title: Variable pulse erbium:YAG laser skin resurfacing of perioral rhytides and side-by-side comparison with carbon dioxide laser.
abstract: OBJECTIVE
  Laser resurfacing of facial rhytides has become a popular treatment option for many patients with wrinkles, photoaging, and acne scarring. Laser wavelength/pulse duration options and new techniques continue to shorten the healing phase associated with laser skin resurfacing while maintaining clinical efficacy. Variable pulse erbium:YAG (Er:YAG) laser systems are now available that offer the surgeon the ability to vary the Er:YAG pulse duration from a pulse that is primarily ablative to one that is more thermal. The objective of this study was to evaluate the histologic effects created with a variable pulse Er:YAG laser. To study prospectively the clinical effects on upper lip rhytides with a variable pulse Er:YAG laser when compared side by side with pulsed carbon dioxide (CO(2)) laser resurfacing.
  
  
  METHODS
  Forty-two treatment sites on 21 patients were randomized and evaluated after treatment of the upper lip region with CO(2) laser resurfacing on one side and a variable pulse Er:YAG laser on the other. Patient diaries were maintained to assess erythema, crusting, pain, and pigmentary changes. Blinded objective grading of improvement was performed. Chromometer measurements were obtained to analyze erythema.
  
  
  RESULTS
  The variable pulse Er:YAG laser treatment reduced the duration of crusting on average from 7.7 days with CO(2) to 3.4 days. Chromometer measurements noted decreased postoperative erythema. Grading by physicians in a blinded manner showed 63% improvement for the CO(2) treatment site and 48% improvement in the variable pulse Er:YAG site. No cases of permanent hyperpigmentation, hypopigmentation, or scarring occurred.
  
  
  CONCLUSIONS
  The variable pulse Er:YAG laser resurfacing is a safe and effective resurfacing tool, which combines ablative and thermal modalities. The protocol used in this study approaches but does not equal the results we have traditionally seen with CO(2) laser resurfacing.
authors.affiliation: Laser Center of Virginia, Virginia Beach, Virginia 23454, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Newman
authors.forename: J L
authors.initials: JL
authors.lastname: Lord
authors.forename: K
authors.initials: K
authors.lastname: Ash
authors.forename: D H
authors.initials: DH
authors.lastname: McDaniel
mesh_terms: D002245:Carbon Dioxide; D062109:Dermatologic Surgical Procedures; D004871:Erbium; D004890:Erythema; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D007834:Lasers / Q000009:adverse effects; D015361:Rhytidoplasty / Q000379:methods*; D015595:Skin Aging; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: D002245:Carbon Dioxide; D004871:Erbium