A special application of the CO2 laser is its use as a cutting or incisional instrument. This laser can be operated in a continuous wave (CW) mode, in which the laser is not pulsed but is constantly on while it is being used. If the laser energy is focused on a very small point (typically 0.1 millimeter), the beam will cut through skin or other tissues much as would a scalpel. There is one major difference, however. The CO2 laser coagulates (denatures) the tissue due to the heat generated as water molecules absorb the laser energy. All tissue structures are coagulated, including blood vessels. The result is a bloodless incision. A regular scalpel does not cause coagulation and invariably produces copious bleeding as it cuts through skin and other tissues. The bloodless surgery possible with the CO2 laser can be a significant advantage during any cosmetic surgery that requires incision of tissue; it is particularly well suited to blepharoplasty (eyelid lift).
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