Laser Treatment
Wrinkles can be the result of any one, or a combination of factors including loss of collagen, sun damage,
smoking, alcohol consumption and also hormonal changes. Aging itself is a large contributing factor. Collagen can
decrease at a rate of 1% per year after the age of 40. Sun exposure accelerates the aging process and loss of collagen.
It also damages the collagen fibers so that it may no longer support the upper layers of the skin, which results
in the formation of wrinkles. Carbon dioxide is the main ablative laser utilized.
Prior to the procedure a full medical history should be discussed with your physician or office staff. Cosmetics or
facial lotions should be removed at least 30 minutes prior to the procedure so they don't interfere with the laser treatment.
The area to be treated should be clear of redness or irritation.
Preoperatively do not take medication that suppress inflammation, ie aspirin, NSAIDs, Motrin, Advil, Aleve,
arthritis medication and steroids two weeks before or one week after the laser process. Remove all makeup and
moisturizers one hour prior to the procedure.
CARBON DIOXIDE LASER AND ERBIUM lASER RESURFACING
CO2 laser techniques have been introduced for the treatment of certain facial wrinkles, facial scars and aging or
sun damaged skin including perioral lip lines, eyelid lines, crows feet and facial scarring, especially acne scarring.
The laser relies on extremely high pulse energy delivered in very short pulses causing immediate coagulation of
small predictable volumes of tissue.
Conditions treatable with this laser include perioral vertical furrows or lip lines, crows feet and the fine lower
eyelid wrinkles seen in aging skin. Patients with acne scarring, who are good candidates for dermabrasion, are also
excellent candidates for the use of this laser. Until lasers, lip lines, eye lines and glabellar frown lines were
treated by means of dermabrasion, chemical peeling agents, or the introduction of dermal filling substances.
Dermabrasion is a time-consuming, clinically difficult procedure, which requires careful technique in order to avoid
complications. Even with proper technique, scarring, textural changes and pigmentary changes are observed.
Chemical peels have been used to treat facial wrinkles, however, except for deep peeling with phenol, all but the
finest wrinkles are unaffected by these procedures. Phenol peels are always associated with permanent pigment loss,
textural changes in the skin, and may have serious systemic effects if used improperly. Trichloracetic acid and
glycolic acid, although useful in certain clinical circumstances, are not capable of eliminating deeper wrinkle lines.
Dermabrasion is a procedure widely used to treat lip lines and facial scars, especially caused by acne. It is a
very technique-sensitive procedure requiring proper training, surgical skill, and good judgment in order to obtain
good results. Dermabrasion, even under ideal conditions, can cause scarring, pigmentary disturbances, and skin
texture changes.
ERBIUM AND CO2
The Erbium emits at 2.94 microns and the CO2 emits at 10.6 microns. 2.94 microns is absorbed in tissue approximately
18.8 times more readily than 10.6 microns. This means that residual thermal damage at 2.94 microns is substantially
less than 10.6 microns. Histology has shown that after tissue is ablated, there is a zone of thermal damage of between
50 and 150 microns a 10.6 microns. At 2.94 microns this zone is between 4 and 10 microns, approximately the thickness
of one cell. Additionally, 2.94 microns is directly absorbed by collagen and other dermal proteins allowing true dermal
ablation. 10.6 microns only vaporizes extracellular water in the dermas. These are the factors that contribute to the
advantages of Erbium over CO2.
Advantages of Erbium over CO2
· Typically, only topical anesthesia require
* EMLA pre-op (optional)
* 0.5%, 1% and 2% Xylocaine with or without Epinephrine applied topically between passes
* Facial nerve blocks (if necessary)
· Reduced post-operative pain
* Typically, slight burning for up to 24 hours. Tylenol is used.
· Reduced re-epithelization time
* 4-7 days
· Fewer complications
· Reduced Erythema
* Within 4-14 days the skin has gone to a very light pink shade
· Reduced post-inflammatory hyperpigmentation
* A study of Korean patients has shown that with the CO2 between 90 to 95% post-inflammatory
hyperpigmentation and with the Erbium about 4%
· True dermal ablation
* More successful removal of sun damaged dermal tissue
* Better improvement of acne scars
* Cleaner removal of epidermal and dermal cutaneous lesions
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