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CO₂ Laser Skin Resurfacing

New developments in CO₂ laser technology, based on the understanding of laser - tissue interactions, have fueled an explosive interest in CO₂ laser skin resurfacing. A short-pulsed or scanned CO₂ laser beam can precisely remove thin layers of skin, leaving behind a very narrow zone of thermal damage. This retrospective study evaluated the effectiveness and side effects of a CO₂ laser with a scanning device (the Sharplan Silktouch laser) for skin resurfacing of glabellar, periorbital, or perioral wrinkles in 47 women.

Photographs of 28 patients were reviewed and an improvement score was calculated based on a quartile scale of 0 (no improvement) to 4 (greater than 75% improvement). The average score was 2.7 in the glabellar area, 3.2 in the perioral area, and 3.4 in the periorbital region. All patients had postoperative edema, a burning discomfort, pruritus, a tight sensation, and erythema. Hyperpigmentation developed in 17% of patients, milia formation in 8.5%, impetiginization in 6%, eczematization and contact dermatitis in 4% each, and herpesvirus infection in 2%. One patient developed focal atrophy. There were no cases of hypertrophic scarring or hypopigmentation.

Comment: This is the first published, peer-reviewed analysis of CO₂ laser skin resurfacing. Its impressive results support the tremendous excitement that short-pulsed and scanned CO₂ lasers have generated over the last year. The results of this study are similar to those of other large series now in press. Periorbital wrinkles appear to improve best, followed by perioral and glabellar rhytides. Improvement, in terms of absolute change, is greater for severely photodamaged skin than for areas with early photodamage, but the percentage improvements are similar. The major side effect of this procedure is postoperative erythema, which lasted one to four months in most patients.

This technique is still relatively new, the number of patients evalu-ated scientifically is small, and the duration of follow-up is relatively short. The risk - benefit ratio of the procedure appears to be quite low, but as it is performed by more and more physicians, the number of patients who develop hypertrophic scarring will likely increase and other long-term side effects will become apparent. Large prospective, comparative studies are needed to help us predict long-term outcomes and better understand the mechanism of facial rejuvenation.

— JS Dover

Published in Journal Watch Dermatology January 1, 1996

Citation(s):

Waldorf HA et al. Skin resurfacing of fine to deep rhytides using a char-free carbon dioxide laser in 47 patients. Dermatol Surg 1995 21 940 -946.