One-pass resurfacing with a combined-mode erbium: YAG/CO2 laser system: a study in 102 patients

One-pass resurfacing with a combined-mode erbium: YAG/CO2 laser system: a study in 102 patients
Issue online:
20 Apr 2002
Accepted for publication 21 October 2001
To cite this article: M.A Trelles, I Allones, R Luna (2002)
One-pass resurfacing with a combined-mode erbium: YAG/CO2 laser system: a study in 102 patients
British Journal of Dermatology 146 (3), 473Ò480.
doi:10.1046/j.1365-2133.2002.04643.x
Blackwell Synergy

M.A.Trelles, I.Allones and R.LunaInstituto M»dico Vilafortuny/Antoni de Gimbernat Foundation, Av. Vilafortuny 31, E-43850 Cambrils, Spain

Correspondence: Mario A.Trelles. E-mail: imv@tinet.fut.es . The authors hereby affirm that they have no interest, financial or otherwise, to disclose regarding the manufacturers of the systems used in this study.

Abstract
SummaryBackground The CO2 and erbium: YAG (Er: YAG) lasers have been used for skin resurfacing. A recently developed system combines pulsed ablative Er: YAG and continuous wave subablative CO2 wavelengths in one console.

Objectives To assess the potential benefits of this system.

Methods The study follows 102 women, skin types IÒV, with 26 full face, 48 perioral and 28 periocular resurfacing procedures. The ablative Er: YAG pulse (350 μs, 29 J cm−2) is followed immediately by a non-ablative CO2 laser shot (4Ò6 W, 50 ms) through the same collimated handpiece (3-mm diameter spot), 50% overlapping, repetition rate 10 Hz, giving two-pass equivalence with one single pass.

Results Patients scored the results as very good (n = 67), good (n = 25) and fair (n = 10). Mild but successfully resolved side-effects occurred in only four patients. The 2-month histology showed a good band of new collagen tightening the overlying healthy epidermis. Follow-up periods ranged from 1?5 to 2 years (mean ± SD 1?76 ± 0?33).

Conclusions This device at the above settings offers speedy resurfacing without compromising the quality of the procedure for the patient, and may well satisfy the basic requirements of laser skin resurfacing.

When specially designed CO2 lasers were first introduced into the field of resurfacing for laser skin rejuvenation, they revolutionized the treatment of facial rhytides. However, side-effects associated with the CO2 resurfacing laser include hyper- and hypopigmentation and prolonged erythema.1,2 A sound knowledge of laser/tissue interaction at 10 600 nm is therefore necessary.

Overtreatment resulting in atrophic and hypertrophic scarring has been noted in the literature. However, deep but controlled coagulative residual thermal damage (RTD) in laser-treated skin, such as has been reported with the CO2 laser, encourages the synthesis of new collagen, which acts on the newly formed epidermis to tighten it, thereby removing rhytides. The degree of RTD depends on the laser fluence employed and the number of laser passes made across the treated area. Because of the coagulative effect in the dermis, the CO2 laser also offers good control of bleeding with a dry treatment field.3,4

The appearance of the erbium: YAG (Er: YAG) laser and its use in resurfacing introduced a new set of tissue effects, governed by the approximately 10 times higher absorption in water of the Er: YAG 2940 nm wavelength compared with the 10,600 nm of the CO2 laser, and the short pulse width (typically about 350 μs). These settings produced a constant depth of highly efficient ablation per laser shot with minimal thermal damage in the underlying tissue, the depth of ablation being fluence dependent.5 The comparatively shallow coagulated field did not have the same collagen synthesis effect or haemostatic effect as the CO2 laser, so bleeding was reported as more prevalent with the Er: YAG, and the end result was not as good.6,7

A new system, the DermaÙ K, was introduced by ESC/Sharplan (Yokneam, Israel), which combined the two lasers in one console, delivered through a single handpiece. We have already reported a preliminary trial of this system with 10 patients.8 The present study reports our experience with 102 patients, and a mean follow-up of 1?76 years.

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