Blepharoplasty and Resurfacing in a Single Platform Unlocks New Opportunity for Ophthalmologists

What Sets the ULTRAPulse Alpha Apart

When I performed traditional blepharoplasty, there was more bleeding, more bruising, longer procedure times, and longer recovery for my patients. I knew there had to be a better way.

Back in the 1990s, the CO₂ laser was still fairly new. After doing my research and attending live surgery courses, I acquired my first UltraPulse CO₂ system from Lumenis (formerly Coherent Medical)—and I’ve used the UltraPulse technology exclusively ever since, most recently investing in ULTRAPulse Alpha.

CO₂ is fully ablative, removing tissue to drive more pronounced remodeling. The laser targets water, and because human tissue is largely water, the interaction is controlled and predictable. But not all CO₂ systems are created equal: what separates them is power.

The ULTRAPulse Alpha’s high-powered design features fast energy delivery with less thermal damage to surrounding tissue. At the same time, its high power per pulse drives deeper tissue penetration for more significant tissue remodeling. Together, this leads to more effective treatment with reduced patient discomfort and downtime.

Rethinking Blepharoplasty

For blepharoplasty, ULTRAPulse Alpha’s ability to precisely cut and simultaneously coagulate reduces bleeding, swelling, and bruising compared to a scalpel. The procedure is more controlled and efficient from a surgical standpoint.

It also takes less time. For upper lid blepharoplasty, I’m typically done in 15 to 20 minutes, and it can be performed comfortably in the office under local anesthesia with the patient fully awake. This makes the procedure easier to integrate into ophthalmic practice workflows while also making the surgery accessible to those who may not be ideal candidates for intravenous or general anesthesia. Targeted removal of excess upper eyelid tissue restores function, contour, and visual field, while the correction of lower eyelid fat and skin smooths contours and rejuvenates the periocular area.

Patient satisfaction has been off the charts. I’ve even performed blepharoplasties on more than a dozen of my own staff and family members. When you trust a technology like ULTRAPulse Alpha enough to use it on the people closest to you, that says everything.

For blepharoplasty, ULTRAPulse Alpha’s ability to precisely cut and coagulate simultaneously reduces bleeding, swelling, and bruising compared with a scalpel. The procedure is more controlled and efficient from a surgical standpoint.

Adding Periocular Skin Resurfacing to the Same Platform

Beyond blepharoplasty, I also perform laser skin resurfacing, which the ULTRAPulse Alpha handles on the same platform. For ophthalmologists, this creates an opportunity for additional treatment offerings without needing another device. Targeted CO₂ resurfacing for periocular skin improves texture, with treatment tailored to the patient. Those with early aging concerns benefit from gentler treatments, while advanced photodamage can be addressed with more intensive periorbital resurfacing.

For the periocular area, treatment is performed using fractional delivery, which treats only a portion of the skin while preserving the surrounding tissue. This approach supports faster healing due to intact skin bridges, with reduced downtime, and a lower risk profile than fully ablative resurfacing.

Using the same device for both blepharoplasty and periocular skin resurfacing allows ophthalmologists to expand beyond surgical eyelid correction into more comprehensive periocular treatment. By addressing both clinical and aesthetic concerns on a single platform, ophthalmologists can broaden the scope of care they provide while increasing the versatility and value of the technology within practice.

Better Together

For patients seeking comprehensive eye rejuvenation, I recommend combining blepharoplasty and periocular resurfacing in a single session, and I routinely perform both treatments. Most lower lid patients can benefit from resurfacing, with approximately 90% to 95% considered suitable candidates.

Blepharoplasty addresses structural redundancy, while resurfacing improves skin texture—together delivering more harmonious results under a single anesthesia and recovery period. This is where ULTRAPulse Alpha truly shines. The system’s intuitive, patient-adaptive interface features built-in presets for both procedures, streamlining setup and supporting enhanced safety—making it straightforward to deliver complete periocular rejuvenation in a single visit—with one session and one recovery period.

From a practice standpoint, bundling procedures into a single session reduces the number of visits, enhancing the patient experience while improving overall efficiency.

Building Practice Growth and Expanding Access

Adding a CO₂ laser didn’t just improve patient outcomes—it fundamentally changed the trajectory of my practice. By introducing a high-demand procedure at a time of declining insurance reimbursements, I created a revenue stream that has grown steadily for nearly 30 years.

For ophthalmologists considering adding ULTRAPulse Alpha, my advice is to start conservatively and build systematically. Model out a modest, achievable procedure volume and let the numbers make the case. Bundling high-value, out-of-pocket procedures such as resurfacing and lower lid blepharoplasty into a single treatment session can increase per-case value while accelerating return on investment for the practice. At an average treatment cost of approximately $4,500, performing just 10 combined procedures per month could generate roughly $45,000 in monthly revenue.^†

What has surprised me most is the power of word-of-mouth and how far the reputation travels. I see patients from across Arizona and well beyond, many referred by injectors and other aesthetic providers who trust the results. This alone has driven a steady flow of consultation requests.

One of the most rewarding aspects of this work has been sharing my experience with other physicians. For several years now, I have hosted a three-day workshop in my office, where doctors come to observe consultations and watch live surgeries before bringing these techniques back to their own practices. Upper lid blepharoplasty, in particular, is highly teachable, making it accessible to a wide range of specialties, including non-surgical.

The Bigger Picture

Over the course of my career, one principle has held true: when you commit to a procedure, invest in patient awareness, and deliver consistent results, growth follows. The ULTRAPulse Alpha has been central to that equation, bringing a level of consistency, control, and predictability that shapes how I approach periocular surgery today. Whether addressing clinical concerns or improving skin texture, these procedures allow us to support vision and ocular health in a comprehensive way.

If you haven’t taken a close look at your patients’ eyelids lately, I encourage you to start. The need is greater than most physicians realize, and the ability to address it has never been better.

* Dr. Emilio Justo serves as a consultant for Lumenis Be. Ltd.
† This reflects general experience and assumptions; revenue levels are not guaranteed and may vary.

Dr. Emilio M. Justo is a leading ophthalmologist and cosmetic surgeon specializing in refractive cataract surgery and CO₂ laser blepharoplasty. He is the founder of the Arizona Eye Institute & Cosmetic Laser Center near Phoenix, bringing nearly four decades of expertise and close to 50,000 procedures to his patients. Dr. Justo is also a globally celebrated three-time TEDx speaker.

WARNINGS AND RISKS

CO₂ lasers are intended solely for use by professionals trained in the use of the Carbon Dioxide laser (10.6 μm) wavelength. Incorrect treatment settings or misuse of the technology can present risk of serious injury to patient and operating personnel. Risks that may be associated with any CO₂ laser procedure may include change of pigmentation, infection, erythema, skin induration or scarring. Read and understand the CO₂ systems and accessories operator manuals for a complete list of intended use, contraindications, and risks. The use of Lumenis® CO₂ laser is contraindicated where a patient has taken Accutane (Isotretinoin) within the past 6-12 months, has a history of keloid formation and demonstrates excessive or unusually prolonged erythema.