Laser Skin Resurfacing

For patients who suffer from facial wrinkles and age spots, laser skin resurfacing can be a good option for facial rejuvenation. Unfortunately one laser does not necessarily address all concerns. There are many different lasers on the market today and the topic can be very confusing. In addition to the various technologies which are available, there are many brand names within each technology claiming superiority over another. In laser facial resurfacing, there are ablative lasers and non-ablative lasers. The two most common technologies for ablative lasers are carbon dioxide lasers and erbium lasers.

Carbon dioxide lasers resurface the skin by heating water molecules. The depth of penetration for the carbon dioxide laser is around 0.2mm per pass, though heating can occur to a greater depth. Multiple passes can be made with the laser to increase the depth of tissue injury.  The carbon dioxide laser addresses pigment and wrinkles in two ways. CO2 laser resurfacing will ablate the outer layer of skin, the epidermis. This is the layer in which pigment cells live. The heat from the laser will be transmitted to the dermis causing the collagen of the skin to denature and have to reform. By reforming the collagen and removing some water from the skin, the skin is tightened and wrinkles are reduced. Histologic studies have shown that CO2 laser treatments are one of only three treatments thus far scientifically proven to increase collagen in the skin. Care must be taken though not to ablate the skin to the level of the dermis as scarring can occur.

Erbium lasers are also ablative though not as deep as the carbon dioxide. Erbium lasers will penetrate about 0.05mm. This means that there is less tissue damage which results in faster recovery. Unfortunately because the laser does not penetrate significantly into the epidermis, wrinkle improvement is not as great.
Even within the lasers there are different delivery systems which can be used.

Lasers can be delivered in classic mode where an entire area is treated or fractional mode, where a checkerboard type pattern is created. This leaves islands of undamaged tissue between the treated areas allowing for faster wound healing and decreased down time. The fractional technology has been used with erbium lasers for some time but has just recently been applied to carbon dioxide lasers with excellent results