Carbon dioxide laser skin resurfacing with a cooled handpiece.

Abstract

Carbon dioxide (CO(2)) laser skin resurfacing has become an accepted procedure for the rejuvenation of aged and wrinkled facial skin. The benefits of this technique have been limited by the prolonged postoperative erythema, delayed re-epithelialization, and potential changes in pigmentation. We investigated the effects of coupling a pulsed CO(2) laser to a zinc selenide handpiece at various temperatures to cool and conduct heat from the skin surface. We compared the heat conducting handpiece to standard techniques used to determine the effects on epithelial preservation, depth of thermal damage, and new collagen growth. The dorsal aspect of piglets was treated with four handpiece arrangements: no thermally conducting window; a zinc selenide thermally conducting window at room temperature; and the zinc selenide thermally conducting window cooled to 10 and 5 degrees C. Intensities were measured to account for reflections from the surface of the handpiece. With the CO(2) laser in scanning mode and a spot size of 1 mm, each handpiece was used at intensities ranging from 8-30 W in one pass. Biopsies for histopathologic analysis and determination of the degree of epithelial damage and the depth of thermal damage were taken on days 0, 2, and 16. All specimens revealed complete re-epithelialization by day 16. The addition of a cooled handpiece did not affect either the amount of epithelial preservation or the depth of thermal damage. There is no significant advantage in using a cooled or room temperature zinc selenide handpiece for epithelial preservation or decreasing the inflammatory response in CO(2) laser resurfacing.