Ultrapulse Carbon Dioxide Laser Research Articles

Skin resurfacing with the Ultrapulse carbon dioxide laser. Observations on 100 patients.

The Ultrapulse carbon dioxide (CO2) laser has been shown to be a highly effective treatment for photodamaged skin including improvement of rhytides, precancerous and benign skin lesions, as well as superficial benign pigmented lesions. We describe our experiences using the Ultapulse CO2 laser in treating 100 patients with different severities of photodamaged skin. All patients had moderately or severely photodamaged skin and were selected for treatment with the Ultrapulse CO2 laser to evaluate the efficacy and toxicity of this treatment. The patients were placed on a pretreatment regimen for 2-6 weeks prior to receiving treatment with the Ultrapulse CO2 laser. Patients were evaluated for pre- and posttreatment severity of photodamage. In addition, skin surface replicas were obtained in selected patients and evaluated by computer image analysis technology. At 1 month post-laser treatment, 68 patients received a moderate improvement, five patients achieved a marked improvement, and the remaining 27 patients showed minimal improvement. By 2 months post-laser treatment, 20 of the 27 patients who at 1 month showed only minimal improvement revealed a moderate to marked improvement from baseline. All the patients studied developed a transient erythema that lasted up to 6 weeks, and many of these patients showed a transient hyperpigmentation that persisted for up to 4 months. The Ultrapulse CO2 laser is confirmed as an effective treatment for skin resurfacing of photodamaged skin.

Mini-Slit Graft Hair Transplantation Using the Ultrapulse Carbon Dioxide Laser Handpiece

The new Ultrapulse carbon dioxide (CO2) laser technology has added a new dimension to many cosmetic surgery procedures including hair transplantation. Early reports by Unger and David (Laser Hair Transplantation. J Dermatol Surg Oncol 1994;20:515-21) have been encouraging with the potential of minimal bleeding, ease of placing transplanted grafts, and an overall shortened operative time. A 2-mm slit handpiece has been recently created to expedite this procedure. The purpose of this study is to further investigate the use and efficiency of the new Ultrapulse CO2 laser slit handpiece in hair transplants. Mini-slit graft hair transplants using the new Ultrapulse CO2 laser slit handpiece were done on 25 patients in 30 transplant sessions. Donor minigrafts were obtained by the strip harvesting technique using a triple-blade scalpel. Approximately 200-400 recipient slits were made with the 2-mm slit handpiece at the laser setting of 350 mJ, 12 W, 0.8 seconds per pulse. All grafts were easily placed into recipient sites with minimal bleeding and charring. The procedure was done in half the time of the conventional non-laser technique. Postoperatively, patients were quite satisfied with little pain and swelling. Histologic exams of the laser-treated slits showed minimal adjacent tissue necrosis. Long-term follow-up visits showed good regrowth of hair in these grafts. The new Ultrapulse CO2 laser slit handpiece proved to be an effective tool for mini-slit graft hair transplantation.

Laser Resurfacing in Pigmented Skin

Laser skin resurfacing is a very promising new treatment for solar elastosis and acne scars. The Ultrapulse carbon dioxide (CO2) laser and the SilkTouch flashscanner allow precise depth control and char-free ablation. Earlier studies have been done mainly on Caucasian skin types I and II, but very little data were available on pigmented skin. The purpose of this study is to assess the efficacy and safety of laser skin resurfacing in skin types III and IV. Thirty Asian and Hispanic patients were treated for facial rhytides and acne scars. All patients were instructed to use tretinoin cream 0.05%, hydroquinone 5%, and desonide 0.1% cream nightly for 2-4 weeks prior to the laser treatment. The Ultrapulse 5000C CO2 laser with the Truespot 3-mm collimated handpiece at the setting of 250-450 mJ per pulse, or the Silk-Touch flashscanner at the setting of 5-7 W, 0.2-second pulse duration, and 4-mm (M) spot size, was used. Patients were evaluated clinically, and global response was assessed by both clinicians and patients. The facial rhytides and acne scars improved 25-50% in all patients after one laser treatment. The most common side effects were persistent erythema that resolved on the average of 6 weeks. Hyperpigmentation occurred, but was reduced with regular use of tretinoin, hydroquinone, and desonide cream both pre- and postoperatively along with use of broad spectrum sunscreen after treatments. Laser skin resurfacing can be used to treat facial rhytides and acne scars in skin phototypes III and IV. When proper pre- and postoperative management is implemented, the risk of dyspigmentation can be reduced.

Animal study of skin resurfacing using the ultrapulse carbon dioxide laser.

Ultrapulse carbon dioxide laser ablation of rabbit skin was investigated. Macroscopic and microscopic appearance of the ablation site was evaluated for 1 month. The Ultrapulse carbon dioxide laser was set in the ultrapulse mode and the parameters selected were 250 mJ of energy per pulse and 2 W average power with the 3-mm spot size collimated handpiece. Macroscopic investigation showed that ultrapulse carbon dioxide laser ablation removed rabbit skin precisely and bloodlessly without char formation. Skin re-epithelialization without scarring and perfect hair growth restoration within 3 weeks were impressive. Microscopic investigation demonstrated a layer of tissue thermal necrosis measured as 70 +/- 10 microns. During the first 2 weeks, laser ablation wound re-epithelialization begins with multiplying epidermal layers (from 2-3 cell layers to about 13 to 15 cell layers). There were marked fibroblastic reactions and capillary congestion within papillary dermis. By the end of 4 weeks, the thickened epidermal layer appeared normal. The repaired papillary dermal collagen showed a relative compact configuration and greater cellularity in Masson stain was found 2 to 3 weeks later and also was near normal 4 weeks after laser treatment. These findings suggest that Ultrapulse's delivery of short-duration, high-energy pulses may provide a new approach (laser dermal ablation) to damage selectively the epidermis and papillary dermis of rabbit skin in one single-pulse impaction with uneventful wound healing within 1 month.

Ultrapulse carbon dioxide laser resurfacing and facial cosmetic surgery

Over 100 patients have been treated with the ultrapulse carbon dioxide laser since July 1994. The high power square wave pulse of 600 watts at less than 1 msec (which is less than the thermal relaxation time of tissue) dissipates heat during vaporization, thus producing a ‘cold beam’ and decreasing thermal injury. Similarly, hemostatic incision may be achieved by the focus beam at short repetition rates allowing incision with simultaneous coagulation of small vessels. Seventy-four patients underwent resurfacing for rhytides and photo aging with excellent cosmetic results and no texture or pigmentary change. Facial cosmetic surgery (facelift/eyelid lift/forehead lift) was accomplished in 41 patients using the laser scalpel. Patient selection, preparation, sequence of the laserbrasion and incisional techniques are summarized.

Ultrapulse carbon dioxide laser resurfacing and facial cosmetic surgery

Ultrapulse carbon dioxide laser resurfacing and facial cosmetic surgery

Ultrapulse carbon dioxide laser removal of periocular wrinkles in association with laser blepharoplasty.

Removal of periocular wrinkles is a common yet difficult problem. There are many techniques currently available, all of which have some drawbacks. With the advent of new generation ultrapulse carbon dioxide lasers, skin can now be resurfaced successfully with minimal risk and side effects. In our study of 36 patients we assessed the benefit of using ultrapulse carbon dioxide (CO 2) laser to resurface the periorbital skin in association with transconjunctival lower lid CO 2 laser blepharoplasty. We found that 36/36 (100%) patients had good to excellent results. The incidence of side effects was very low. We also found that 2/36 (5.6%) of patients developed mild clinically insignificant hypopigmentation and 1/36 (2.8%) developed mild scarring, which resolved with one injection of triamanalone 10 mg/ml. No patients had hyperpigmentation. In addition, 1/36 (2.8%) patients developed transient ectropion, which resolved spontaneously in 6 weeks. We conclude that ultrapulse CO 2 laser is an excellent method for treating periocular wrinkle lines and can be readily performed in conjunction with a transconjunctival lower lid blepharoplasty.