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Pulsed Carbon Dioxide Laser Resurfacing of Photoaged Facial Skin

Pulsed Carbon Dioxide Laser Resurfacing of Photoaged Facial Skin Abstract Background and Design: Public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microseconddomain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1-millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four "blinded" reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded. Results: All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythema and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar. Conclusions: Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heatinduced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.(Arch Dermatol. 1996;132:395-402) References 1. Gilchrest BA. Skin aging and photoaging: an overview . J Am Acad Dermatol. 1989;21:610-613.Crossref 2. Kurban RS, Bhawan J. Histologic changes in skin associated with aging . J Dermatol Surg Oncol. 1990;16:908-914.Crossref 3. Smith L. Histopathologic characteristics and ultrastructure of aging skin . Cutis. 1989;43:414-424. 4. Braverman IM, Fonferko BA. Studies in cutaneous aging, I: the elastic fiber network . J Invest Dermatol. 1982;78:434-443.Crossref 5. Braverman IM, Fonferko BA. Studies in cutaneous aging, II: the microvasculature . J Invest Dermatol. 1982;78:444-448.Crossref 6. Montagna W, Kirchner S, Carlisle K. Histology of sun-damaged skin . J Am Acad Dermatol. 1989;21:907-918.Crossref 7. Warren R, Gartstein V, Kligman AM, et al. Sunlight and facial skin: a histologic and quantitative study . J Am Acad Dermatol. 1991;25:751-760.Crossref 8. West MD. The cellular and molecular biology of skin aging . Arch Dermatol. 1994;130:87-95.Crossref 9. Bolgnia JL. Aging skin . Am J Med. 1995;98( (suppl 1A) ):99S-103S.Crossref 10. Fitzpatrick RE, Goldman MP. Advances in carbon dioxide laser surgery . Clin Dermatol. 1995;13:35-47.Crossref 11. Polanyi TG. Laser physics . Otolaryngol Clin North Am. 1983;16:753-761. 12. Fitzpatrick RE, Tope WD, Goldman MP, Satur NM. Pulsed carbon dioxide laser, trichloracetic acid, Baker-Gordon phenol, and dermabrasion: a comparative clinical and histological study of cutaneous resurfacing in a porcine model . Arch Dermatol. 1996;132:469-471.Crossref 13. Griffiths CEM, Wang TS, Hamilton TA, Voorhees JJ, Ellis CN. A photonumeric scale for the assessment of cutaneous photodamage . Arch Dermatol. 1992; 128:347-351.Crossref 14. Griffiths CEM, Russman AN, Majmudar G, Singer RS, Hamilton TA, Voorhees JJ. Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid) . N Engl J Med. 1993;329:530-535.Crossref 15. Mandy SH. Tretinoin in the pre-operative and post-operative management of dermabrasion . J Am Acad Dermatol. 1986;15:878-879.Crossref 16. Nelson BR, Fader DJ, Gillard M, et al. Pilot histologic and ultrastructural study of the effects of medium-depth chemical facial peels on dermal collagen in patients with actinically damaged skin . J Am Acad Dermatol. 1995;32:472-480.Crossref 17. Kligman AM, Baker TJ, Gordon HL. Long-term histologic follow-up phenol face peels . Plast Reconstr Surg. 1985;75:652-659.Crossref 18. Spira M, Dahl C, Freeman R, Gerow FJ, Hardy SB. Chemosurgery: a histological study . Plast Reconstr Surg. 1970;45:247-253.Crossref 19. Baker TJ, Gordon HL, Mosienko P, Seckinger DL. Long-term histological study of skin after chemical face peeling . Plast Reconstr Surg. 1974;53:522-525.Crossref 20. Pollack SV. Wound healing: a review: the biology of wound healing . J Dermatol Surg Oncol. 1979;5:389-393.Crossref 21. Behin F, Feuerstein SS, Marovitz WF. Comparative histological study of mini pig skin after chemical peel and dermabrasion . Arch Otolaryngol. 1977;103:271-277.Crossref 22. Nelson BR, Majmudar G, Griffiths EM, et al. Clinical improvement following dermabrasion of photoaged skin correlates with synthesis of collagen I . Arch Dematol. 1994;130:1136-1142.Crossref 23. Benedetto AV, Griffin TD, Bendetto EA, Humenink HM. Dermabrasion: therapy and prophylaxis of the photoaged face . J Am Acad Dermatol. 1992;27:439-447.Crossref 24. Winton GR, Salasche SJ. Dermabrasion of the scalp as a treatment for actinic damage . J Am Acad Dermatol. 1986;14:661-668.Crossref 25. Epstein E. Dermabrasion . In: Skin Surgery . Philadelphia, Pa: WB Saunders Co; 1987:593-610. 26. Green HA, Burd E, Mishioka NS, et al. Middermal wound healing: a comparison between dermatomal excision and pulsed carbon dioxide laser ablation . Arch Dermatol. 1992;128:639-645.Crossref 27. Hall RR. The healing of tissues incised by a carbon-dioxide laser . Br J Surg. 1971;58:222-225.Crossref 28. Rainoldi R, Candiani P, Virgilis G, et al. Connective tissue regeneration after CO2 laser therapy . Int Surg. 1983;68:167-170. 29. Tans LJ. Experimentelle Untersuchungen über Entstehung von astigmatismus durch nicht-perforirende Corneawunden . Graefes Arch Ophthalmol. 1898; 45:117-152.Crossref 30. Stringer H, Parr J. Shrinkage temperature of eye collagen . Nature . 1964;204: 1307.Crossref 31. Stringer AR, Shaw EL, Kaufmann HE, et al. Themokeratoplasty . Trans Am Acad Ophthalmol Otolaryngol. 1973;77:441. 32. Allain JC, Lous LE, Cohen-Solal L, Bagin S, Maroteaux P. Isometric tensions developed during the hydrothermal swelling of rat skin . Connective Tissue Res. 1980;7:127-133.Crossref 33. Thompson VM, Seiler T, Durrie DS, Cavanaugh TB. Holmium:YAG laser thermokeratoplasty for hyperopia and astigmatism: an overview . Refract Corneal Surg. 1993;9( (suppl) ):S134-S137. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Pulsed Carbon Dioxide Laser Resurfacing of Photoaged Facial Skin

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Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1996.03890280047007
Publisher site
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Abstract

Abstract Background and Design: Public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microseconddomain pulsed CO2 laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO2 laser energy (10 600 nm, 3-mm collimated beam, <1-millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four "blinded" reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded. Results: All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythema and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar. Conclusions: Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO2 laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heatinduced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.(Arch Dermatol. 1996;132:395-402) References 1. Gilchrest BA. Skin aging and photoaging: an overview . J Am Acad Dermatol. 1989;21:610-613.Crossref 2. Kurban RS, Bhawan J. Histologic changes in skin associated with aging . J Dermatol Surg Oncol. 1990;16:908-914.Crossref 3. Smith L. Histopathologic characteristics and ultrastructure of aging skin . Cutis. 1989;43:414-424. 4. Braverman IM, Fonferko BA. Studies in cutaneous aging, I: the elastic fiber network . J Invest Dermatol. 1982;78:434-443.Crossref 5. Braverman IM, Fonferko BA. Studies in cutaneous aging, II: the microvasculature . J Invest Dermatol. 1982;78:444-448.Crossref 6. Montagna W, Kirchner S, Carlisle K. Histology of sun-damaged skin . J Am Acad Dermatol. 1989;21:907-918.Crossref 7. Warren R, Gartstein V, Kligman AM, et al. Sunlight and facial skin: a histologic and quantitative study . J Am Acad Dermatol. 1991;25:751-760.Crossref 8. West MD. The cellular and molecular biology of skin aging . Arch Dermatol. 1994;130:87-95.Crossref 9. Bolgnia JL. Aging skin . Am J Med. 1995;98( (suppl 1A) ):99S-103S.Crossref 10. Fitzpatrick RE, Goldman MP. Advances in carbon dioxide laser surgery . Clin Dermatol. 1995;13:35-47.Crossref 11. Polanyi TG. Laser physics . Otolaryngol Clin North Am. 1983;16:753-761. 12. Fitzpatrick RE, Tope WD, Goldman MP, Satur NM. Pulsed carbon dioxide laser, trichloracetic acid, Baker-Gordon phenol, and dermabrasion: a comparative clinical and histological study of cutaneous resurfacing in a porcine model . Arch Dermatol. 1996;132:469-471.Crossref 13. Griffiths CEM, Wang TS, Hamilton TA, Voorhees JJ, Ellis CN. A photonumeric scale for the assessment of cutaneous photodamage . Arch Dermatol. 1992; 128:347-351.Crossref 14. Griffiths CEM, Russman AN, Majmudar G, Singer RS, Hamilton TA, Voorhees JJ. Restoration of collagen formation in photodamaged human skin by tretinoin (retinoic acid) . N Engl J Med. 1993;329:530-535.Crossref 15. Mandy SH. Tretinoin in the pre-operative and post-operative management of dermabrasion . J Am Acad Dermatol. 1986;15:878-879.Crossref 16. Nelson BR, Fader DJ, Gillard M, et al. Pilot histologic and ultrastructural study of the effects of medium-depth chemical facial peels on dermal collagen in patients with actinically damaged skin . J Am Acad Dermatol. 1995;32:472-480.Crossref 17. Kligman AM, Baker TJ, Gordon HL. Long-term histologic follow-up phenol face peels . Plast Reconstr Surg. 1985;75:652-659.Crossref 18. Spira M, Dahl C, Freeman R, Gerow FJ, Hardy SB. Chemosurgery: a histological study . Plast Reconstr Surg. 1970;45:247-253.Crossref 19. Baker TJ, Gordon HL, Mosienko P, Seckinger DL. Long-term histological study of skin after chemical face peeling . Plast Reconstr Surg. 1974;53:522-525.Crossref 20. Pollack SV. Wound healing: a review: the biology of wound healing . J Dermatol Surg Oncol. 1979;5:389-393.Crossref 21. Behin F, Feuerstein SS, Marovitz WF. Comparative histological study of mini pig skin after chemical peel and dermabrasion . Arch Otolaryngol. 1977;103:271-277.Crossref 22. Nelson BR, Majmudar G, Griffiths EM, et al. Clinical improvement following dermabrasion of photoaged skin correlates with synthesis of collagen I . Arch Dematol. 1994;130:1136-1142.Crossref 23. Benedetto AV, Griffin TD, Bendetto EA, Humenink HM. Dermabrasion: therapy and prophylaxis of the photoaged face . J Am Acad Dermatol. 1992;27:439-447.Crossref 24. Winton GR, Salasche SJ. Dermabrasion of the scalp as a treatment for actinic damage . J Am Acad Dermatol. 1986;14:661-668.Crossref 25. Epstein E. Dermabrasion . In: Skin Surgery . Philadelphia, Pa: WB Saunders Co; 1987:593-610. 26. Green HA, Burd E, Mishioka NS, et al. Middermal wound healing: a comparison between dermatomal excision and pulsed carbon dioxide laser ablation . Arch Dermatol. 1992;128:639-645.Crossref 27. Hall RR. The healing of tissues incised by a carbon-dioxide laser . Br J Surg. 1971;58:222-225.Crossref 28. Rainoldi R, Candiani P, Virgilis G, et al. Connective tissue regeneration after CO2 laser therapy . Int Surg. 1983;68:167-170. 29. Tans LJ. Experimentelle Untersuchungen über Entstehung von astigmatismus durch nicht-perforirende Corneawunden . Graefes Arch Ophthalmol. 1898; 45:117-152.Crossref 30. Stringer H, Parr J. Shrinkage temperature of eye collagen . Nature . 1964;204: 1307.Crossref 31. Stringer AR, Shaw EL, Kaufmann HE, et al. Themokeratoplasty . Trans Am Acad Ophthalmol Otolaryngol. 1973;77:441. 32. Allain JC, Lous LE, Cohen-Solal L, Bagin S, Maroteaux P. Isometric tensions developed during the hydrothermal swelling of rat skin . Connective Tissue Res. 1980;7:127-133.Crossref 33. Thompson VM, Seiler T, Durrie DS, Cavanaugh TB. Holmium:YAG laser thermokeratoplasty for hyperopia and astigmatism: an overview . Refract Corneal Surg. 1993;9( (suppl) ):S134-S137.

Journal

Archives of DermatologyAmerican Medical Association

Published: Apr 1, 1996

References