Several ablative and nonablative laser technologies are available for the treatment of cosmetic concerns including photodamage, rhytides, and scarring.
Fractional laser technology has increased clinical applications and reduced postoperative recovery and side-effect profiles of laser skin resurfacing.
Individual patient characteristics and expectations, as well as the risks and benefits inherent to each treatment modality, should be considered prior to laser selection.
Years of damaging ultraviolet light exposure manifests clinically with skin dyspigmentation, roughened surface texture, and variable degrees of wrinkling and laxity. Other imperfections, such as scars from trauma, past surgical procedures, or acne, also affect the appearance of the skin. Histologically, the effects of aging and trauma are usually limited to the epidermis and upper papillary dermis, levels that are easily targeted by a variety of ablative and nonablative lasers.
The selection of lasers available to treat cutaneous photodamage, textural irregularities, and cosmetic imperfections continues to grow. Progress over the past few decades has led to a great increase in the number of laser skin resurfacing procedures with options that cater to a diverse patient population. The spectrum ranges from fully ablative resurfacing with pulsed and scanned carbon dioxide (CO2) and erbium:yttrium aluminum garnet (Er:YAG) lasers, to newer nonablative and fractional laser devices.1-3 Determining the most appropriate laser system requires consideration of the severity of the photodamage, scarring, or other imperfection to be treated, the expertise of the dermatologic surgeon, and the expectations and lifestyle of the individual patient. Thorough preoperative patient evaluation and preparation, intraoperative technical expertise, and close postoperative care and followup are all essential to optimizing clinical outcomes while preventing and minimizing the risk of complications.
ABLATIVE LASER RESURFACING
The mechanism of action of either the CO2 or Er:YAG system for laser skin resurfacing (LSR) involves the absorption of infrared wavelengths by water-containing tissue. Treatment with these laser systems causes tissue vaporization and dermal collagen denaturation, which results in tissue contraction and subsequent stimulation of neocollagenesis.4,5 Ablative LSR treatment thus causes removal of the entirety of the epidermis and a portion of the dermis.6
Ablative laser wounds induce a cascade of physiologic healing responses, ultimately leading to cutaneous remodeling and the desirable aesthetic results of laser resurfacing. After ablative LSR, it is thought that progenitor cells dwelling within the pilosebaceous units play a key role in repopulating the epidermis as well as recruiting other cells to the area to aid in various wound-healing processes. For this reason, the use of ablative LSR is not advocated on nonfacial skin as the relative paucity of pilosebaceous units in such areas hampers postoperative healing and may lead to increased risk of adverse events.7
Tissue ablation results in significant postoperative recovery for patients with serosanguinous discharge and crusting during the 7- to 10-day reepithelialization ...