocautery on the contralateral eyelid, and one used a nonpaired comparison. For postoperative ecchymosis, the pooled OR from 3 split-face studies was 8.05 (95% confidence interval: 1.73–37.35; p = 0.008; I 2 = 0%), indicating significantly worse bruising on the scalpel-treated side. For postoperative edema, the pooled OR was 7.40 (95% confidence interval: 1.21–45.10; p = 0.030; I 2 = 0%), which also favored the laser. All 4 studies consistently reported reduced intraoperative bleeding with the CO 2 laser, describing a nearly bloodless operative field on the laser side compared with minimal-to-substantial bleeding on the scalpel side. Three studies assessed postoperative pain and discomfort; 2 found no difference between sides, whereas 1 reported no discomfort on the laser side but discomfort on the scalpel side. Quantitative data for bleeding and pain were unavailable, precluding formal meta-analysis of these outcomes. Conclusion: Carbon dioxide laser blepharoplasty significantly reduces postoperative ecchymosis and edema and improves intraoperative hemostasis compared with conventional techniques, with similar long-term outcomes.