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Over the last 40 years, the explosive advancement of laser technology has revolutionized the treatment of numerous skin conditions. The principle of selective photothermolysis set forth in 1983 by Anderson and Parrish1 has formed the basis for the development of lasers that selectively target and destroy tissues containing water, hemoglobin, and pigment. Lasers exhibiting such selective action were first applied to improve various potentially disfiguring medical conditions such as port-wine stains, hemangiomas, and pigmented birthmarks. More recently, these same principles have been implemented in an effort to improve the cosmetic appearance of normal and aging skin. The principle of fractional photothermolysis (FP) set fort by Manstein and Anderson2 has further revolutionized nonablative and ablative resurfacing by improving safety and shortening patient recovery times. Because laser treatments target all aspects of photoaging, from ameliorating the appearance of fine and deep rhytides to softening skin texture and improving pigmentation and skin laxity, they are becoming an indispensable tool in the armamentarium of the cosmetic dermatologist. A thorough understanding of the benefits and limitations of each laser technique and the expectations and lifestyle of the individual patient allow the practitioner to achieve the most satisfying cosmetic results.
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Skin rejuvenation by laser was originally performed with devices that resulted in the destruction or ablation of the epidermis and elements of the dermis. The demand for less invasive procedures with shorter recovery times than those of traditional ablative laser resurfacing has led to the development of nonablative laser surgery. Many of these systems emit light in the infrared portion of the electromagnetic spectrum (1,000–1,500 nm), which is absorbed by water in deeper tissues while leaving the epidermis intact. This type of dermal wounding stimulates new collagen and elastin formation, which can improve the appearance of skin with mild-to-moderate photodamage. In general, the results are not comparable to those achieved with ablative lasers, but many patients are willing to accept more modest clinical improvements in exchange for fewer side effects and shorter recovery times. The advent of fractional nonablative laser technology has enabled the delivery of higher energy fluences to treat a fraction of the skin surface. This technology generally allows more effective and safer treatments for photoaging compared to traditional nonablative lasers.
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Proper patient selection is the key to successful nonablative laser resurfacing (see Chapter 251 for ablative laser procedures). Patients with realistic expectations who have mildly to moderately photodamaged skin are the best candidates for nonablative procedures. Results ...