Carbon Dioxide Laser Skin Research Articles

Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation

ABSTRACTPurposeTo evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis.MethodsTwenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified.ResultsIncreased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534).ConclusionsWhen combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.

Topical Curcumin for the Healing of Carbon Dioxide Laser Skin Wounds in Mice

The purpose of this study was to evaluate the effect of topical curcumin on the healing of skin wounds produced by the CO(2) laser in an animal model. A prospective, randomized study was made of 90 mice assigned to three groups (30 animals per group), with the creation of 6-mm incisions in the skin of the dorsal region by means of the CO(2) laser. A total of 270 wounds were made (3 wounds by animal). No product was applied to the resulting wound in group I (control group); vehicle was applied in group II (5 mg/day by wound); and topical curcumin was applied to the mice in group III (5 mg/day by wound). Re-epithelialization and inflammation of the wounds were measured from histological sections of wounds, after 2, 7, and 14 days. Two days after production of the wounds, most of the latter showed incomplete re-epithelialization. After 7 days, 73.33% of the wounds treated with curcumin presented re-epithelialization covering the entire wound, with irregular thickness; nevertheless, only 37.50% of the wounds in control group and 41.67% in the vehicle group showed this degree ot re-epithelialization. After 14 days, all the wounds had completed re-epithelization. No significant differences were observed regarding resolution of the inflammatory process in any of the study groups after 2, 7, and 14 days. This study shows that topical curcumin applied to CO(2) laser-induced skin wounds may be useful, because improved re-epithelialization is observed after 7 days.

Bilateral corneal opacities in a LASIK patient after the use of titanium eye shields

We report a case of bilateral corneal opacities in a laser in situ keratomileusis (LASIK) patient who subsequently had carbon dioxide (CO(2)) laser skin resurfacing. The presumed etiology of the visually significant corneal opacities was late-onset diffuse lamellar keratitis (DLK), secondary to traumatic corneal abrasions from the use of metal eye shields. The DLK went untreated for 1 month, resulting in permanent interface scarring and a corrected distance visual acuity of 20/30 in the patient's right eye and 20/20 in the left eye. We think patients who have had LASIK and are planning to have CO(2) laser skin resurfacing or any procedure that uses protective metal eye shields should be counseled about the risk for late-onset DLK as a potential complication. This warning is particularly germane now as an increasing number of patients who have had LASIK are entering the decades of life when cosmetic surgery is most likely to be sought. Neither author has a financial or proprietary interest in any material or method mentioned.

Fractional Carbon Dioxide Laser and Plasmakinetic Skin Resurfacing

Photodamage is one of the most common reasons that patients visit a dermatologist's office. Carbon dioxide (CO(2)) laser resurfacing has always been the gold standard for reversing photodamage. Because of the relatively high incidence of side effects and the prolonged downtime associated with CO(2) resurfacing, new technologies have emerged to address photodamage. Portrait skin regeneration (PSR) is a novel device that has been developed to treat photodamage, and this device yields fewer side effects and downtime than traditional CO(2) laser resurfacing. At our center, we have performed more than 500 high-energy PSR treatments and have developed a unique and highly effective treatment protocol. In addition, fractional CO(2) laser resurfacing has emerged as the latest technology developed to combat photoaging. This technology yields impressive results and is much safer and causes less downtime than traditional CO(2) laser resurfacing. In this article, we will review our treatment techniques and protocols as well as address patient selection, preoperative and postoperative care, and anesthesia.

Safe and effective carbon dioxide laser skin resurfacing of the neck

CO2 laser skin resurfacing remains the gold standard for treatment of photoaged facial skin. It can be used onto the neck to further blend in the treated area with non-treated, adjacent photodamaged skin as well as improve the superficial textural quality of the neck skin. This article provides an overview of laser skin resurfacing of the neck, including pre-operative evaluation, patient education and selection, laser settings and technique used, post-operative care, and identification and treatment of possible complications.

In Vivo Effect of Carbon Dioxide Laser-Skin Resurfacing and Mechanical Abrasion on the Skin's Microbial Flora in an Animal Model

Although beam-scanning carbon dioxide (CO2) lasers have provided a highly efficient tool for esthetic skin rejuvenation there has been no comprehensive animal studies looking into microbial skin changes following CO2 laser skin resurfacing. To evaluate the in vivo effects of CO2 laser skin resurfacing in an experimental rat model in comparison with mechanical abrasion on the skin microbial flora. Four separate cutaneous sections of the right dorsal surface of 10 Wistar rats were treated with a CO2 laser, operating at 18 W and delivering a radiant energy of 5.76 J/cm2, while mechanical abrasions of the skin were created on four sections of the left dorsal surface using a scalpel. Samples for culture and biopsies were obtained from the skin surfaces of the rats on day 1 of application of the CO2 laser or mechanical abrasion, as well as 10, 30, and 90 days after the procedure. The presence of four microorganisms (staphylococci, streptococci, diphtheroids, and yeasts) was evaluated as a microbe index for the skin flora, and colony counts were obtained using standard microbiological methods. Skin biopsy specimens, following CO2 laser treatment, initially showed epidermal and papillary dermal necrosis and later a re-epithelization of the epidermis as well as the generation of new collagen on the upper papillary dermis. The reduction in microbial counts on day 1 of the CO2 laser-inflicted wound was statistically significant for staphylococci and diphtheroids compared with the baseline counts (p=.004 and p<.001, respectively), and for staphylococci, diphtheroids, and yeasts compared with the scalpel-inflicted wound on the same day (p=0.029, p<.001, and p=.030, respectively). Skin resurfacing using CO2 lasers considerably reduces microbial counts of most microorganisms in comparison with either normal skin flora or a scalpel-inflicted wound. This might contribute to the positive clinical outcome of laser skin resurfacing.

In Vivo Effect of Carbon Dioxide Laser-Skin Resurfacing and Mechanical Abrasion on the Skinʼs Microbial Flora in an Animal Model

BACKGROUND Although beam-scanning carbon dioxide (CO2) lasers have provided a highly efficient tool for esthetic skin rejuvenation there has been no comprehensive animal studies looking into microbial skin changes following CO2 laser skin resurfacing. OBJECTIVE To evaluate the in vivo effects of CO2 laser skin resurfacing in an experimental rat model in comparison with mechanical abrasion on the skin microbial flora. METHODS Four separate cutaneous sections of the right dorsal surface of 10 Wistar rats were treated with a CO2 laser, operating at 18 W and delivering a radiant energy of 5.76 J/cm2, while mechanical abrasions of the skin were created on four sections of the left dorsal surface using a scalpel. Samples for culture and biopsies were obtained from the skin surfaces of the rats on day 1 of application of the CO2 laser or mechanical abrasion, as well as 10, 30, and 90 days after the procedure. The presence of four microorganisms (staphylococci, streptococci, diphtheroids, and yeasts) was evaluated as a microbe index for the skin flora, and colony counts were obtained using standard microbiological methods. RESULTS Skin biopsy specimens, following CO2 laser treatment, initially showed epidermal and papillary dermal necrosis and later a re-epithelization of the epidermis as well as the generation of new collagen on the upper papillary dermis. The reduction in microbial counts on day 1 of the CO2 laser-inflicted wound was statistically significant for staphylococci and diphtheroids compared with the baseline counts (p=.004 and p<.001, respectively), and for staphylococci, diphtheroids, and yeasts compared with the scalpel-inflicted wound on the same day (p=0.029, p<.001, and p=.030, respectively). CONCLUSIONS Skin resurfacing using CO2 lasers considerably reduces microbial counts of most microorganisms in comparison with either normal skin flora or a scalpel-inflicted wound. This might contribute to the positive clinical outcome of laser skin resurfacing.

Side effects and complications of variable-pulsed erbium:yttrium-aluminum-garnet laser skin resurfacing: extended experience with 50 patients.

Recent advances in technology have provided laser surgeons with new options for cutaneous laser resurfacing. Despite its popularity, there is limited information on the short-term and long-term side effects and complications of variable-pulsed erbium:yttrium-aluminum-garnet (erbium:YAG) laser skin resurfacing. The purpose of this study was to prospectively evaluate postoperative wound healing, side effects, and complications of multiple-pass, variable-pulsed erbium:YAG laser skin resurfacing for facial photodamage, rhytides, and atrophic scarring. Fifty consecutive patients with facial photodamage, rhytides, or atrophic scarring were treated with a variable-pulsed erbium:YAG laser. Side effects and complications relating to postoperative healing, erythema, and pigmentary changes were tabulated. Patients were evaluated at postoperative days 3 through 7 and at 1, 3, 6, and 12 months after laser skin resurfacing. The average time for reepithelialization was 5.1 days. Prolonged erythema (>1 month) was observed in three patients (6 percent). Transient hyperpigmentation occurred in 20 patients (40 percent), with an average duration of 10.4 weeks. No cases of hypopigmentation or scarring were seen. In summary, a variable-pulsed erbium:YAG laser can safely be used for the treatment of facial photodamage, rhytides, and atrophic scarring. Although more postoperative erythema is seen after variable-pulsed erbium:YAG laser treatment than is usually produced with a short-pulsed erbium:YAG system, the side-effect profile and recovery period after variable-pulsed erbium:YAG laser skin resurfacing still are more favorable than after multiple-pass carbon dioxide laser skin resurfacing.

Single‐pass CO2 laser skin resurfacing of light and dark skin: extended experience with 52 patients

BACKGROUND: Multiple‐pass carbon dioxide (CO2) laser skin resurfacing has been a favored treatment modality for photodamaged and acne‐scarred skin over the past several years. Its association with numerous side effects and complications, particularly prolonged erythema and dyspigmentation, however, has dampened the initial enthusiasm reserved for its use. By reducing the laser‐associated tissue ablation depth and degree of thermal necrosis, it is possible that the incidence of these side effects can also be reduced.PURPOSE: To evaluate the clinical efficacy and side effect profile of single‐pass CO2 laser skin resurfacing in a large series of patients.MATERIALS AND METHODS: A total of 52 consecutive patients (skin phototypes I–VI) with mild facial rhytides, atrophic scars, or infraorbital hyperpigmentation underwent single‐pass treatment with a high‐energy, pulsed CO2 laser. Side effects to treatment were closely monitored and tabulated. Clinical improvement using a quartile grading scale was assessed independently by two masked medical evaluators at 1, 3, 6, and 12 months postoperatively.RESULTS: Significant clinical improvement was seen in all patients, with peak improvement scores noted at 12 months. Greater clinical improvement was seen in patients with darker skin tones despite the near universal incidence of transient postoperative hyperpigmentation in these patients.CONCLUSIONS: Single‐pass CO2 laser skin resurfacing can improve the appearance of fine rhytides, mild atrophic scars, and infraorbital hyperpigmentation in all skin types. The severity and duration of side effects and complications are reduced with this technique (compared with multiple‐pass procedures) and may offer a possible solution to the problem of treating patients with darker complexions.

Carbon dioxide laser skin resurfacing with a cooled handpiece.

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.

Wiping away debris between passes during laser surgery: is it really efficient or causing complications?

Although carbon dioxide laser skin resurfacing offers a controlled and predictive tissue ablation, it is not completely without complications, such as cobblestone-like appearance or scar formation. It has been supposed that these were the results of thermal loading on overlapped areas. In order to obtain a smoother surface, an experimental study dealing with the effect of wiping procedure between the sessions was carried out. Laser beams were applied in two sessions to the backs of 20 rats. Between the sessions, the debris was wiped away in half and left unwiped in the others. Despite a statistically higher ablation rate in the wiped group, its surface irregularity was statistically significant when compared to unwiped group. It is supposed that the amount of debris left on the surface has the regulatory role in laser application. Because laser beams can be absorbed more by untreated skipped areas and less by overlapped sites, the second pass can ensure a smoother surface. Considering both benefits and disadvantages, it is concluded that wiping vaporized debris every two passes is the most reliable laser treatment modality.

The significance of orbital anatomy and periocular wrinkling when performing laser skin resurfacing.

Knowledge of orbital anatomy and the interaction of muscle contractions, gravitational forces and photoagingis fundamental in understanding the limitations of carbon dioxide (CO2) laser skin resurfacing when rejuvenating the skin of the periocular area. Laser resurfacing does not change the mimetic behavior of the facial muscles nor does it influence gravitational forces. When resurfacing periocular tissue, the creation of scleral show and ectropion are a potential consequence when there is an over zealous attempt at improving the sagging malar fat pad and eyelid laxity by performing an excess amount of laser passes at the lateral portion of the lower eyelid. This results in an inadvertent widening of the palpebral fissure due to the lateral pull of the Orbicularis oculi. Retrospectively, 85 patients were studied, who had undergone periorbital resurfacing with a CO2 laser using anew treatment approach. The Sharplan 40C CO2 Feather Touchlaser was programmed with a circular scanning pattern and used just for the shoulders of the wrinkles. A final laser pass was performed with the same program over the entire lower eyelid skin surface, excluding the outer lateral portion (e.g. a truncated triangle-like area),corresponding to the lateral canthus. Only a single laser pass was delivered to the lateral canthal triangle to avoid widening the lateral opening of the eyelid, which might lead to the potential complications of scleral show and ectropion. When the area of the crows' feet is to be treated, three passes on the skin of this entire lateral orbital surface are completed by moving laterally and upward toward the hairline. Patients examined on days 1, 7, 15, 30, 60, and one year after laser resurfacing showed good results. At two months after treatment, the clinical improvement was rated by the patient and physician as being "very good" in 81 of the 85 patients reviewed. These patients underwent laser resurfacing without complications. The proposed technique of periocular resurfacing prevents complications of scleral show and laxity in the lateral eyelid opening and even ectropion, because treatment conforms to the osseo-muscular anatomical relationship of eyelid structures.

Eyelid healing after carbon dioxide laser skin resurfacing: Mannor G., Phelps R, Friedman A. et al. Arch Opthalmol 117: 913, 1999

Eyelid healing after carbon dioxide laser skin resurfacing: Mannor G., Phelps R, Friedman A. et al. Arch Opthalmol 117: 913, 1999

Spontaneous bullae over laser resurfaced skin

We report 2 cases of facial bullae occurring subsequent to full-face carbon dioxide laser skin resurfacing. Although the cause is unknown, both responded to potent topical corticosteroid treatment. Laser resurfacing is a relatively new procedure, and physicians should be aware of this complication. (J Am Acad Dermatol 2000;42:288-90.)

Prophylactic fluconazole promotes reepithelialization in full-face carbon dioxide laser skin resurfacing

Background and Objective Laser skin resurfacing is used to treat photodamaged skin, rhytids, and acne scarring. Many patients are placed on antibiotics and antivirals pre- and postoperatively. The purpose of this study was to determine whether prophylactic fluconazole increased the rate of reepithelialization in patients undergoing full-face CO2 laser skin resurfacing. Study Design/Materials and Methods Ninety-one patients underwent full-face CO2 laser skin resurfacing with the Coherent Ultrapulse 5000C. At least two passes of 300 mJ, density 5, were used except periocularly. Study group I consisted of 48 consecutive patients who received either cephalexin or ciprofloxacin for 7 days postoperatively. Study group II consisted of 43 patients who received 300 mg of fluconazole on postoperative days 3–8, in addition to ciprofloxacin. Both groups received acyclovir 400 mg t.i.d. pre- and postoperatively. Results Time to complete reepithelialization was compared between the groups by t-test. Group II reepithelialized significantly faster than group I (7.65 ± 1.20 days vs. 10.27 ± 2.94 days; P < 0.0001). Ninety-five percent of patients receiving fluconazole (group II) healed completely by day 9 versus only 53% of patients in group I. Conclusion Fluconazole administered postoperatively between days 3 and 8 significantly promotes reepithelialization in patients undergoing full-face CO2 laser skin resurfacing. Lasers Surg. Med. 26:201–207, 2000. © 2000 Wiley-Liss, Inc.

Prophylactic fluconazole promotes reepithelialization in full-face carbon dioxide laser skin resurfacing.

Laser skin resurfacing is used to treat photodamaged skin, rhytids, and acne scarring. Many patients are placed on antibiotics and antivirals pre- and postoperatively. The purpose of this study was to determine whether prophylactic fluconazole increased the rate of reepithelialization in patients undergoing full-face CO(2) laser skin resurfacing. Ninety-one patients underwent full-face CO(2) laser skin resurfacing with the Coherent Ultrapulse 5000C. At least two passes of 300 mJ, density 5, were used except periocularly. Study group I consisted of 48 consecutive patients who received either cephalexin or ciprofloxacin for 7 days postoperatively. Study group II consisted of 43 patients who received 300 mg of fluconazole on postoperative days 3-8, in addition to ciprofloxacin. Both groups received acyclovir 400 mg t.i.d. pre- and postoperatively. Time to complete reepithelialization was compared between the groups by t-test. Group II reepithelialized significantly faster than group I (7.65 +/- 1.20 days vs. 10.27 +/- 2.94 days; P < 0.0001). Ninety-five percent of patients receiving fluconazole (group II) healed completely by day 9 versus only 53% of patients in group I. Fluconazole administered postoperatively between days 3 and 8 significantly promotes reepithelialization in patients undergoing full-face CO(2) laser skin resurfacing.

Quantification of skin elasticity changes associated with pulsed carbon dioxide laser skin resurfacing.

While skin resurfacing using pulsed carbon dioxide lasers appears to have a skin-tightening effect clinically, the debate continues over its actual effects on dermal collagen. To provide quantitative measures of skin elasticity changes associated with pulsed carbon dioxide laser skin resurfacing and to introduce to the facial plastic surgery community the Cutometer SEM 575 skin elasticity meter, an instrument that is useful in the measurement of skin elasticity. University-based facial plastic surgery clinic and wound healing laboratory. Intervention. Measurements taken prior to and 6 months after procedure. Thirty-two patients undergoing pulsed carbon dioxide full-face laser skin resurfacing participated. There were 12 test sites measured in 6 aesthetic units per participant. The Cutometer SEM 575 skin elasticity meter was used to measure skin elasticity changes accompanying this procedure. This device measures skin deformation with an accuracy of 10 microns. The change in elastic recovery (Ur/Ue) was determined. At all 6 of the facial sites, there was a statistically significant increase in skin elasticity (P < .001). Overall, there was an 18.2% improvement in skin elasticity. Site-specific changes ranged from 9% (forehead) to 22% (prejowl and periorbital). Skin resurfacing with the pulsed carbon dioxide laser produces a true skin-tightening effect. The Cutometer is a valuable instrument that permits accurate quantification of skin elasticity and may be useful in the evaluation of other facial plastic procedure results.

Combined Erbium:YAG and Carbon Dioxide Laser Skin Resurfacing

Archives of Facial Plastic SurgeryVol. 1, No. 2 CommentaryCombined Erbium:YAG and Carbon Dioxide Laser Skin ResurfacingPaul J. CarniolPaul J. Carniol9 Deforest Ave, Summit, NJ 07902-1005Search for more papers by this authorPublished Online:1 Apr 1999https://doi.org/10.1001/archfaci.1.2.117AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"Combined Erbium:YAG and Carbon Dioxide Laser Skin Resurfacing." Archives of Facial Plastic Surgery, 1(2), p. 117FiguresReferencesRelatedDetails Volume 1Issue 2Apr 1999 InformationCopyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.To cite this article:Paul J. Carniol.Combined Erbium:YAG and Carbon Dioxide Laser Skin Resurfacing.Archives of Facial Plastic Surgery.Apr 1999.117-117.http://doi.org/10.1001/archfaci.1.2.117Published in Volume: 1 Issue 2: April 1, 1999PDF download

Combined Erbium:YAG and Carbon Dioxide Laser Skin Resurfacing

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.

Why does carbon dioxide resurfacing work? A review.

Despite the unquestionable efficacy of carbon dioxide laser skin resurfacing, mechanisms for cosmetic enhancement remain poorly characterized. Histological studies have provided some insight into the cascade of events from initial laser impact to final skin rejuvenation. However, there are few comprehensive studies of gross and microscopic wound healing. Additionally, the literature is fragmented; excellent individual articles appear in journals from widely disparate disciplines. For example, some reports relevant to laser skin resurfacing are "sequestered" in the engineering literature. This article is intended to update the physician on laser skin resurfacing based on the broadest review of the current literature. It proceeds from a discussion of initial laser-tissue interactions, such as collagen denaturation, to examination of long-term biological sequelae. At some cost to scientific rigor, mathematical models describing laser-tissue interactions are not presented.