Argon laser surgery of skin lesions in tuberous sclerosis

Two patients with tuberous sclerosis whose skin lesions included facial angiofibromas (adenoma sebaceum), fibromatous pigmented plaque, and periungual fibromas were treated with the argon laser. Their lesions responded favorably and did not recur during our follow-up period of four to five years.     

Resurfacing of Facial Angiofibromas in Tuberous Sclerosis Patients Using CO2 Laser with Flashscanner

BACKGROUND: Angiofibromas are a common presentation of tuberous sclerosis. They cause considerable cosmetic and hygienic morbidity for patients. Treatments of angiofibromas have included curettage, cryosurgery, chemical peel, dermabrasion, shave excision, and 13-cis retinoic acid. Results from these modalities in many cases were not satisfactory from a cosmetic standpoint. Copper vapor, argon, pulsed dye, and CO2 lasers have been used with success in isolated cases. OBJECTIVE: The purpose of this study was to evaluate the efficacy of CO2 laser resurfacing with flashscanner in the treatment of facial angiofibromas. METHODS: Two patients with angiofibromas on the face were treated with a CO2 laser with flashscanner. The cheek and nose were treated in one patient, and entire face was done in the other. RESULTS: Both patients showed remarkable cosmetic improvements without scarring. Mild hyperpigmentation was found in both patients, which disappeared in 1 month with the application of topical agents. Facial erythema persisted about 2 months in both patients. CONCLUSION: A CO2 laser equipped with flashscanner causes less residual thermal damage than conventional CO2 lasers and enables controlled depth vaporization for more precise and regular removal of angiofibromas. In whole-face resurfacing, more cosmetically acceptable results are possible because localized treatment leaves marginal prominences. Laser resurfacing is an effective alternative in the treatment of multiple protuberant angiofibromas even though we cannot permanently clear these lesions due to their nature.     

Treatment of Fordyce Spots With CO2 Laser

BACKGROUND: Fordyce spots are heterotopic sebaceous glands that can be located at the lips' vermilion or the oral mucosa. Although this is considered a rather common disorder, a treatment for this condition that sometimes affects patients from only a cosmetic viewpoint has not yet been described. OBJECTIVE: To evaluate CO2 superpulsed laser treatment in two subjects with Fordyce spots. METHODS: Two patients with papules and yellowish plaques at the upper lip corresponding to Fordyce spots were treated with coherent Ambulase CO2 superpulsed laser (Coherent Medical, Palo Alto, CA); after informed consent was obtained, two to three passes were performed in one session using 2 and 4 W and a spot size of 2 mm. RESULTS: Complete re-epithelization was observed 2 weeks later with no residual Fordyce papules in the treated area and no side effects. CONCLUSION: Our findings suggest that CO2 superpulsed laser can be considered a safe and effective treatment for patients with Fordyce spots, offering excellent cosmetic results.     

Laser Blepharoplasty: Diamond Laser Scalpel Compared to the Free Beam CO2 Laser

BACKGROUND: Blepharoplasty has long been employed for functional and cosmetic purposes. Different modalities have been utilized to incise and remove excess eyelid tissue in an attempt to improve surgical technique. OBJECTIVE: This study compares a free beam CO2 laser to a diamond surgical scalpel combined with a CO2 laser for performance of blepharoplasty. METHODS: Ten patients underwent bilateral upper lid blepharoplasty. One side was randomly assigned to the free beam CO2 laser technique, while the other side was performed with the diamond laser scalpel. Intraoperative surgical times and hemostasis were measured. Masked observers assessed postoperative parameters at day 1, week 1, week 2, week 4, and month 4. These assessments were analyzed clinically and statistically. RESULTS: The two modalities produced similar results for the intraoperative and postoperative parameters studied. CONCLUSION: The diamond laser scalpel has the advantage of tactile feedback and the option of use without coagulation.     

The Treatment of Eruptive Syringomas in an African American Patient with a Combination of Trichloroacetic Acid and CO2 Laser Destruction

BACKGROUND: Eruptive syringomas are uncommon benign adnexal neoplasms. They are numerous and disseminated and often have a predilection for the neck, face, chest, and axillary fossae. Because they are persistent, usually numerous, and often on exposed sites, the lesions may be disfiguring and often pose significant cosmetic concerns for patients. Many treatment modalities such as dermabrasion, electrodesiccation with curettage, and scissors excision have been tried with some success, but more recently lasers have provided good to excellent results. OBJECTIVE: To describe an approach to the treatment of eruptive syringomas in an African American patient with a combination of trichloroacetic acid (TCA) and CO2 laser resurfacing, providing acceptable cosmetic results without significant side effects. METHODS: We describe an African American patient with eruptive syringomas of the face treated with a combination of TCA and CO2 laser resurfacing with good results. RESULTS: While the syringomas were not completely ablated, the combination of TCA and CO2 laser resurfacing provided acceptable cosmetic results without significant side effects. CONCLUSION: The TCA pretreatment probably removed some of the bulk of the surface of the lesions, thereby reducing the number of laser passes required to flatten the remainder of the lesions and thus lessening the potential for thermal damage at the treated sites and of surrounding normal skin.     

Carbon dioxide laser excision of benign pedal lesions.

The CO2 laser is a very important tool to remove benign pedal lesions. It certainly is not the only method, but once the technique is developed by the surgeon, it becomes easier to remove these lesions and, consequently, the results become better. In dealing with the mucoid cysts, the laser surgery is second to none and even if it has to be repeated there is basically no disability for the patient. This is also true with fibromas because many types of fibromas would require suturing that would create an inconvenience for the patient. With the use of the laser, sutures are not required and the patients recover much faster. In dealing with plantar fibromatosis, ganglionic cysts, and lipomas, the convalescence is probably about the same with CO2 laser as with conventional removal, especially when deep resection is necessary and suturing of the skin is required. With plantar fibromata surgery, the resultant long-term scarring is much less with the CO2 laser, especially when followed up with the appropriate injectables. CO2 laser surgery performed on the punctata aeriata, interdigital clavus formations, and hypertrophic scars are not always as successful but offer the surgeon another modality in taking care of the patient's problems without the need for extensive surgery.     

The role of the CO2 laser in out-patient oral surgery

The treatments of 250 patients with the CO₂ laser is described. The procedures were performed under local anaesthesia with minimal instrumentation apart from the laser. Operations were rapid and relatively bloodless, and excellent cosmetic and functional results were obtained. In the post-operative period there was minimal oedema and no significant bleeding. Post-operative pain was also minimal allowing patients to resume their normal diet on the first post-operative day and to return to work. The experience gained with this first group of patients suggests that ideal cases for treatment by this modality include leukoplakia, haemangiomas, epulis and prosthesis fibromas.The CO₂ laser is now being used to a lesser extent on in-patients and on those with malignant lesions.     

Management of rhinophyma with carbon dioxide laser: Lahey Clinic experience

The carbon dioxide (CO2) laser as a surgical tool for the difficult cosmetic problem of rhinophyma permits unprecedented refinement in treatment. Previously described conventional techniques have included the cold knife and the dermabrader. With these methods, hemostasis must be obtained with electrocautery, which if used extensively makes fine sculpting difficult. Seven patients with rhinophyma were treated with the CO2 laser at the Lahey Clinic from 1982 to 1987. We used a laser handpiece with a variable spot size. With this technique, we found the laser to be an excellent cutting tool while simultaneously providing superior hemostasis. In the followup period of up to 4.5 years, the cosmetic results have been excellent. Thus, the CO2 laser has become our treatment of choice for the management of patients with rhinophyma.     

Symptomatic Periungual Fibroma of the Hand

Periungual fibromas are benign nodules commonly found on acral digital areas that are commonly associated with tuberous sclerosis. They vary in size and are challenging to treat, with a high recurrence rate. We present a case of a patient with a periungual fibroma, which by virtue of its size, was of functional concern. The intraoperative findings and their implications on the clinical outcome, together with a literature review on other treatment modalities, are also presented.     

The Treatment of Syringomas by CO2 Laser Using a Multiple-Drilling Method

BACKGROUND: Syringomas are relatively common benign adnexal tumors, predominantly developing in middle-aged women. They frequently involve the periorbital areas and cause cosmetic problems. Up to now, various treatment modalities such as electrodesiccation, laser ablation, cryosurgery, and some chemical peelings have been tried. All of them, however, have the possibilities of frequent recurrences and postoperative complications such as scarring or pigmentary changes. OBJECTIVES: The objective of this study was to determine the effectiveness of a multiple-drilling method in the treatment of syringomas. METHODS: We tried a new multiple-drilling method using CO(2) laser for 11 patients having syringomas. Clinical improvement and complications were evaluated by medical records and pre- and postlaser photograph review. RESULTS: All patients had good or excellent cosmetic results. No complications, such as scarring, erythema, and pigmentary changes, were observed. CONCLUSION: The multiple-drilling method by CO(2) laser might be an alternative to gain good cosmetic results without complications if applied repeatedly. The authors have indicated no significant interest with commercial supporters.     

Port-Wine Stain Nodules in the Adult: Report of 20 Cases Treated by CO2 Laser Vaporization

BACKGROUND: Port-wine stain (PWS) is a congenital vascular malformation of the superficial dermal vessels. These vessels become progressively ectatic, with development of nodular and hypertrophic areas on the surface of the lesions. OBJECTIVE: To determine the efficacy of CO2 laser vaporization in the treatment of nodules in PWS. METHODS: Twenty adult patients with PWS who developed nodules and hypertrophy on the surface of the lesions were treated by CO2 laser vaporization. Only one pass was performed to each area of the lesions, using a continuous and defocused mode, with a power density of 10 W/cm2. When the treated lesion was very large, several sessions of treatment were necessary to vaporize its entire surface. Photographic controls were performed before and after treatment. RESULTS: The nodules and hypertrophy were removed and the smooth surface of the lesions was reestablished. The color, usually violaceous, was transformed in a slight erythema. CONCLUSION: CO2 laser is a good method for treatment of nodules and hypertrophy in PWS. With adequate precautions, excellent cosmetic results can be obtained. Other more-specific laser systems may be successively used to treat the remaining erythema.     

One-Pass CO2 Versus Multiple-Pass Er:YAG Laser Resurfacing in the Treatment of Rhytides: A Comparison Side-by-Side Study of Pulsed CO2 and Er:YAG Lasers

BACKGROUND: The CO2 laser is normally described as an aggressive resurfacing tool, whereas the erbium:YAG laser has enjoyed a reputation as the ideal tool for superficial resurfacing. The implication from many studies is that the CO2 laser is incapable of "minimally invasive" resurfacing. OBJECTIVE: To compare a short-pulsed CO2 laser with an Er:YAG laser over a range of parameters intended to produce equivalent microscopic and clinical injuries. METHODS: A prospective, randomized, comparative interventional trial was conducted in a tertiary care teaching hospital. Thirteen patients with facial wrinkles were enrolled in the study. A side-by-side comparison was performed using periorbital and perioral regions as treatment sites. One side was treated with a pulsed CO2 laser and the other with an Er:YAG laser. Postauricular skin was treated in an identical fashion to the study sites and biopsied for microscopic analysis. The biopsies were obtained before treatment, immediately after treatment, and either 3 or 6 months after treatment to evaluate the acute level of injury and subsequent degree of fibroplasia. Photographs were taken at baseline, immediately after treatment, 1, 2, and 6 weeks, and 3 and 6 months after treatment. Nine physicians evaluated the photographs for erythema, pigmentation, and wrinkle improvement. RESULTS: Investigator assessment showed no statistically significant differences between the lasers with respect to hyperpigmentation and wrinkle reduction. There was less erythema at the CO2 laser-treated sites 2 weeks after treatment; the differences had resolved by 6 weeks after treatment. Histologic examination demonstrated equivalent dermal thermal injury on immediate postoperative biopsies and equivalent fibroplasia on subsequent biopsies. Both CO2 and Er:YAG laser-treated sites showed overall modest wrinkle improvement compared to the pretreatment photographs. CONCLUSION: When CO2 and Er:YAG lasers are used in a manner such that there are equivalent immediate postoperative histologic results, equivalent healing and cosmetic improvement occurs. One can use CO2 laser with one pass to mimic a moderately aggressive Er:YAG laser treatment.     

Treatment of Pearly Penile Papules with CO2 Laser

BACKGROUND: Pearly penile papules are angiofibromas found on the corona and sulcus of the glans penis. While these represent a benign condition, psychological and cosmetic concerns often prompt patients to seek therapeutic removal of these lesions. Multiple therapeutic modalities have been reported; however, use of CO2 laser has proven to be the most effective to date. OBJECTIVE: To demonstrate the efficacy of CO2 laser in treating pearly penile papules. METHODS: Case report. RESULTS: We report the successful treatment of pearly penile papules in an African American man with CO2 laser. CONCLUSION: The use of CO2 laser is an effective treatment for pearly penile papules. J. E. Lane, MD, C. M. Peterson, MD, and J. L. Ratz, MD have indicated no significant interest with commercial supporters.     

Management of facial angiofibromas in tuberous sclerosis: use of the carbon dioxide laser

Facial angiofibromas are estimated to occur in 90% of patients with tuberous sclerosis and can cause considerable cosmetic disfigurement, emotional distress, obstruction of vision, and hemorrhage when abraded. Postoperative wound management associated with skin grafting and dermabrasion is often difficult because patients are mentally retarded and noncooperative. Three patients with extensive facial angiofibromas were treated successfully with the carbon dioxide (CO2) laser, with follow-up period ranging from 8 to 48 months. Uncomplicated wound healing occurred in each patient with minimal recurrence of lesions. Ablation with the CO2 laser is our treatment of choice for angiofibromas associated with tuberous sclerosis.     

A Comparative Clinical and Histologic Study of Hair Transplantation Using Er:YAG, Er:YAG/CO2, and Standard Punch Techniques

BACKGROUND: This study compares the effects of Er:YAG laser alone, Er:YAG/CO2 laser at 5 W (low power), Er:YAG/CO2 at 10 W (high power), and standard punch techniques in 10 men with androgenetic alopecia. OBJECTIVE: To study the clinical and histologic features of hair transplantation with recipient graft defects created by a new hybrid Er:YAG and CO2 laser. METHODS: Ten male patients (mean age 34 y) with Norwood IV-VI androgenetic alopecia had hair replacement surgery with the recipient sites divided into four quadrants comparing cold stell, erbium, combined erbium low-power CO2, and combined erbium high-power CO2 technologies. Hair growth, intraoperative procedure, lateral thermal damage, and patient satisfaction were compared, utilizing each of the four stated technologies. RESULTS: The addition of CO2 laser at both low and high power settings resulted in improved hemostasis when compared with standard punch or Er:YAG laser alone. The mean hair counts were similar for the Er:YAG laser, Er:YAG/CO2 (5 W) laser, and standard punch at both 3 and 6 months after treatment. Lateral thermal damage was not significantly increased by the addition of low-power CO2 to Er:YAG. The addition of high-power CO2 (10 W) laser resulted in slightly lower mean hair counts at 3 months, but significantly decreased at 6 months (P =.05). Also, high-power CO2 laser caused significantly increased lateral damage. There were no detectable differences in hsp70 expression among the groups. CONCLUSION: The addition of 5 W CO2 laser to Er:YAG laser results in better hemostasis than Er:YAG laser alone, while not significantly diminishing mean hair counts or inducing increased lateral thermal damage.     

Treatment of Facial Skin Using Combinations of CO2, Q-Switched Alexandrite, Flashlamp-Pumped Pulsed Dye, and Er:YAG Lasers in the Same Treatment Session

BACKGROUND: Many patients who seek facial CO2 laser resurfacing for improvement of photodamage are also concerned with "dark circles" under their eyes (periorbital hyperpigmentation) and/or telangiectasia as well as various types of deep scars on their faces. CO2 laser resurfacing alone provides limited improvement for these problems. OBJECTIVE: The purpose of this study was to demonstrate the conjunctive therapeutic effects of the CO2, Q-switched alexandrite, Er:YAG, and/or flashlamp-pumped pulsed dye lasers on facial skin treatments. METHOD: Thirty patients who underwent CO2 laser resurfacing were treated with additional lasers specific for their cosmetic concerns. Twenty patients with facial telangiectasias were treated with the pulsed dye laser immediately prior to CO2 laser resurfacing. Eleven patients with periorbital hyperpigmentation were treated with the Q-switched alexandrite laser immediately following use of the pulsed CO2 laser. Eight patients having sharply defined acne scars were treated with the Er:YAG laser following use of the CO2 laser. All patients had peripheral feathering performed with the Er:YAG laser. Nine patients were treated with all four lasers. RESULTS: In addition to significant improvement of the wrinkle scores from the CO2 laser resurfacing, patients had 75-100% clearing of the periorbital hyperpigmentation. All patients with facial telangiectasia showed virtually 100% improvement. All deep wrinkles and sharply defined scars responded with combined CO2/Er:YAG laser better than with CO2 laser resurfacing alone. All feathering was more uniform, with a more subtle transition to nontreated skin. There were no complications that could be attributed to the simultaneous use of multiple lasers. CONCLUSIONS: For patients who present with multiple cosmetic complaints, combined treatment using appropriate lasers offers excellent therapeutic outcome.     

Comparison of carbon dioxide laser and scalpel for breast lumpectomy: a randomized controlled trial

OBJECTIVE: To investigate whether the CO2 laser is superior to conventional surgical techniques for minor breast surgery in a randomized clinical trial. BACKGROUND DATA: It has been suggested in the literature that application of CO2 laser in breast surgery might be superior to conventional surgery in some aspects. PATIENTS AND METHODS: Sixty women whose breast masses were suitable for excisional biopsy were randomly allocated to laser and control (conventional surgical technique with scalpel) groups. Perioperative and postoperative variables were recorded and analyzed. RESULTS: The patients' ages ranged from 16-63 y. There were no significant differences between the two groups in total operative time (17.4 min with laser and 17.5 min with scalpel). There was a significant decrease in the required dose of lidocaine in the laser group (9.3 mL) compared to the scalpel group (12.4 mL; p = 0.01). In addition, hemorrhage was significantly lower in the laser group (6.6 mL) compared to the control group (11.9 mL; p = 0.006). There was no difference in the grade of the scar or postoperative pain between the two groups. CONCLUSION: Use of the CO2 laser in breast mass biopsy has some advantages, including a lower requirement for local anesthetic and a lower rate of intraoperative bleeding. Furthermore, using the laser does not prolong the operative time.     

Treatment of Surgical Scars with the Cryogen-Cooled 595 nm Pulsed Dye Laser Starting on the Day of Suture Removal

BACKGROUND: Cosmetic results after skin surgery are a key component of patient satisfaction and self-image. Various lasers have been used to attempt scar improvement, without consistent results. The optimal time to initiate laser treatment has not been determined. A recent study using a noncooled 585 nm pulsed dye laser starting on the day of suture removal demonstrated substantial improvement in scar appearance. OBJECTIVE: To determine the efficacy of the 595 nm cryogen-cooled pulsed dye laser in the treatment of surgical scars starting on the day of suture removal. METHODS: Sixteen patients with postoperative linear scars of greater than 2 cm were treated three times at 4- to 8-week intervals with a 595 nm cryogen-cooled pulsed dye laser. All patients had Fitzpatrick skin types I to IV. Each scar was divided at the midline into two fields, with half receiving treatment using a 7 mm spot size at 1.5 ms with 8 J/cm2 and a 30 ms spray duration with a 10 ms delay. The other half was not treated. Scars were evaluated for pigmentation, vascularity, pliability, and height by a blinded examiner using the Vancouver Scar Scale (VSS). In addition, the same blinded examiner evaluated the cosmetic appearance using a scale from 0 (worst) to 10 (best) prior to the second treatment and 1 month after the final treatment. RESULT: SThe average sum of all parameters in the VSS showed significant improvement from 1-month post-treatment to the final evaluation of 60% compared with the control of -3%. Also, scars in the treated portions scored an average of 2 points higher in the overall cosmetic appearance by the same blinded examiner based on a scale of 0 (worst) to 10 (best). Among the individual parameters in the VSS, the most significant improvements were found in vascularity and pliability. CONCLUSION: The cryogen-cooled 595 nm pulsed dye laser is a safe and effective option to improve the cosmetic appearance of surgical scars in skin types I to IV starting on the day of suture removal.     

Hemangioma of the Glans Penis Treated with Nd:YAG Laser

Hemangioma of the glans penis is a rare entity and usually has been treated with surgical excision or cryotherapy which carry suboptimal cosmetic results and bleeding problem. We present a 18-year-old male patient with hemangioma of the glans penis who was treated with Nd:YAG laser with excel lent cosmetic results.     

超脉冲CO2激光辅助下的睑袋整形术

目的 探讨将超脉冲CO2激光技术应用于辅助睑袋整形术,以提高手术的效率和疗效,同时减少出血并发症的发生.方法 选择上下睑皮肤松弛需行睑袋整形术233例,其中经眉下皮肤切口26例,经上睑重睑线皮肤切口48例,经下睑缘皮肤切口159例.用激光刀切开皮肤并在CO2激光辅助下行睑袋整形术.结果 233例术中出血少,消肿快,切口愈合良好.无一例出现睑外翻、血肿、复视等并发症.术后随访3个月至3年半,效果满意.结论 应用超脉冲CO2激光辅助行睑袋整形术,可以提高手术的效率和疗效,并可减少出血等并发症的发生.