Purpose

To compare the efficacy and safety of carbon dioxide (CO₂) laser-assisted versus conventional scalpel blepharoplasty.

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Methods

Systematic review and meta-analysis following Cochrane and PRISMA guidelines. PubMed, Embase, Scopus, and CENTRAL were searched through November 2025. Comparative studies were included. For split-face designs, odds ratios (OR) were calculated using a McNemar approach with Haldane–Anscombe correction. Random-effects models were applied.

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Results

Four studies (133 patients) were included, three with split-face design. The scalpel side showed significantly higher rates of ecchymosis (OR 8.05; 95% CI 1.73–37.35; p=0.008; I²=0%) and edema (OR 7.40; 95% CI 1.21–45.10; p=0.030; I²=0%). All studies consistently reported superior intraoperative hemostasis with CO₂ laser, frequently describing a near bloodless surgical field. Pain outcomes were heterogeneous, with no consistent difference. Quantitative data for bleeding and pain were insufficient for meta-analysis.

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Conclusion

CO₂ laser blepharoplasty provides superior early postoperative outcomes—reducing ecchymosis and edema—and offers clear intraoperative advantages in hemostasis, without compromising overall results.

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Additional Authors

First name	Last name	Base Hospital / Institution
Vitor	Ribeiro	Faculty of Medicine, Federal University of Piauí, Piauí, PI, Brazil
Carlos	Sampaio	Faculty of Medicine, Pontifical Catholic University of Paraná, Londrina, PR, Brazil
Bruna	Melgaço	Department of Medicine, University Center of Patos de Minas, Minas Gerais, Brazil.
Ivana	Pereira	UNIVERSITY OF SAO PAULO
Davi	Araf	UNIVERSITY OF SAO PAULO
Suzana	Matayoshi	UNIVERSITY OF SAO PAULO
Matheus	de Almeida	UNIFAA-Universidade Fundação Dom André Arcoverde

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