One-pass resurfacing with a combined-mode erbium: YAG/CO2 laser system: a study in 102 patients

BACKGROUND: The CO2 and erbium: YAG (Er: YAG) lasers have been used for skin resurfacing. A recently developed system combines pulsed ablative Er: YAG and continuous wave subablative CO2 wavelengths in one console. OBJECTIVES: To assess the potential benefits of this system. METHODS: The study follows 102 women, skin types I-V, with 26 full face, 48 perioral and 28 periocular resurfacing procedures. The ablative Er: YAG pulse (350 micros, 29 J cm(-2)) is followed immediately by a non-ablative CO2 laser shot (4-6 W, 50 ms) through the same collimated handpiece (3-mm diameter spot), 50% overlapping, repetition rate 10 Hz, giving two-pass equivalence with one single pass. RESULTS: Patients scored the results as very good (n = 67), good (n = 25) and fair (n = 10). Mild but successfully resolved side-effects occurred in only four patients. The 2-month histology showed a good band of new collagen tightening the overlying healthy epidermis. Follow-up periods ranged from 1.5 to 2 years (mean +/- SD 1.76 +/- 0.33). CONCLUSIONS: This device at the above settings offers speedy resurfacing without compromising the quality of the procedure for the patient, and may well satisfy the basic requirements of laser skin resurfacing.     

Laser skin resurfacing with a novel portable erbium:YAG laser.

BACKGROUND AND OBJECTIVE: The erbium:YAG laser is a popular modality for laser skin resurfacing (LSR). This study was performed to evaluate the safety and efficacy of a new portable Er:YAG laser in the treatment of photo-damaged skin. METHODS: Nine patients with skin types I-III were treated for rhytides, large pores, pigmented lesions, lentigines and photo-damage. Small facial areas such as the periorbital area, nose, cheeks, and upper lip were treated with one to six passes at 5-6 J/cm2 with a new portable Er:YAG laser. Topical and local anesthesia was used. RESULTS: All treated areas showed improvement and, depending upon the number of passes, re-epithelialization was complete within 2-7 days. The intense erythema resolved within 7 days and there was blending of treated and untreated areas within 2 weeks. CONCLUSION: The technique of applying a tailored number of 5-6 J/cm2, 300 micros pulses of a new portable Er:YAG laser to small areas appears to be safe and effective. There was minimal discomfort and a high level of patient satisfaction after a relatively short recovery time.     

Laser skin resurfacing with a novel portable erbium:YAG laser

Background and objective. The erbium:YAG laser is a popular modality for laser skin resurfacing (LSR). This study was performed to evaluate the safety and efficacy of a new portable Er:YAG laser in the treatment of photo‐damaged skin.

Methods. Nine patients with skin types I–III were treated for rhytides, large pores, pigmented lesions, lentigines and photo‐damage. Small facial areas such as the periorbital area, nose, cheeks, and upper lip were treated with one to six passes at 5–6 J/cm² with a new portable Er:YAG laser. Topical and local anesthesia was used.

Results. All treated areas showed improvement and, depending upon the number of passes, re‐epithelialization was complete within 2–7 days. The intense erythema resolved within 7 days and there was blending of treated and untreated areas within 2 weeks.

Conclusion. The technique of applying a tailored number of 5–6 J/cm², 300 µs pulses of a new portable Er:YAG laser to small areas appears to be safe and effective. There was minimal discomfort and a high level of patient satisfaction after a relatively short recovery time.     

Efficacy of erbium:yttrium-aluminum-garnet laser-assisted delivery of topical anesthetic

BACKGROUND: Penetration through the stratum corneum limits effectiveness of topical anesthetics. OBJECTIVE: Our aim was to evaluate the effectiveness of 5% lidocaine (ELA-Max) cream applied after erbium:yttrium-aluminum-garnet (Er:YAG) laser ablation of the stratum corneum. METHODS: Randomized, controlled, split-face comparison of anesthesia was performed on 12 volunteers. The stratum corneum was painlessly ablated with a low-fluence Er:YAG laser on half of the face, then the whole face was covered with ELA-Max cream for 60 minutes. Full-face laser resurfacing was performed, and visual analog pain scores (0 to 10) were recorded during each of 2 passes. RESULTS: Laser-assisted topical anesthesia demonstrated significantly lower mean pain scores than topical anesthesia alone. This was more pronounced during the more painful second pass. Resurfacing after laser-assisted topical anesthesia was well tolerated by 72% of subjects in pass 1 and 58% in pass 2. CONCLUSION: Laser-assisted topical anesthesia is fast, painless, and substantially more effective than conventional topical anesthesia but does not provide adequate anesthesia for full-face resurfacing in all subjects.     

Laser ablative resurfacing for photorejuvenation based on more than a decade's experience and 1200 patients: personal observations

Background Before lasers, the rejuvenation of photoaged skin, presented clinicians with many problems. Conventional methods, such as dermabrasion and various peels, gave inconsistent results with the potential for adverse side‐effects. Lasers have dramatically changed resurfacing procedures and results, although the potential for severe side‐effects still exists. Patients and methods The author's experience of over a decade in the use of the pulsed and continuous wave CO₂, Er:YAG, and combined CO₂ and Er:YAG lasers in ablative resurfacing in more than 1200 patients is summarized. Parameters are discussed, and laser/tissue interactions are investigated. Results Among the CO₂ lasers used, the C/W system proved more effective in the long term than the pulsed system. For the Er:YAG laser, a novel dual‐mode approach was developed which was seen to give better results than the usual ablative Er:YAG settings. The combined Er:YAG/CO₂ system proved, in the author's hands at least, to be an ideal laser ablative resurfacing system when used with the collimated hand‐piece and a 50% overlap, which achieves a two‐pass equivalence in a single pass. Representative case reports are presented. Conclusions Laser ablative resurfacing with the CO₂ or Er:YAG dual‐mode lasers has the potential to produce excellent and long‐lasting results, but at the cost of patient downtime and unpleasant side‐effects. The combined Er: YAG/CO₂ system, in combination with good wound management techniques has helped reduce downtime and adverse effects.     

A systematic review of comparative studies of CO2 and erbium:YAG lasers in resurfacing facial rhytides (wrinkles)

Background: Laser resurfacing is used to minimize wrinkles, solar scars and sequelae of acne. Objective: Purpose of the systematic review was to compare resurfacing outcomes of CO₂ laser and erbium: yttrium aluminium garnet (erb:YAG) laser therapies. Materials and methods: Medline, Cochrane Library, EMBASE and Google Scholar databases were searched until 9 April 2015 using the following terms: laser, carbon dioxide/CO₂, facial wrinkles, rhytides and erbium-doped yttrium aluminium garnet/erbium:YAG/Er:YAG. Two-armed controlled split faced studies that compared CO₂ laser and erbium:YAG laser in patients with mild-to-moderate facial wrinkles or rhytides were included. Results: The pooled data in this study and findings of other studies support the greater efficacy with the CO₂ laser in improving facial wrinkles, but the erb:YAG laser was associated with a better complication profile compared with the CO₂ laser. Except one case of hypopigmentation, other complications (i.e., erythema, hyperpigmentation and crusting) and their rates were reported by studies examining both lasers. Conclusion: In general, the CO₂ laser appeared to be more efficacious then the erb:YAG laser in treating facial wrinkles. Both lasers treatments were well tolerated.     

A pilot investigation to subjectively measure treatment effect and side-effect profile of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration laser

BACKGROUND AND OBJECTIVE : Carbon dioxide laser skin resurfacing has become a standard treatment for wrinkles and sun-damaged skin. This ablative treatment, however, is associated with undesirable complications and long recovery times. A growing body of evidence suggests that dermal inflammation and subsequent collagen formation can be stimulated without removal of the epidermis, raising the possibility of effective non-ablative skin remodeling for mild to moderately photodamaged skin. MATERIALS AND METHODS : This preliminary study was performed to evaluate the safety and subject satisfaction of non-ablative skin remodeling using a 532 nm, 2 ms pulse-duration, frequency-doubled Nd:YAG laser. Subjects with mild-to-deep lip wrinkles and mild-moderate acne scarring were treated one half of their lip (wrinkles) or cheek (acne scarring), leaving the other side as an untreated control. Subjects were treated at 3-6 week intervals for an average of three treatments. Subjective assessment of improvement was estimated by subject self-evaluation of the percentage improvement over baseline, and a blinded observer attempted to identify the treated side on physical examination. RESULTS : Subjective assessment revealed an average improvement of 51.4% and 53.6% for upper lip wrinkles and facial acne scarring, respectively. Side effects were limited to transient erythema that resolved over 0.25-2 hours following treatment. CONCLUSIONS : These results demonstrate that non-ablative treatment with the 532 nm, 2 ms pulse-duration Nd:YAG laser results in subjective improvement of rhytides and acne scarring, with a high safety profile.     

Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides

OBJECTIVE: To compare the efficacy, adverse effects, and histological findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in removing facial rhytides. DESIGN: An intervention study of 21 subjects with facial rhytides. All participants were followed up for 6 months. The end points of the study were wrinkle improvement and duration of adverse effects. SETTING: Academic referral center. SUBJECTS: Nineteen female and 2 male volunteers with skin type I to III and wrinkle class I to III participated in the study. INTERVENTION: In all subjects, 1 side of the face was treated with a CO2 laser and other side with an Er:YAG laser. Skin biopsies were performed in 6 subjects before treatment and immediately, 1 day, 2 days, and 6 months after treatment. Observations were recorded by subjects, investigators, and a blinded panel of experts. MAIN OUTCOME MEASURES: Improvement in wrinkles and severity and duration of adverse effects. RESULTS: The CO2 laser-treated side had relatively better wrinkle improvement when evaluating all subjects (P<.03). However, in subjects receiving more than 5 passes of Er:YAG laser, improvement scores were not significantly different from those for 2 to 3 passes of CO2 laser treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2 laser-treated side. The frequency of erythema was significantly less after Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi2, P<.05). Histological evaluation showed residual thermal damage of up to 50 microm on the Er:YAG-treated side and up to 200 microm on the CO2-treated side. CONCLUSIONS: Erbium:YAG laser is safe and effective in removing facial rhytides. Subjects treated with Er:YAG laser recover more quickly from the procedure than those receiving CO2 laser treatment.     

Congenital naevi treated with erbium:YAG laser (Derma K) resurfacing in neonates: clinical results and review of the literature

BACKGROUND: Giant congenital melanocytic naevi (CMN) are often disfiguring, potentially malignant pigmented lesions present at birth. Their management is based on two main considerations: attempt to minimize the risk of malignancy and to obtain an acceptable cosmetic result. In the past various approaches have been used to treat these naevi. OBJECTIVES: To describe clinical and histopathological results after treatment of CMN in neonates with erbium:YAG (Er:YAG) laser resurfacing. METHODS: Ten children with CMN were treated with Er:YAG laser resurfacing in the first weeks of life. RESULTS: Laser ablation was well tolerated by all children and immediate results were good. At a total follow-up ranging from 3 to 36 months we saw good results, with no or minimal repigmentation, in eight of 10 patients. Patients experienced minimal side-effects such as postoperative pain, bleeding and scar formation. Postoperative histopathology showed disappearance of heavily pigmented cells in the upper part of the dermis. CONCLUSIONS: Er:YAG laser resurfacing is an effective method of ablating CMN, with minimal scarring and postoperative complications.     

Erbium:YAG cutaneous laser resurfacing

The short-pulsed Er:YAG laser system is an excellent ablative tool for cutaneous resurfacing. This system is most efficacious for patients with milder cutaneous involvement, including mild photoinduced facial rhytides, mildly atrophic scars, and textural changes caused by fibrosis and dermatochalasis. The Er:YAG laser cannot achieve the same dramatic clinical and histologic improvements produced with the CO2 laser but does offer some distinct advantages that make it a valuable addition to the laser surgeon's armamentarium. The Er:YAG laser, because of its higher affinity for water-containing tissues, effects a much finer level of tissue ablation. Although erbium laser resurfacing results in decreased postoperative morbidity with a shorter recovery period, it cannot effect the same degree of improvement in photodamaged skin as can the CO2 laser. Excellent results, however, can be achieved with this laser, up to 50% or more overall clinical improvement, in patients with milder photodamage and scarring (Glogau classes I and II). In darker-skinned patients, the Er:YAG laser is often the preferred treatment modality. Continued research in the field has already led to the development of longer-pulsed Er:YAG lasers, which offer a compromise between the CO2 laser and the short-pulsed Er:YAG lasers in terms of clinical benefits while maintaining the safety profile of the traditional short-pulsed system. In addition, many surgeons now use a combination approach with the CO2 and Er:YAG lasers in an effort to maximize collagen contraction in certain areas and limit postoperative morbidity. As more research is conducted within the field of cutaneous resurfacing, newer systems will be developed in the continuing effort to create the ideal laser system--one which ameliorates the signs of photoaging without risk of major side effects or significant postoperative recovery.     

A fractional 2940 nm short-pulsed,erbium-doped yttrium aluminium garnet laser is effective and minimally invasive for the treatment of photodamaged skin in Asians

Abstract

Background: Although ablative fractional laser for the facial photodamaged skin was effective and safe, there have been only limited reports regarding the efficacy and safety of fractional Er:YAG laser treatments for photodamaged facial skin in Asians. Objective: Our objective was to assess the efficacy and safety of the Er:YAG laser (2940 nm) using the ‘‘ablative’’ fractional resurfacing mode to treat photodamaged facial skin. Methods: A total of 29 Korean patients were treated for photodamaged facial skin using a fractional Er:YAG laser. The number of treatments was mean 2.3 sessions at two-week intervals. Independent investigators assessed the efficacy using standardized photographs. The patients’ satisfaction rate was also evaluated. Results: For dyspigmentation, 62.5% of the treated patients showed improvement greater than 26%. Regarding wrinkles, 50% of the treated patients showed improvement greater than 26%. All patients showed various degrees of improvement in skin laxity. Assessing the overall features, 62.5% of the study subjects showed improvement greater than 26%, and most of them (91.7%) reported that their subjective satisfaction rate was above ‘slight satisfaction’. Downtime accounted for approximately one week in most patients. Conclusions: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for photodamaged facial skin in Asians.     

The effects of a high glycerin content hydrogel premolded mask dressing on post-laser resurfacing wounds

Abstract

Background: Laser resurfacing for the rejuvenation of facial skin remains a popular cosmetic procedure. Postoperative care for laser resurfacing is important to optimize healing, reduce pain and minimize complications. Objective: To compare the efficacy of the new dressing against placebo (Vaseline^® cream) after Er:YAG laser resurfacing. Methods: Fifteen patients between 45 and 72 years of age with facial wrinkles were enrolled in the study. Patients underwent full-face Er:YAG procedures. The wounds were then dressed: one side of the face was treated with Vaseline and the other with a hydrogel dressing. Erythema, edema, pigmentation, average time of re-epithelization, pain score, itching, clinical evaluation of infection, crust formation and acidity were documented. Results: The hydrogel dressing decreased postoperative morbidity. The site treated by hydrogel showed a shorter epithelial healing time than the Vaseline site. The dressing relieved the immediate pain of facial resurfacing as well as preventing crust formation and itching. Conclusion: A hydrogel dressing is a better and suitable alternative to the open technique to manage post-laser wound healing.     

A study of multiple full-face treatments with low-energy settings of a 2940-nm Er:YAG fractionated laser

Abstract

Background and objective: Fractional Er:YAG 2940-nm laser resurfacing is a relatively new approach to the treatment of photodamaged skin. Typically, this approach uses fairly high delivered energies in order to create ‘microscopic wounds’ of tissue coagulation at various dermal depths. The purpose of this study was to evaluate the efficacy, safety and tolerability of low-energy, multiple-treatment, fractional Er:YAG laser resurfacing for the treatment of photoaged skin. Methods: Sixteen subjects with photoaged skin received six, lower-fluence laser treatments with a 2940-nm wavelength Er:YAG laser, using a fractionated handpiece and a maximum energy of 30 mJ per micro-spot. Subject satisfaction, treatment tolerability, and subject outcome assessment were performed. Results: Of the 12 subjects who completed the trial, all recorded improvement in their treated skin; half reported over 50% improvement. Most patients reported none or only mild stinging and burning during and after treatment. There was no downtime associated with the procedure. No adverse events were reported. Patient satisfaction rates were high. Conclusion: Low-energy, multiple treatment, 2940-nm Er:YAG laser resurfacing with this novel device is a safe and well-tolerated method for the treatment of superficial to moderate photoaged skin.     

Comparison of efficacy and safety of fractional radiofrequency and fractional Er:YAG laser in facial and neck wrinkles: Six‐year experience with 333 patients

Lasers and other light sources are popular treatment options for facial rejuvenation in recent years. In this study, we aimed to compare the efficacy and safety of fractional radiofrequency (RF) and fractional Erbium: YAG (Er:YAG) laser for facial and neck skin wrinkles, objectively. Three hundred and thirty‐three patients treated with fractional RF and fractional Er:YAG laser were evaluated by two blinded dermatologists. Fractional Er:YAG laser was more effective for the periorbital area; whereas fractional RF treatment was more effective for perioral, nasolabial and jawline areas. There was no statistically significant difference in side effects between two treatment groups. In conclusion, both modalities significantly improve skin wrinkles; however, it should be considered that there may be regional differences between the treatment outcomes of them.     

Becker's naevus: a comparative study between erbium: YAG and Q-switched neodymium:YAG; clinical and histopathological findings

BACKGROUND: Becker's naevus (BN) may represent a distressing cosmetic handicap and a challenging issue regarding treatment. OBJECTIVES: To compare clinical and histopathological findings of patients with BN treated with two different lasers: an erbium:yttrium-aluminium-garnet (Er:YAG) system vs. a neodymium:YAG (Nd:YAG) laser. PATIENTS AND METHODS: In this prospective and comparative study we present the clinical and histopathological evolution during a 2-year follow-up of 22 patients with BN treated with only one pass of the Er:YAG laser (n = 11) or three treatment sessions with the Q-switched Nd:YAG system (n = 11). RESULTS: Clinical evaluation 2 years after treatment with the Er:YAG laser showed complete clearance (100%) in 54% of the patients (n = 6) and clearance of > 50% in 100% of the subjects. In relation to Nd:YAG laser treatments our results echo those of other authors. Numerous sessions are necessary to get an acceptable clinical clearance rate. Only one patient showed marked clearance (51-99%) after three treatment sessions. Moderate (26-50%) and mild (1-25%) clearance was observed in 45.5% (n = 5) and 27.3% (n = 3) of the patients. CONCLUSIONS: Both Er:YAG and Nd:YAG are safe tools to treat BN. However, in terms of pigment removal, one pass with Er:YAG is a superior technique to three treatment sessions with the Nd:YAG.     

Maximizing benefits and minimizing risk with CO2 laser resurfacing

Laser resurfacing using the high-energy, pulsed and scanned CO2 laser produces the most dramatic improvement in severe photo-induced facial rhytides and deeply atrophic scars. More recently, the use of short- and long-pulsed erbium lasers in conjunction with CO2 laser resurfacing has been shown to speed healing by removing the upper layer of thermally induced necrotic tissue. The Er:YAG lasers are more superficial ablative tools that inflict less residual thermal damage on the tissue, thus allowing healing to occur without the requisite internal clearance of excessive debris. With continued research and advances in laser surgery, cutaneous resurfacing will be further enhanced with improved outcomes and lessened morbidity.     

High-fluence fractional treatment of photodamaged facial skin using a 2940 nm erbium:yttrium-aluminum-garnet laser

Abstract

Introduction: Fractional resurfacing with an Erbium:yttrium-aluminum-garnet (Er:YAG) 2940 nm laser is an increasingly popular option for the treatment of the signs of facial photoaging, which include wrinkles as well as pigmentation issues and unwanted textural changes. Fractional treatment has produced favorable clinical responses, but with less complications and shorter recovery times than traditional laser resurfacing. This study was conducted to evaluate a fractionated Er:YAG treatment regimen of 1–2 higher fluence sessions with a multiple-pass technique. Materials and methods: Eight subjects with moderate to severely photodamaged facial skin received one to two full-face laser treatments. Multiple-pass (MP) treatment results were evaluated in terms of procedure time, discomfort, social downtime and effectiveness. A photographic evaluation, subject improvement assessments and a subject satisfaction assessment were performed. Results: An investigator's photographic review showed a 26–75% improvement in the signs of overall photoaging. Subjects treated with the MP technique exhibited a relatively short 3–4 day downtime and ratings of mostly moderate discomfort with the use of topical anesthetic cream only. Subjects treated with higher fluences demonstrated the highest average improvement in specific features of photoaging. Two laser treatments resulted in substantially higher improvement scores than those received just one laser treatment.     

Multiple minimally invasive Erbium: Yttrium Aluminum Garnet laser mini-peels for skin rejuvenation: an objective assessment

Background As the demand for minimally invasive rejuvenation is increasing, micropeel resurfacing using Erbium:Yttrium Aluminum Garnet (Er:YAG) laser 2940 nm has been reported for the treatment of photoaged skin without ablation of the epidermis. However, little is known about the efficacy and underlying histologic changes associated with this type of treatment. Aims The aims of this study are to evaluate the clinical effect and objectively quantify the histological changes in response to multiple sessions of Er:YAG laser 2940 nm mini‐peels. Patients and methods Six female volunteers of Fitzpatrick skin type III–IV and Glogau’s class I–III wrinkles were subjected to six microresurfacing peels at 2‐week intervals using Er:YAG 2940 nm laser at subablative fluences of 2–3 J/cm² to treat periorbital rhytides. Quantitative evaluation of collagen types I, III, and VII, newly synthesized collagen, total elastin, and tropoelastin was performed by histochemistry and immunohistochemistry coupled with computerized morphometric analysis at base line, end of treatment, and 3 months post‐treatment. Results Compared to the base line, evaluation of volunteers revealed obvious clinical improvement in response to Er:YAG mini‐peels. Collagen types I, III, and VII, as well as newly synthesized collagen, together with tropoelastin showed a statistically significant increase in response to treatment, while the mean level of total elastin was significantly decreased in response to treatment. However, this was followed by regression of improvement at 3 months post‐treatment but was still better than baseline. Conclusions This study revealed that multiple Er:YAG mini‐peels is a promising treatment option for photoaging as it reverses the signs of photoaged skin with little downtime and side effects. However, to maintain the short‐term improvement achieved after treatment, continued Er:YAG 2940 nm laser mini‐peels is required.     

Effect of pulse width of a variable square pulse (VSP) erbium:YAG laser on the treatment outcome of periorbital wrinkles in Asians

Background Uses of appropriate laser parameters are essential for an optimum outcome with minimal risks of complications. Objective To evaluate the effect of pulse width of a variable square pulse (VSP) Er:YAG laser on the treatment outcome. Methods Twenty‐four Thais with periorbital wrinkles received two treatments with a low‐fluence, VSP Er:YAG laser resurfacing 1 month apart. Subjects were randomly divided into two groups and treated with two different parameters including a pulse width of 0.3 ms (short pulse, SP) for one group and a pulse width of 250 ms (super‐long pulse, SL) for the other group. Assessments were evaluated at baseline, 1‐month and 3‐month follow‐up visits. Results After one treatment, 63.7% and 33.4% of the subjects in the SP and SL groups, respectively, were assessed to have obvious to marked improvement of their wrinkles. After two treatments, a higher percentage of the subjects were rated to have obvious to marked improvement including 91% and 66.7% in the SP and SL groups, respectively. There was no significant difference in therapeutic outcome between the SP and SL groups. Conclusions There was no significant difference in efficacy and side effects, between the SP and SL groups. However, a trend toward better response with the shorter pulse width was observed.     

Er:YAG laser resurfacing for inoperable medium-sized facial congenital melanocytic naevi in children

Congenital melanocytic naevi (CMN) can cause significant psychosocial morbidity, especially if they are in visually exposed areas. The preferred treatment is surgical excision, though not all lesions are amenable to this because anatomical location may preclude aesthetic and functional reconstruction. Three children with inoperable facial CMN were treated with Er:YAG resurfacing under general anaesthetic. Two children were Fitzpatrick skin type II, and one child was skin type VI. Treatment was performed at 4-9-monthly intervals. The procedure achieved significant lightening and thinning in all three cases, without scarring or dyspigmentation. One child developed herpes simplex infection in the treated area on one occasion, which was managed with oral aciclovir, and did not lead to scarring or preclude further treatment. We conclude that Er:YAG laser resurfacing is effective for CMN, even in darker skin types. The incidence of side-effects is low, although repeated treatment is necessary.