Combined Erbium:YAG and Carbon Dioxide Laser Skin Resurfacing

Abstract

To compare clinical and histological results of 2 different protocols for cosmetic laser skin resurfacing. Masked comparison of 2 cohort groups. Forty-eight carefully selected patients who met specific inclusion and exclusion criteria for cosmetic laser skin resurfacing. Age, sex, and skin type were matched in both groups. Twenty-five patients had undergone cosmetic skin resurfacing with 2 impacts of a carbon dioxide laser. Another 23 patients underwent a different protocol involving 2 initial impacts of an erbium:YAG laser to ablate the epidermis followed by a single impact with a carbon dioxide laser. Skin punch biopsy specimens were obtained 1 to 2 weeks after the procedure in both groups of patients. Time to reepithelialization, duration of erythema, and patient acceptance were compared among 2 patients groups via Student t test. Patients were examined daily until reepithelialization, then weekly for 6 weeks, and then monthly for 6 months. Mean skin reepithelialization time was 7 days (range, 4-9 days) in the combined laser group vs 12 days (range, 9-15 days) in the carbon dioxide laser-only group (P = .04). Mean duration of erythema was 2.5 weeks (range, 1.5-3 weeks) in the combined laser group vs 7 weeks (range, 5-13 weeks) in the carbon dioxide laser-only group (P = .02). All 23 patients (100%) in the combined group but only 15 (60%) of 25 in the carbon dioxide laser-only group were willing to repeat their cosmetic laser surgery (P = .04). There were greater and deeper coagulative changes in the dermis of patients in the carbon dioxide laser-only group compared with those of patients in the combined laser group. The combined laser protocol showed less significant clinical and histological morbidity than the carbon dioxide laser-only protocol. Patients preferred the combined protocol. Combining these 2 lasers is a safe and patient-friendly alternative to using only the carbon dioxide laser.