Facial resurfacing using a high-energy, short-pulse carbon dioxide laser

Facial skin resurfacing is now possible using short-pulse, high-energy carbon dioxide (CO₂) lasers. The laser utilized in this particular paper is the Ultrapulse CO₂ laser. The Ultrapulse laser represents the first CO₂ laser able to vaporize tissue in a single pulse with the use of a large spot size. This laser utilizes the principles of selective photothermolysis. The high-power pulses are completed in less than the thermal relaxation time of skin, estimated to be less than 1 millisecond. This translates into rapid vaporization of tissue with little heat conduction to surrounding tissues. It also should allow a reproducibility of results between practitioners with set parameters not possible with previous CO₂ lasers. Clinically, this laser is useful for the removal of skin lesions, and the resurfacing of areas of sun damage, wrinkles and scars. The immediate haemostasis and excellent visibility allows for precise vaporization of abnormal tissue. Rapid and pain-free wound healing is usual. The complication rate would appear to compare very favourably with dermabrasion and chemical peeling techniques.     

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.     

Ablative laser resurfacing -- postoperative care

Wound care after laser skin resurfacing (LSR) is critical for achieving a successful result. The superficial thermal injury created by LSR heals more quickly and with a reduced risk of scarring under occlusion. While open and closed wound care regimens can be employed to expedite reepithelialization, closed methods with semi-occlusive dressings may decrease morbidity. Effective medications and management techniques can help to minimize expected effects of the procedure such as crusting, discomfort, pruritus, erythema, and swelling.     

Preoperative and postoperative considerations for carbon dioxide laser resurfacing

Cutaneous laser resurfacing is a tremendous advance in the treatment of photoaged skin. With the recent developments in laser technology, the procedure has become widely utilized among many physician subspecialists. The latest laser systems permit controlled vaporization of skin so that most novice operators feel comfortable with the technique in a short period of time. Nevertheless, there are many issues that need to be addressed before performing the procedure. First, not every person is an appropriate candidate for laser resurfacing. Second, both the physician and the patient must be aware of the preoperative preparation and prolonged postoperative care involved with the procedure. Finally, the physician must be able to identify and treat, and the patient must be educated about, the side effects and potential complications associated with the procedure. It is only by addressing these issues that the clinical results obtained by CO2 laser resurfacing can be maximized.     

Basic physics of erbium laser resurfacing

The rapid growth in erbium laser resurfacing gives rise to a need for clinicians to become familiar with some new terminology and concepts. The design of erbium laser machines used for these procedures is described giving clinicians a basis for machine selection. The basic concepts of energy, fluence and overlap will allow the clinician to manipulate the laser parameters so as to achieve the desired clinical results.     

Superficial erbium:YAG laser resurfacing of photodamaged skin

Background: Light chemical peels and microdermabrasion have enjoyed recent popularity for the treatment of mild photoaging. However, clinical improvement from these modalities is often minimal from both a patient's and physician's perspective. Erbium:YAG lasers have been effective in treating mild to moderate photoaging, but the need for either regional or general anesthesia, as well as the significant post‐treatment recovery period has limited its use.

Objective: We sought to utilize a very low fluence approach to erbium:YAG laser resurfacing, with topical anesthesia, to ascertain its efficacy in treating mild to moderate photoaging.

Methods: A total of 250 subjects aged 28–80 years with skin types 1–4 and mild to moderate facial rhytids were treated with topical anesthesia and subsequently one pass of a 2940?nm erbium:YAG laser, using between 5 and 17.5?J/cm². In addition, 58 of the treated facial subjects underwent neck resurfacing with fluences between 5 and 15?J/cm² and eight treated facial subjects underwent upper chest resurfacing at fluences of 5–7?J/cm². A single treatment was received by 246 subjects; four subjects were treated a second time after a 1‐month interval.

Results: Most subjects completely re‐epithelialized by 3–4 days; healing time was depth dependent. Most subjects were able to start skin care regimens within 1–2 weeks after the procedure. Results were judged to be excellent in individuals with thin skin and good in subjects with thicker skin.

Conclusions: One pass of low fluence erbium:YAG resurfacing, under topical anesthesia, was effective for the treatment of mild to moderate photoaging.     

Depth of vaporization and the effect of pulse stacking with a high-energy, pulsed carbon dioxide laser

BACKGROUND: Laser resurfacing of photodamaged skin has become popular, but questions regarding its safety with regard to the risks of scarring have arisen. OBJECTIVE: This study was designed to investigate the depth of vaporization and residual thermal necrosis of single-pulse vaporization and multiple passes versus pulse-stacking and multiple passes. The potential significance of operator technique and laser parameters is considered. METHODS: Skin samples from surgical excisions were treated by means of a Coherent Ultrapulse carbon dioxide laser at 250 mJ per pulse and 500 mJ per pulse with a 3 mm collimated beam and a repetition rate of 10 Hz. A total of 70 treatment areas were performed. Blinded analysis of the histologic effects of single-pulse, double-pulse, and triple-pulse vaporization after 1 through 10 passes was undertaken. RESULTS: A plateau of vaporization was observed after 3 passes at both 250 and 500 mJ whether single-, double-, or triple-pulse vaporization was used. This plateau occurs at approximately 100 to 250 microm from the skin surface. Thermal necrosis is well controlled only with single-pulse vaporization. There is a direct linear increase in the depth of thermal necrosis both with the number of pulses stacked and the number of passes. CONCLUSION: Pulsed carbon dioxide laser resurfacing is a safe and self-limited procedure if a pulse width of less than 1 msec is used with single-pulse vaporization and fluences of 3.5 J/cm2 and 7.0 J/cm2. There appears to be little justification for performing more than 3 or 4 passes. Pulse stacking may significantly increase residual thermal necrosis, thereby increasing the risk of scarring. Operator technique may be significant in avoidance of this occurrence.     

Superficial erbium:YAG laser resurfacing of photodamaged skin.

BACKGROUND: Light chemical peels and microdermabrasion have enjoyed recent popularity for the treatment of mild photoaging. However, clinical improvement from these modalities is often minimal from both a patient's and physician's perspective. Erbium:YAG lasers have been effective in treating mild to moderate photoaging, but the need for either regional or general anesthesia, as well as the significant post-treatment recovery period has limited its use. OBJECTIVE: We sought to utilize a very low fluence approach to erbium:YAG laser resurfacing, with topical anesthesia, to ascertain its efficacy in treating mild to moderate photoaging. METHODS: A total of 250 subjects aged 28-80 years with skin types 1-4 and mild to moderate facial rhytids were treated with topical anesthesia and subsequently one pass of a 2940 nm erbium:YAG laser, using between 5 and 17.5 J/cm2. In addition, 58 of the treated facial subjects underwent neck resurfacing with fluences between 5 and 15 J/cm2 and eight treated facial subjects underwent upper chest resurfacing at fluences of 5-7 J/cm2. A single treatment was received by 246 subjects; four subjects were treated a second time after a 1-month interval. RESULTS: Most subjects completely re-epithelialized by 3-4 days; healing time was depth dependent. Most subjects were able to start skin care regimens within 1-2 weeks after the procedure. Results were judged to be excellent in individuals with thin skin and good in subjects with thicker skin. CONCLUSIONS: One pass of low fluence erbium:YAG resurfacing, under topical anesthesia, was effective for the treatment of mild to moderate photoaging.     

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.     

Epidermal naevi treated with pulsed erbium:YAG laser

Epidermal naevi are common and can cause marked cosmetic disability. Ablative laser treatment may be successful in their removal, but may result in significant scarring. Surprisingly the erbium:YAG laser is rarely reported for this indication even though it produces minimal tissue damage. We report our experience using this laser to treat six patients with epidermal naevi. Patients (five female, one male; aged 4-41 years) underwent treatment with pulsed 2940 nm erbium:YAG laser at 0.4-0.45 J/cm(2), 2 mm spot size at 4 pulses/s. All six patients had excellent cosmetic results at follow up ranging from 6 to 60 months. The favourable results were dependent on selection of cases with superficial or small, discrete lesions which could be ablated accurately. The erbium:YAG laser is therefore an effective treatment for relatively nonverrucous or papular epidermal naevi.     

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.     

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.     

Long-term effectiveness and side effects of carbon dioxide laser resurfacing for photoaged facial skin

BACKGROUND: Laser resurfacing has been used for treatment of photoaged facial skin since late 1993. Very few long-term follow-up studies regarding the effectiveness and side effects of this procedure have been reported. METHOD: Patients who received carbon dioxide laser resurfacing for facial photoaging and wrinkling from Dec 17, 1993, to Nov 30, 1996, were followed up with clinical evaluation and patient questionnaires. Histologic study was also performed in 10 representative patients who had had preoperative biopsies. All treatments were performed by 2 experienced laser surgeons (R. E. F. and M. P. G.). RESULTS: One hundred four patients were examined and interviewed with an average 24-month postoperative follow-up (range 12 to 44 months). We observed high patient satisfaction ratings and significant persistence of wrinkle score improvement. Long-term histologic features confirmed the long-lasting nature of the clinical improvement and demonstrated continuing, progressive improvement in solar clastosis deep in the dermis for an average follow-up period of 2 years. Prolonged use of topical tretinoin (retinoic acid) postoperatively may contribute to continued improvement. The incidence of long-term side effects, including pigmentary changes and scarring, was generally very low and these side effects were usually not noticed by the patients. CONCLUSION: Improvement from cutaneous laser resurfacing has persisted for an average 24-month postoperative period with a low incidence of side effects. Hypopigmentation is the most common long-term side effect and appears to be related to the degree of pre-existing photodamage as it contrasts with the newly healed undamaged skin.