title: Noninvasive skin measurements after CO(2) and erbium laser resurfacing.
abstract: BACKGROUND
  Improvement in skin after laser resurfacing depends on treatment to a precise level. The target treatment level will depend on skin type, anatomic location, and severity of the presenting problem. The development of noninvasive skin measurements that correlate with histologic changes would provide a useful intraoperative guide for treatment.
  
  
  OBJECTIVE
  The relationship among different types of lasers and levels of applied energy; objective real-time noninvasive measures of the skin; and histologic condition were studied in an attempt to gain information that could aid in achieving safer and more predictable laser skin resurfacing.
  
  
  METHODS
  The paraspinal skin of Yorkshire hybrid pigs was used for the study. In pig 1, study sites were treated with the Ultrapulse CO(2) laser (Coherent, Inc, Santa Clara, CA) with the CP-G at 300 ml for 0 to 5 passes. The Sciton Contour erbium: YAG llaser (Contour, Sciton, Palo Alto, CA) set at 200 mum of pure ablation was used to treat a separate but adjacent area for 0 to 5 passes. Treated sites and control sites were evaluated by measurements of biomechanical properties, digital imaging, and barrier integrity. In pig 2, the study was repeated with the Sciton Contour erbium:YAG laser at 10 different energy levels. Full-thickness punch biopsy specimens were obtained immediately after treatment and correlated with the biomechanical measures.
  
  
  RESULTS
  After the third pass with the CO(2) laser, there was no additional tissue ablation or change in surface biophysical measurements. There was an apparent increase in inflammation in the lower dermis with passes 4 and 5 seen on day 2 biopsies that suggested deeper thermal effects. The erbium laser continued to ablate with increasing applied energy. The change in viscoelastic creep correlated with the laser energy applied and inversely correlated with the remaining dermal depth of the skin after laser treatment.
  
  
  CONCLUSIONS
  The measurement of immediate changes in viscoelastic creep should be further studied as a means of guiding intraoperative erbium laser resurfacing. Histologic evaluation suggests that the erbium:YAG laser may be a more effective tool for dermal ablation than the CO(2) laser.
authors.affiliation: Division of Plastic, Reconstruction, and Hand Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA.
authors.forename: W John
authors.initials: WJ
authors.lastname: Kitzmiller
authors.forename: Ryan A
authors.initials: RA
authors.lastname: Stanton
authors.forename: R Randall
authors.initials: RR
authors.lastname: Wickett
authors.forename: Gaurva
authors.initials: G
authors.lastname: Tolia
authors.forename: Raymond E
authors.initials: RE
authors.lastname: Boissy
authors.forename: Marty O
authors.initials: MO
authors.lastname: Visscher