The filtrum remodelling with combined Er:YAG CO 2 laser resurfacing

BACKGROUND: Upper lip wrinkles develop with aging and they can be successfully treated with laser resurfacing. The treatment eliminates the wrinkles and, ideally, should also recover the aesthetic configuration. METHODS: This report includes 32 patients treated for wrinkles of the upper lip with the Derma? K. The first pass was done using 29 J/cm 2 , 5 Hz, 3 mm collimated spot size, plus the CO 2 laser 5 W, 50% duty cycle, 50% overlapping. Following this pass, Derma? K was reprogrammed to emit only with the Er:YAG at 1.4 J/cm 2 , 10 Hz, approximately 50% overlapping and with a beam diameter of 3 mm. Then, several passes were done where wrinkles could still be seen, focusing on the area corresponding to the filtrum . Biopsies were taken to examine possible particular implications of underlying muscle and its role in the recovery of anatomic aesthetics of young lip characteristics when using the proposed technique. RESULTS: Using Derma? K resurfacing with extra passes of the Er:YAG at relatively low density, at the aforementioned area, it was possible to achieve the recovery of the aesthetic youthful appearance of the upper lip. Also, the shape of the filtrum recovered its youthful appearance together with the cupid's bow shape. Histology samples collected at the end of resurfacing showed that the laser thermal effect was also related to muscle fibres due to the proximity of this layer to the dermis because of the narrow subcutaneous fat layer. CONCLUSION: The combination of Er:YAG and CO 2 laser of Derma? K has potential to enhance the results of resurfacing for elimination of wrinkles of the upper lip. Moreover, the fact that only one laser pass of high energy density is used permits clear and secure control of treatment, preventing complications and obtaining good results.