Laser Resurfacing

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Carbon dioxide (CO2) laser was firstly used in the medical field in 1964 and then becomes the most widely used laser in dermatology.

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Melasma is a common pigmentary disorder that remains resistant to available therapies. Facial resurfacing with the pulsed CO2 laser has been reported successful but requires significant downtime, and there is a risk of adverse sequelae. To determine if melasma will respond to a new treatment paradigm, fractional resurfacing. Ten female patients (Fitzpatrick skin types III-V) who were unresponsive to previous treatment were treated at 1- to 2-week intervals with the Fraxel laser (Reliant Technologies, Palo Alto, CA, USA). Wavelengths of 1,535 and 1,550 nm were both used, and 6 to 12 mJ per microthermal zone with 2,000 to 3,500 mtz/cm2 were the treatment parameters. Four to six treatment sessions were performed. Responses were evaluated according to the percentage of lightening of original pigmentation. Two physicians evaluated the photographs, and each patient evaluated her own response. The physician evaluation was that 60% of patients achieved 75 to 100% clearing and 30% had less than 25% improvement. The patients' evaluations agreed, except for one patient, who graded herself as 50 to 75% improved as opposed to the physician grading of over 75%. There was one patient with postinflammatory hyperpigmentation and no patient with hypopigmentation. No downtime was necessary for wound healing. Fractional resurfacing affords a new treatment algorithm for the treatment of melasma that combines decreased risk and downtime with significant efficacy. This treatment modality deserves further exploration to maximize benefits.
We have obtained cw laser action on a number of rotational transitions of the Sigmau+-Sigmag+ vibrational band of CO2 around 10.4 and 9.4mu. The laser wavelengths are identified as the P-branch rotational transitions from P(12) to P(38) for the 00°1-10°0 band and from P(22) to P(34) for the 00°1-02°0 band. Strongest laser transition occurs at 10.6324mu (vacuum). A cw power output of about 1 mW has been measured. All these laser transitions can also be made to oscillate under pulsed discharge conditions with a small increase in the peak laser power output. No R-branch transitions have been seen to oscillate either under cw or pulsed discharge conditions. The wavelength measurements are in reasonable agreement with earlier measurement of the bands in absorption, but there are slight differences. These are ascribed to possible pressure-dependent frequency shift effects. A study has been made of the time dependence of the laser output under pulsed excitation, and some conclusions about possible excitation processes are given. Theoretical interpretation given earlier for laser action on vibrational-rotational transitions is discussed in a generalized form. The theory is applicable to both the linear polyatomic molecules and the diatomic molecules.
Laser resurfacing with the 950 μs pulsed CO2 laser is an effective treatment for photodamage and acne scarring; however, the potential for prolonged erythema and delayed re-epithelialization dissuade many patients from the procedure. With the use of erbium lasers alone, there is a decrease in the incidence and severity of these adverse sequelae; however, it is difficult to achieve the same degree of improvement as with the CO2 laser because of the more superficial depth of resurfacing. Thus, new erbium lasers have been developed with longer pulse durations to deliver increased thermal effects to tissue. It is hypothesized that with the use of these lasers, diminished erythema and faster wound healing will be observed as well as enhanced clinical outcomes. Sixteen patients were randomized to receive laser resurfacing on one-half of the face with the 950 μs pulsed CO2 laser (UPCO2) followed by short pulse erbium:YAG ablation, and to the other half with a variable pulsed erbium laser (VP Er:YAG) followed by traditional short pulse erbium laser. Patients were evaluated clinically before resurfacing and at 1, 2, 4, 8, and 12 weeks post-operatively. Histologic samples taken at various time periods before and after resurfacing were also evaluated. Overall clinical improvement was equal for both UPCO2 and VP Er:YAG treated sides with an average improvement in photoaging scores of 57%. Decreased erythema, less edema, and faster healing were observed on the VP Er:YAG treated side. The VP Er:YAG laser can achieve a similar degree of improvement as seen with short pulse CO2 laser resurfacing with decreased thermal tissue effects and decreased risk for adverse sequelae. Lasers Surg. Med. 29:136–141, 2001.
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.
Laser skin resurfacing has become a popular therapeutic modality for the correction of acne scars, but it is not always effective in all types of acne scars. To evaluate the clinical effects of resurfacing with the short-pulsed Er:YAG laser, the variable-pulsed Er:YAG laser, and the dual-mode Er:YAG laser for each type of facial acne scars. One hundred fifty-eight patients with facial acne scars were included in this study. Eighty three patients (18 deep boxcar scars, 8 ice-pick scars, 11 rolling scars, and 46 shallow boxcars) were treated with the 350-micros short-pulsed Er:YAG laser at the setting of 12.5 to 15%/cm(2). Thirty-five patients (8 deep boxcar scars, 4 ice-pick scars, 12 rolling scars, and 11 shallow boxcars) were treated with the variable-pulsed Er:YAG laser at the setting of 7.0 to 7.5%/cm(2) and 7-ms pulse duration. Forty patients (8 deep boxcar scars, 4 ice-pick scars, 17 rolling scars, and 11 shallow boxcars) were treated with the dual-mode Er:YAG laser with 350-micro ablation mode at 17.5%/cm(2) and 8-ms coagulation mode at 3.15%/cm(2). Facial photographs were obtained at baseline and at 2- to 4-week intervals postoperatively. Acne scars were classified into four types, and clinical improvements of facial acne scars were evaluated. Resurfacing with the short-pulsed Er:YAG laser shows good to excellent results for ice-pick and shallow boxcar scars, fair to good for deep boxcar scars, and poor to fair for rolling scars. Resurfacing with the variable-pulsed laser shows good to excellent results for ice-pick and shallow boxcar scars, fair to good for deep boxcar scars, and good for rolling scars. Resurfacing with the dual-mode laser shows good to excellent results for ice-pick, shallow, and rolling scars and produced good results on deep boxcar scars. Shallow boxcar and ice-pick scars can be treated successfully using any types of Er:YAG laser. In cases of rolling and deep boxcar scars, however, Er:YAG laser with a long-pulse duration for a thermal effect is needed for successful treatment.
Innovations in lasers, light and radiofrequency devices have allowed for improved therapeutic efficacy and safety and the ability to treat patients with an ever-increasing number of medical and aesthetic indications. Safety remains a primary concern and the timely communication of complications and their management is vital to insure that treatments be as safe as possible. The purpose of this report on the Proceedings of the First International Laser Surgery Morbidity Meeting is to provide laser experts the opportunity to present and discuss complications that their patients have experienced and how they were successfully managed. Laser experts were invited to present complications of laser, light, and radiofrequency treatments that their patients have experienced and to discuss the potential mechanisms leading to the complications their management and final outcomes. Nineteen unique cases are presented and the clinical management of each case discussed. Eighteen sets of pre- and post-operative photos are presented. This report shows that even experts, with extensive experience using light-based therapies, can and do have patients who develop complications. Sound clinical judgment, and knowing how to avoid complications and their timely post-operative management, is essential to insure optimal therapeutic outcome.
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. 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. 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. 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. One pass of low fluence erbium:YAG resurfacing, under topical anesthesia, was effective for the treatment of mild to moderate photoaging.
Cutaneous laser surgery: the art and science of selective photothermolysis
  • Mp Goldman
  • Re Fitzpatrick
Resurfacing of different types of facial acne scar with short-pulsed, variable-pulsed and dual mode ER:YAG laser
  • Sh Whoo
  • Jh Park
  • Nk Soo
The treatment of melasma with fractional resurfacing: a pilot study
  • Ck Rokhsar
  • Re Fitzpatrick