This study compares and contrasts the use of the CO2 laser with the conventional cold-steel scalpel and electrocautery in cosmetic blepharoplasty. Ten patients underwent bilateral, upper, and lower eyelid cosmetic blepharoplasty using the CO2 laser as the exclusive cutting and cauterizing instrument for one eye, and the cold-steel scalpel and electrocautery as the exclusive cutting instrument and cauterizing tool for the remaining eye. This comparison evaluated administrative factors, procedural ease, and long- and short-term results. The benefits of using the CO2 laser rather than the cold-steel scalpel in blepharoplasty are reduced operative time, less bleeding, superior intraoperative visibility, less bruising and swelling, no pain or discomfort, and a shorter recuperation period. There were no complications with either the scalpel or the laser. Using the laser with standard safety protocols presents no greater risk to the patients undergoing blepharoplasty than does using the cold steel scalpel with an electrocautery device. The disadvantages of using the laser compared with the steel scalpel include the cost of purchasing and maintaining the laser equipment, the need for additional and extensive laser training for surgeons and assistants, and the need for two assistants rather than the one needed for scalpel surgery.