Laser ablative resurfacing for photorejuvenation based on more than a decade's experience and 1200 patients: personal observations.
BACKGROUND
Before lasers, the rejuvenation of photoaged skin, presented clinicians with many problems. Conventional methods, such as dermabrasion and various peels, gave inconsistent results with the potential for adverse side-effects. Lasers have dramatically changed resurfacing procedures and results, although the potential for severe side-effects still exists.


METHODS
The author's experience of over a decade in the use of the pulsed and continuous wave CO(2), Er:YAG, and combined CO(2) and Er:YAG lasers in ablative resurfacing in more than 1200 patients is summarized. Parameters are discussed, and laser/tissue interactions are investigated.


RESULTS
Among the CO(2) lasers used, the C/W system proved more effective in the long term than the pulsed system. For the Er:YAG laser, a novel dual-mode approach was developed which was seen to give better results than the usual ablative Er:YAG settings. The combined Er:YAG/CO(2) system proved, in the author's hands at least, to be an ideal laser ablative resurfacing system when used with the collimated hand-piece and a 50% overlap, which achieves a two-pass equivalence in a single pass. Representative case reports are presented.


CONCLUSIONS
Laser ablative resurfacing with the CO(2) or Er:YAG dual-mode lasers has the potential to produce excellent and long-lasting results, but at the cost of patient downtime and unpleasant side-effects. The combined Er: YAG/CO(2) system, in combination with good wound management techniques has helped reduce downtime and adverse effects.
Trelles
Mario A
MA
Instituto Médico Vilafortuny/Antoni de Gimbernat Foundation, E-43850 Cambrils, Spain. imv@laser-spain.com