Ablative and Nonablative Facial Resurfacing

Abstract

Ablative resurfacing was first introduced in the mid 1990s. Technological advancements with carbon dioxide (CO2) lasers had emerged to minimize their thermal impact on tissue and, subsequently, possible clinical uses were explored. Two types of CO2 lasers were developed. The first utilized ultrashort pulse durations to minimize heat deposition in the tissue. The other utilized the laser beam in a continuous wave (CW) mode, in conjunction with a scanning device, to shorten the laser dwell time and, thereby, minimize thermal damage (Lask et al. 1995). These lasers were first used for the treatment of rhytides and acne scars; however, investigators soon discovered that superficial sun damage changes, including lentigines, as well as actinic keratoses, fine lines, and other superficial imperfections also improved. Additionally, the deposition of heat was noted to cause a tissue-tightening effect, which softened deeper wrinkles (Fitzpatrick et al. 2000). The CO2 laser proved to be very effective; however, as the technology expanded into the dermatologic and plastic surgeon’s armamentarium, it was found to have significant side effects, especially in inexperienced hands. Many patients experienced erythema that lasted for weeks to months as well as temporary hyperpigmentation, acne, and contact sensitivity to topical products. Yeast, bacterial, and viral infections were a potential problem. Prolonged hypopigmentation and scarring, although infrequent, were also of great concern. In an effort to decrease the risk/side effect profile, the use of erbium lasers was explored (Zachary 2000) These short-pulsed lasers, with stronger water absorption at 2.94 μm were less injurious to deeper tissues; they ablated tissue but left little residual thermal damage. Unfortunately it became apparent that this laser, although good for smoothing out the surface, did not lead to the same tightening effect as was noted with the CO2 lasers. The next level of advancement entailed increasing the pulse width of the erbium lasers to include some deposition of heat, which would allow tightening (Pozner and Goldberg 2000). In addition, lasers were developed that combined both erbium and CO2 lasers to allow heat deposition by the CO2 component as well as pure ablation by the erbium component. The potential benefit was great; however, side effects continued to be present (Tanzi and Alster 2003). A recent paper showed that utilizing a topical anesthetic, which hydrated the skin, minimized side effects even Ablative and Nonablative Facial Resurfacing