High-energy Pulsed CO2 Laser Research Articles

Letter regarding “Clinical and histologic effects from CO(2) laser treatment of keloids”

Dear Editor, We read with great interest the article by Nicoletti et al. [1] entitled “Clinical and histologic effects from CO(2) laser treatment of keloids.” The authors introduce their experiences with high-energy pulsed CO2 laser for the treatment of earlobe keloids. Considering the consequences of keloids including cosmetic deformity and psychological trauma, complete cure without recurrence is one of the most important considerations to physicians as well as patients [2, 3]. As sessile-type keloids are not sharply demarcated and marginal recurrences of sessile-type keloids are not infrequent in the clinical practice, we suggested that pedunculated-type keloids be the best candidate for the treatment with laser [4]. The present study by Nicoletti et al. was differentiated from published literature which introduced laser treatment as an initial treatment regimen rather than adjuvant therapy [5, 6]. As CO2 laser treatment is considered as one of the surgical traumas, using this regimen as an adjuvant to surgical excision can be another major cause of keloid recurrence. In the third case shown in the article by Nicoletti et al., we are afraid that a successful outcome was not achieved despite improved Vancouver Scar Scale. Rather, we observed that the scar was somewhat elevated and extended beyond the original surgical field. In conclusion, to validate the authors’ treatment regimen, a prospective, multicenter, further study would be warranted.

Clinical and histologic effects from CO2 laser treatment of keloids

Keloids and hypertrophic scars are abnormal responses to wound healing. In general, keloids exhibit a proliferative growth beyond the margins of the scar and remain persistent; while hypertrophic scars are contained to the original wound and may regress over time. In particular, keloid formation is one of the most challenging clinical problems, with increasing frequency in surgical practice. Many treatments are available such as intralesional corticosteroids, topical applications, cryotherapy, surgical excision, radiation therapy, silicone gel sheeting, pressure therapy, and laser therapy. There are no set guidelines for the treatment of keloids and the most common treatments are individualized and depended on the distribution, size, thickness, and consistency of lesions. The authors have evaluated carbon dioxide laser successfully in the treatment of keloids and the aim of this study was to determine the immediate and long-term histologic and clinical effects of keloids after carbon dioxide laser. Fifty consecutive patients (40 females, 10 males, ages 18-60 years, mean age 40 years) with moderate to severe keloids were evaluated. All the patients received regional treatments (deltoid, elbow, chin, and ear) in an outpatient setting with a high-energy pulsed CO2 laser. Significant immediate and prolonged clinical improvement in skin tone, texture, and appearance of carbon dioxide laser was examined in all patients. Dermal remodeling was observed also on histologic examination of biopsied tissue after treatment. Carbon dioxide laser appears to be effective and well tolerated for the treatment of keloids, avoiding the adverse effects and lengthy recovery time.

Treatment of acne scarring with fractional CO2 laser

Background: Fractional ablative CO2 laser therapy is based on the theory of fractional photothermolysis. It can be effective in treating acne scars in a less invasive fashion than conventional ablative CO2 laser therapy. Objective: In this clinical study, the safety and efficacy of a novel CO2 fractional ablative laser was investigated for the treatment of facial atrophic acne scarring in Chinese individuals. Materials and methods: A total of 31 patients (11 females, 20 males, Fitzpatrick skin phototypes III–IV) with facial acne scarring received three sequential fractional treatments over a 6-month period. Outcome measurements included blinded evaluations of before and after photographs by two physicians at 3 and 12 months after the final treatment. Global improvement was noted as well as any untoward events. Results: At the 12 months follow-up time period, 12.9% of the patients showed excellent improvement in their acne scars, while 38.71% noted good to fair results. The clinical response at the 12-month follow-up visit tended to be better than at the 3-month follow-up visit, but was not statistically significant. Four patients experienced post-treatment and transient PIH but three patients were noted to have prolonged erythema. There was no evidence hypopigmentation or worsening of the scarring in any of the study patients. Conclusion: This high-energy pulsed and cool-scanned fractional ablative CO2 laser system is safe and effective for facial atrophic acne scarring. Improvement in scarring was noted in the majority of patients with minimal discomfort and minimal downtime. Continued improvement over time is also an important clinical finding.

Re: Improvement of Dermatochalasis and Periorbital Rhytids with a High-Energy Pulsed CO2 Laser: A Retrospective Study

Dermatologic SurgeryVolume 30, Issue 12p1 p. 1500-1500 Re: Improvement of Dermatochalasis and Periorbital Rhytids with a High-Energy Pulsed CO2 Laser: A Retrospective Study Tina S. Alster MD, Tina S. Alster MD Washington, DCSearch for more papers by this authorSupriya G. Bellew MD, Supriya G. Bellew MD Washington, DCSearch for more papers by this author Tina S. Alster MD, Tina S. Alster MD Washington, DCSearch for more papers by this authorSupriya G. Bellew MD, Supriya G. Bellew MD Washington, DCSearch for more papers by this author First published: 13 December 2004 https://doi.org/10.1111/j.1524-4725.2004.t01-1-30513.xRead the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume30, Issue12p1December 2004Pages 1500-1500 RelatedInformation

Re: Improvement of Dermatochalasis and Periorbital Rhytids with a High-Energy Pulsed CO2 Laser: A Retrospective Study

Re: Improvement of Dermatochalasis and Periorbital Rhytids with a High-Energy Pulsed CO2 Laser: A Retrospective Study

Improvement of Dermatochalasis and Periorbital Rhytides With a High-Energy Pulsed CO2 Laser

Improvement of Dermatochalasis and Periorbital Rhytides With a High-Energy Pulsed CO2 Laser

Improvement of dermatochalasis and periorbital rhytides with a high-energy pulsed CO2 laser: a retrospective study.

Upper eyelid dermatochalasis is typically treated with excisional blepharoplasty. The role of the CO2 laser previously had been confined to that of a vaporizing, incisional, or hemostatic tool. Over the past several years, however, ablative CO2 laser skin resurfacing has been popularized as an adjunctive treatment to blepharoplasty to minimize periorbital rhytides through its vaporizing as well as skin-tightening action. To evaluate the safety and efficacy of a high-energy pulsed CO2 laser as a stand-alone treatment for dermatochalasis and periorbital rhytides. Sixty-seven patients (skin phototypes I-IV) with mild-to-severe upper eyelid dermatochalasis and periorbital rhytides received periocular CO2 laser skin treatment. Global assessment scores of dermatochalasis and rhytides were determined by a side-by-side comparison of periocular photographs preoperatively and 1, 3, and 6 months postoperatively. In addition, caliper measurements of upper eyelids before and 1, 3, and 6 months after treatment were obtained. Both dermatochalasis and periorbital rhytides were significantly improved after periocular CO2 laser skin resurfacing. Patients with more severe dermatochalasis and rhytides showed greater improvement after CO2 laser treatment than did those with mild or moderate involvement. Side effects were limited to erythema and transient hyperpigmentation. No scarring, hypopigmentation, or ectropion were observed. Periocular skin resurfacing with a CO2 laser can safely and effectively improve upper eyelid dermatochalasis and periorbital rhytides.

Is Laser Therapy an Adequate Treatment for Giant Congenital Melanocytic Nevi?

Summary Treatment of congenital and acquired nevi nevocellulares is still controversial because of the possibility of incomplete destruction of deeper situated nevi cells and the possibility of masking a melanoma. Giant congenital melanocytic nevi (GCMN) are rare disfiguring potentially malignant lesions. The approach towards these patients is based on two main considerations: attempt to minimize the risk of malignancy, and obtain an acceptable cosmetic result. Sometimes they are too large to be removed by multiple surgical excision or by use of osmotic expander. The objective of the treatment of giant congenital nevi is to obtain ablation without side effects and aesthetic after-effects. At this time, however, such treatment does not exist. Treatment of GCMN with laser is not an alternative to surgery. Lasers should only be regarded as a treatment option for GCMN that cannot be surgically excised. For the moment laser therapy of GCMN should be restricted to well controlled studies or to individual patients in whom surgical procedure is not possible or where unacceptable scarring would otherwise result. Today ultrashort high energy pulsed CO2 laser and the normal mode ruby laser are the two lasers available. But their results are too unforeseeable, and painful. The combined use of different lasers cannot give us a better solution. In the future new picosecond Q-switched laser can perhaps provide us with another form of treatment, with less pain, and no scars.

Concomitant Use of a High-Energy Pulsed CO2 Laser and a Long-Pulsed (810 nm) Diode Laser for Squamous Cell Carcinoma in Situ

Concomitant Use of a High-Energy Pulsed CO2 Laser and a Long-Pulsed (810 nm) Diode Laser for Squamous Cell Carcinoma in Situ

Laser hair transplantation II.

Micrografting has revolutionized hair transplantation, resulting in far more natural results than have been achieved prior to this technique. Operative problems including bleeding, graft compression, and ease of graft insertion have been alleged to be decreased with the use of a high-energy pulsed CO2 laser for creation of recipient sites. However, because of thermal injury to surrounding tissue, diminished hair growth and slower wound healing also have been seen. A new laser handpiece, designed to minimize tissue thermal damage to hair recipient sites was tested in comparison to 18-gauge needle recipient sites in the same patients. Hair growth counts at 6 months as well as various measurements of operative problems were compared. Two hundred laser grafts were performed on one scalp side and compared to 200 needle grafts on the opposite side. Hair counts preoperatively and at 6 months were performed. Biopsies for depth and surrounding tissue damage were taken intraoperatively. Time for completion of various stages of the procedure for each side were recorded, as well as the incidence of side effects per side. Hair growth was equal for each side. Bleeding and operative time were significantly reduced and ease of graft insertion was increased on the laser side. Graft compression and scarring were not seen. Laser hair transplantation is faster than using conventional techniques and results in equal hair growth, and should be considered as a viable alternative technique.

Treatment of atrophic facial scars with combined use of high-energy pulsed CO2 laser and Er:YAG laser: a practical guide of the laser techniques for the Er:YAG laser.

Although CO2 laser resurfacing provides substantial clinical improvement for atrophic facial scars, the CO2 laser often results in excessive thermal damage to the skin. It increases complications postoperatively. The Er:YAG laser ablates thinner layers of tissue than the CO2 laser with minimal thermal damage to the surrounding skin. To determine the efficacy of combined treatment of atrophic facial scars with high-energy pulsed CO2 laser and Er:YAG laser. One hundred fifty-eight patients were treated with a combination of high-energy pulsed CO2 laser and Er:YAG laser for atrophic facial scars. All patients were evaluated after 3 months of treatment. The scars improved 80-89% in 65 patients, 70-79% in 56 patients, more than 90% in 32 patients, 60-69% in 2 patients, and less than 60% in 3 patients after laser treatment. Treatment of atrophic facial scars with combined use of high-energy pulsed CO2 laser and Er:YAG laser is a very effective and useful method.

Prolonged clinical and histologic effects from CO2 laser resurfacing of atrophic acne scars.

The recent development of high-energy pulsed CO2 lasers that minimize thermal injury to uninvolved adjacent structures has revolutionized the manner in which atrophic facial scars are recontoured. Significant improvement of atrophic scars with laser resurfacing has clearly been demonstrated; however, the exact timing for assessment of skin for further treatment has varied due to the unknown amount of time needed after laser scar resurfacing to effect maximal collagen formation and remodeling. The aim of this study was to determine the immediate and long-term (12-18 months) histologic and clinical effects of atrophic acne scars after CO2 laser resurfacing in order to provide physician guidelines for postoperative clinical assessment for retreatment. Sixty patients (50 women, 10 men, mean age 38 years, skin types I-V) with moderate to severe atrophic facial scars were evaluated. Nineteen patients received regional cheek treatment and 41 patients received full-face resurfacing with a high-energy pulsed CO2 laser. Independent clinical assessments of treated scars were performed at 1, 6, 12, and 18 months and blinded histologic analyses were made of skin biopsies immediately prior to and after laser resurfacing, and at 1, 6, 12, and 18 months postoperatively in six patients. Significant immediate and prolonged clinical improvement in skin tone, texture, and appearance of CO2 laser-irradiated scars was seen in all patients. Average clinical improvement scores were 2.22 (69%) at 1 month, 2.1 (67%) at 6 months, 2.37 (73%) at 12 months, and 2.5 (75%) at 18 months. Continued collagenesis and subsequent dermal remodeling were observed on histologic examination of biopsied tissue up to 18 months after surgery. Continued clinical improvement was observed as long as 18 months after CO2 laser resurfacing of atrophic scars, with an 11% increase in improvement observed between 6 and 18 months postoperatively. We propose that a longer postoperative interval (12-18 months) prior to assessment for re-treatment be advocated in order to permit optimal tissue recovery and an opportunity for collagen remodeling.

The effect of wiping on skin resurfacing in a pig model using a high energy pulsed CO2 laser system.

The impact of wiping in laser skin resurfacing has not been systematically studied. We examined the effects of wiping during single- and multiple-pass high energy pulsed CO2 laser skin resurfacing in a farm pig. Consequences of wiping were evaluated with regard to depth of residual thermal damage, tissue necrosis, and fibroplasia. Also, the impact of wiping on gross wound healing was observed. Wounds were followed for 21 days and biopsies were obtained on postoperative days 0, 1, and 21. Immediate postoperative biopsies of single-pass wounds showed equivalent residual thermal damage regardless of wiping; in contrast, biopsies from multiple-pass sites without wiping showed more extensive and variable residual thermal damage than wiped sites. On postoperative day one, single pass sites without wiping were grossly less erythematous than wiped sites, and biopsies showed less extensive necrosis and inflammation. In contrast, multiple pass sites without wiping were grossly more erythematous than corresponding wiped sites, and biopsies revealed significantly increased and variable necrosis. After 21 days, multiple pass sites without wiping were grossly more erythematous and showed a thicker band of fibroplasia microscopy. For single pass wounds, not wiping decreased the level of wounding. In contrast, not wiping in multiple pass wounds significantly increased the depth and variability of residual thermal damage and necrosis, resulting in prolonged healing.

The use of the 1.0 mm handpiece in high energy, pulsed CO2 laser destruction of facial adnexal tumors.

The treatment of syringoma and trichoepithelioma has included punch and shave biopsy, excision, electrodessication, as well as continuous wave and superpulsed carbon dioxide laser ablation. More recently, high-energy pulsed CO2 lasers have been reported to be effective with standard available handpieces that deliver collimated beams. To report our experience using a focusing handpiece (1.0 mm spot at focus) with a high energy pulsed CO2 laser. Four patients with syringoma and two with multiple trichoepithelioma were treated with a high energy pulsed CO2 laser using a 1 mm spot size focusing handpiece. Pulse energies ranged from 125 to 250 mJ. All patients were followed 2 weeks after treatment and then for variable periods ranging from 8 to 18 months (mean=13.3 months). The 1 mm spot focusing handpiece permitted rapid tumor ablation with optimal matching of lesion size and laser spot diameter. Recurrence of tumor was associated with superficial ablation while complications such as hypopigmentation and atrophy were associated with deeper ablation. Facial adnexal tumors such as syringoma and trichoepithelioma can be successfully treated with the 1.0 mm handpiece in tandem with high energy pulsed CO2 lasers.

Improvement of infraorbital hyperpigmentation following carbon dioxide laser resurfacing.

Many patients who request cutaneous carbon dioxide (CO2) laser resurfacing for correction of periorbital rhytides also complain of "dark circles" under their eyes. This study was conducted in order to determine the effectiveness of high-energy pulsed CO2 laser treatment in reducing infraorbital hyperpigmentation. Significant lightening of infraorbital hyperpigmentation was observed 9 weeks following CO2 laser resurfacing. Melanin reflectance spectrometry readings did not correlate with clinical findings. This study represents the first report of the successful use of a non-pigment-specific laser system for the treatment of infraorbital dark circles. The lack of correlation of melanin spectrometry readings with clinical assessment likely represents an insufficient follow-up time period.

Successful treatment of a giant congenital melanocytic naevus with the highenergy pulsed CO2 laser

Successful treatment of a giant congenital melanocytic naevus with the highenergy pulsed CO2 laser

Histologic Effects of the High-Energy Pulsed CO2 Laser on Photoaged Facial Skin

Received for publication December 26, 1996. Gary J. Rosenberg, M.D. 5258 Linton Boulevard, Suite 303 Delray Beach, Fla. 33484

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.

Histology of high-energy pulsed CO2 laser resurfacing.

Cutaneous laser resurfacing is already proving to be a highly effective tool for improving photodamaged or scarred skin. The clinical and histological effects of the new high-energy, pulsed carbon dioxide (CO2) systems compare favorably with other treatments such as dermabrasion and chemical peels. The tissue-tightening effect noted after laser treatment may account for the claims of superior clinical improvement and needs further investigation.