High-energy Pulsed Carbon Dioxide Research Articles

Carbon Dioxide Laser Resurfacing

Carbon Dioxide Laser Resurfacing

Ablative laser resurfacing: high-energy pulsed carbon dioxide and erbium:yttrium-aluminum-garnet

The development of the short-pulsed high-energy carbon dioxide laser in the mid 1990's led to the emergence of laser skin resurfacing. Used in the continuous mode, the CO 2 laser can cut and coagulate simultaneously. Used in the pulsed mode, the CO 2 laser is a powerful tool for epidermal ablation in many different contexts both therapeutic and cosmetic. Both the CO 2 and Erbium YAG lasers emit light in the infrared spectrum. Energy is preferentially absorbed by intracellular water creating rapid heating and vaporization of tissue. Because of the wavelength of the Er:YAG laser (2940nm) more closely approximates the absorption peak of water (3000nm) the target chromophore than the CO 2 laser (10,600nm) nearly all of the energy is absorbed in the epidermis and papillary dermis yielding superficial ablation and less underlying thermal damage. The advantages, disadvantages, and applications of each type of laser resurfacing will be discussed. Despite proven efficacy, the public acceptance of laser resurfacing has declined with the emergence of new laser systems that cause dermal remodeling without ablating the overlying epidermis dramatically reducing recovery time. In the absence of blinded comparison studies, it remains unclear whether the clinical results of the newer ‘nonablative' laser systems compare with their ablative predecessors.

LASER THERAPY FOR CARCINOMA IN SITU OF THE PENIS

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Nov 2001LASER THERAPY FOR CARCINOMA IN SITU OF THE PENIS B.P.J. van BEZOOIJEN, S. HORENBLAS, W. MEINHARDT, and D.W.W. NEWLING B.P.J. van BEZOOIJENB.P.J. van BEZOOIJEN More articles by this author , S. HORENBLASS. HORENBLAS More articles by this author , W. MEINHARDTW. MEINHARDT More articles by this author , and D.W.W. NEWLINGD.W.W. NEWLING More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)65650-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Carcinoma in situ of the penis, also referred to as Bowen’s disease or erythroplasia of Queyrat, may lead to invasive squamous cell carcinoma. We assessed the results of laser therapy for carcinoma in situ of the penis. Materials and Methods: From 1986 to 2000 we treated 19 patients with carcinoma in situ of the penis with the neodymium:YAG or carbon dioxide laser. Treatment was assessed retrospectively. No patient was lost to followup. Results: No complications developed and cosmesis was excellent. After 2 to 4 months 3 patients (16%) received repeat treatment because of incomplete disappearance of the lesion. Mean followup was 32 months. True carcinoma in situ recurrent in 5 patients (26%) at an average followup of 25 months (range 6 to 75), while 1 had infiltrating carcinoma. All patients with carcinoma in situ underwent repeat laser treatment. Conclusions: In our experience laser therapy is appropriate initial treatment for carcinoma in situ of the penis with excellent cosmetic and functional results. This therapy is also suited for recurrence without the need for more mutilating therapy. However, the high incidence of recurrence indicates the need for careful followup and patient self-examination. References 1 : Precancerous dermatoses: a study of two cases of chronic atypical epithelial proliferation. J Cutan Dis1912; 30: 241. Google Scholar 2 : Erythroplasie du gland. Bull Soc Franc Derm Syph1911; 22: 378. Google Scholar 3 : Carcinoma in situ of penis. Is distinction between erythroplasia of Queyrat and Bowen’s disease relevant?. Urology1990; 36: 479. Google Scholar 4 : Squamous cell carcinoma of the penis: premalignant lesions. Scand J Urol Nephrol2000; 205: 187. Google Scholar 5 : Detection of occult metastasis in squamous cell carcinoma of the penis using a dynamic sentinel node procedure. J Urol2000; 163: 100. Link, Google Scholar 6 : Carcinoma of penis. Review of cases treated by surgery and radiation therapy 1960–1977. Urology1981; 18: 149. Google Scholar 7 : Erythroplasia of Queyrat. A clinicopathologic and histochemical study. Cancer1973; 32: 1396. Google Scholar 8 : The management and prevention of premalignant penile lesions. Scan J Urol Nephrol2000; 205: 220. Google Scholar 9 : Treatment of penile intraepithelial neoplasia (PIN) with interferon alpha-2a, CO2 laser (vaporization) and 5-fluorouracil 5% (5-FU). Eur J Gynaecol Oncol1997; 18: 410. Google Scholar 10 : Squamous cell carcinoma of the penis. III. Treatment of regional lymph nodes. J Urol1993; 149: 492. Link, Google Scholar 11 : Treatment of superficial basal cell carcinoma and squamous cell carcinoma in situ with a high-energy pulsed carbon dioxide laser. Arch Dermatol1998; 134: 1247. Google Scholar 12 : High- and low-power CO2-lasers; comparison of results for three clinical indications. J Reprod Med1993; 38: 455. Google Scholar 13 : Laser therapy of squamous cell dysplasia and carcinoma of the penis. Urology1998; 52: 559. Crossref, Medline, Google Scholar 14 : Sapphire probe laser surgery for localized carcinoma of the penis. Eur J Surg Oncol1988; 14: 193. Google Scholar 15 : Local recurrent tumour after penis-conserving therapy. A plea for long-term follow-up. Br J Urol1993; 72: 976. Google Scholar From the Free University Medical Center and The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands© 2001 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byLont A, Gallee M, Meinhardt W, van Tinteren H and Horenblas S (2018) Penis Conserving Treatment for T1 and T2 Penile Carcinoma: Clinical Implications of a Local RecurrenceJournal of Urology, VOL. 176, NO. 2, (575-580), Online publication date: 1-Aug-2006.WINDAHL T, SKEPPNER E, ANDERSSON S and FUGL-MEYER K (2018) SEXUAL FUNCTION AND SATISFACTION IN MEN AFTER LASER TREATMENT FOR PENILE CARCINOMAJournal of Urology, VOL. 172, NO. 2, (648-651), Online publication date: 1-Aug-2004.WINDAHL T and ANDERSSON S (2018) Combined Laser Treatment for Penile Carcinoma: Results After Long-Term FollowupJournal of Urology, VOL. 169, NO. 6, (2118-2121), Online publication date: 1-Jun-2003. (2018) EDITORIAL COMMENTJournal of Urology, VOL. 168, NO. 6, (2421-2421), Online publication date: 1-Dec-2002. Volume 166Issue 5November 2001Page: 1670-1671 Advertisement Copyright & Permissions© 2001 by American Urological Association, Inc.Keywordspenislaserscarcinoma in situMetricsAuthor Information B.P.J. van BEZOOIJEN More articles by this author S. HORENBLAS More articles by this author W. MEINHARDT More articles by this author D.W.W. NEWLING More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgical Pearl: The high-energy pulsed carbon dioxide laser for immediate scar resurfacing

The carbon dioxide laser has been used extensively in dermatologic surgery for many years. 1 Goldman L Blaney DJ Kindel DJ et al. Effect of the laser beam on the skin. J Invest Dermatol. 1963; 40: 121-122 PubMed Scopus (134) Google Scholar , 2 McBurney EL Rosen DA. Carbon dioxide laser treatment of verrucae vulgaris. J Dermatol Surg Oncol. 1984; 10: 45-48 Crossref PubMed Scopus (75) Google Scholar , 3 Ratz JL Bailin PL Lakeland RF. Carbon dioxide laser treatment of epidermal nevi. J Dermatol Surg Oncol. 1986; 12: 567-570 Crossref PubMed Scopus (52) Google Scholar , 4 Kantor GR Wheeland RG Bailin PL et al. Treatment of earlobe keloids with carbon dioxide laser excision: a report of 16 cases. J Dermatol Surg Oncol. 1985; 11: 1063-1067 Crossref PubMed Scopus (59) Google Scholar , 5 Greenbaum SS Krull EA Watnick K. Comparison of carbon dioxide laser and electrosurgery in the treatment of rhinophyma. J Am Acad Dermatol. 1988; 18: 363-368 Abstract Full Text PDF PubMed Scopus (69) Google Scholar , 6 David LM. Laser vermillion ablation for actinic cheilitis. J Dermatol Surg Oncol. 1985; 11: 605-608 Crossref PubMed Scopus (90) Google Scholar , 7 David LM Lask GP Glassberg E et al. Laser abrasion for cosmetic and medical treatment of facial actinic damage. Cutis. 1989; 43: 583-588 PubMed Google Scholar Its uses are well known. High-energy, ultra-short pulsed lasers as well as the flash scanner–type carbon dioxide lasers have been introduced recently.

Pilot ultrastructural evaluation of human preauricular skin before and after high-energy pulsed carbon dioxide laser treatment.

Carbon dioxide laser resurfacing has recently come into favor for the treatment of photodamaged skin. While the clinical and histologic effects of high-energy short-pulse carbon dioxide lasers on human skin have been investigated, the ultrastructural effects of these lasers have not been documented. Our objective was to study the ultrastructural effects of a high-energy pulsed carbon dioxide laser on photodamaged human skin. Before laser surgery, the ultrastructural changes characteristic of photodamaged skin were evident. Immediately after treatment, there was extensive coagulation necrosis of the epidermis and papillary dermis. Thirty days after treatment, there was no evidence of intercellular or intracellular edema, and ordered differentiation of the epidermal keratinocytes, with a loss of keratinocyte dysplasia, was seen. Increased numbers of desmosomes and tonofibrils were noted. New deposition of collagen was present in the papillary dermis. The ultrastructural findings seen at 90 days after treatment were similar to those seen at 30 days, apart from increased organization of collagen fibers in the papillary dermis. Treatment with the high-energy pulsed carbon dioxide laser appears to reverse the epidermal and dermal changes of photoaging on an ultrastructural level. These changes appear morphologically to be consistent with previously described clinical and histologic changes following laser resurfacing.

Scar revision using laser – review of the literature and an appraisal

A variety of scars – erythematous, pigmented, atrophic, and hypertrophic – may occur as a result of trauma, surgery, burns, and skin disease such as acne. Surgery with other adjunctive methods including radiotherapy, intralesional steroid, and pressure therapy have shown variable results. Laser scar revision has been used since the early 1980s. The continuous wave lasers including continuous wave carbon dioxide, argon and the Nd: YAG laser achieve some improvement, but their use is limited by inherent problems of continuous mode lasers. Pulsed lasers have been effective for scar revision probably due to their selective photothermolysis. The pulsed dye laser has been successfully used in erythematous and hypertrophic scars. The pigment-specific lasers have shown a good improvement for pigmented scars. The high-energy pulsed carbon dioxide laser has been used for distensible facial scarring. The erbium: YAG laser may have advantages because of reduced thermal damage to surrounding tissue and low risk of pigmentary change. The selection of appropriate lasers alone or in combination may be of value for scar revision.

Aesthetic CO 2 laser surgery: Evaluation of 907 patients

Resurfacing the skin to improve skin quality is an important concept in aesthetic plasticsurgery. Although time-honored methods (e.g., dermabrasion and chemical peel) are available for this purpose, they have several disadvantages. A newer method with a highenergy pulsed carbon dioxide laser provides a more controllable and more predictable method of resurfacing facial skin. In our study of 907 patients, monitored up to 2 years 868 laser resurfacing procedures were done for facial wrinkles. Eight hundred two of 868 (92.4%) achieved very good to excellent results (>75% removal of wrinkles in 92.4% of cases). Forty-six of 61 (75.4%) patients with acne scars also obtained very good to excellent results. Most patients with selected skin lesions (rhinophyma, actinic cheilitis, epidermal nevi, seborrheic keratoses, syringomas, xanthelasmas, and postsurgical scars) achieved good to excellent results, although these are admittedly more difficult to quantify. Major complications were uncommon. One hundred one of 907 (11.1%) patients had development of temporary hyperpigmentation, which resolved in an average of 2.6 weeks. Thirty-four of 907 (3.8%) patients had development of mild permanent hypopigmentation. Eight of 908 (0.9%) patients had development of some induration that resolved with use of intralesional steroids. Most of these (5 of 8) were in the perioral area. Three of 907 (0.3%) patients had development of a small persistent scar. Seven of 316 (2%) patients undergoing periorbital resurfacing had development of some mild scleral show. Early in our experience one patient developed ectropion that required surgical correction. We conclude that the new generation high-energy pulsed carbon dioxide laser is safe andeffective for resurfacing facial skin. However, this procedure is very technique dependent and requires a combination of didactic and hands-on training, conservative surgical judgment, and diligent patient follow-up to obtain optimal results with minimal complications.

A critical appraisal of high-energy pulsed carbon dioxide laser facial resurfacing for acne scars.

Thirteen patients with mild and severe acne scarring have been treated with the Ultra Pulse carbon dioxide laser over a 24-month period. Nine patients had full-face and 4 patients had regional reurfacing. All patients were pretreated with a Retin-A preparation. The patients healed in an average of 7.3 days and erythema was gone in an average of 7.6 weeks. Eight patients with mild acne experienced a good (1 patient) or excellent (7 patients) result. Of the 5 patients with severe acne characterized by marked irregularity, deep defects, and atrophy, 2 patients experienced fair results and 2 experienced good results (1 patient was lost to follow-up). Thus, laser resurfacing for severe atrophic acne achieves only moderate results, while treatment for mild acne can provide excellent results.

Treatment of facial rhytides with a high-energy pulsed carbon dioxide laser.

Facial rhytides are a common problem that often presents for treatment. Because of the tendency for rhytides to involve delicate tissue areas, traditional treatment modalities have been limited by complications of scarring or pigmentary alterations. With the advent of the new-generation high-energy pulsed carbon dioxide lasers, skin requiring resurfacing can now be treated successfully with minimal risk and side effects. This study included 259 patients with facial rhytides (104 perioral, 83 periorbital, 53 glabellar, and 17 forehead). Each patient received treatment with a high-energy pulsed CO2 laser system, and individual responses were evaluated independently by two blinded assessors at 1, 4, 8, 12, and 24 weeks postoperatively. While clinical response rates were uniformly excellent, they varied in different locations. On average, there was a 90 percent improvement in all areas under study. The periorbital regions responded best, an average 93 percent improvement being seen. The facial rhytides with the lowest response rates (86.8 percent) were those which were most severe and those caused by excessive muscle movement (i.e., frown lines at the glabella). No incidences of scarring were noted, but erythema persisting 1 to 3 months (mean 2.2 months) following laser irradiation was typical. Transient postinflammatory hyperpigmentation of 3 months' average duration was seen in 30 percent of patients and was not limited to those individuals with darker skin tones. The high-energy pulsed carbon dioxide laser is a safe and effective treatment for facial rhytides. Treatment can be delivered in an outpatient setting without the need for general anesthesia, and preliminary evidence suggests long-lasting results.

Laser Hair Transplantation

Micro- and minigrafting have become increasingly popular in hair transplantation over the past decade, resulting in larger numbers of grafts per session and lengthy, potentially technically difficult procedures. The advent of very high energy pulsed carbon dioxide lasers as surgical instruments has led to the investigation of their use in hair transplantation, as bloodless surgery with tissue removal by vaporization has obvious advantages as far as surgical speed is concerned. A prospective study of eight patients comparing conventional micro- and minigrafting using 18- and 14-gauge needle punctures with dilators versus laser-vaporized donor sites with variation of laser parameters was conducted with monthly evaluation of healing and hair growth for 6 months. In addition, an in vitro histological study of laser vaporization recipient sites on excised scalp tissue was conducted to evaluate the residual thermal damage of various laser parameters. The conventional micro- and minigrafts healed faster and resulted in better hair growth than the laser vaporization sites. The donor sites were judged to be comparable as far as healing, but more time consuming with the laser. The operative time for the laser recipient sites was 50% of that of the conventional sites. The clinical results of laser hair transplantation are very dependent upon the laser parameters and technique used. Though operative time may be significantly reduced, the end result clinically is dependent on proper choices of pulse parameters and technique.