Comparison of Colorado Needle Electrocautery and Traditional Scalpel for Lower Eyelid Blepharoplasty Incision: A Randomized Controlled Trial

Background: Lower eyelid blepharoplasty is one of the most popular aesthetic procedures. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains unclear, particularly in Asian skin types. We compared the Colorado needle electrocautery (pure-cutting mode) versus the traditional scalpel in terms of efficacy, complications, and cosmetic outcomes. Methods: A prospective intraindividual randomized controlled trial was conducted to compare the efficacy of Colorado needle electrocautery and scalpel in lower blepharoplasty. The study outcomes were scar quality at different times until 1 year postoperatively, bleeding during incision, and postoperative ecchymosis. Scar quality was evaluated using 3 standard scar ratings: the Vancouver Scar Scale, Patient and Observer Scar Assessment Scale, and Hollander wound evaluation scale. Results: The study included 25 patients, and the electrocautery side had less blood loss during incision than the scalpel side (2.6 ± 0.65 versus 5.28 ± 0.68 sticks; P < 0.001). The electrocautery side had less postoperative ecchymosis (P < 0.001); however, 1-year scar quality was not statistically significant between the groups. Conclusions: Colorado needle electrocautery pure-cutting mode can be an alternative to the traditional scalpel for lower eyelid blepharoplasty skin incision because of long-term scar quality. Electrocautery also has hemostatic benefits, leading to a decrease in intraoperative and postoperative bleeding.