Chap. 64 - FRACTIONATED CO₂ LASER

Summary

The treatment of facial photoaging has spurned many an innovation in dermatology and plastic surgery over the past twenty years. Among these are topical treatments; chemical peels; mechanical treatments such as dermabrasion; and most aggressively, surgical lifts and ablative laser treatments. For such laser treatments, the 10,600-nm CO₂ laser has been the gold standard since the early 1990s. The lengthy period of time during which the CO₂ laser has been the predominant choice certainly speaks to its clinical efficacy.

However, this efficacy does not come without cost. Providing full-thickness epidermal ablation down to depths of 150 μm with multiple passes, the CO₂ laser also provides significant morbidity and downtime in the postoperative period, often lasting three weeks or more. More important, CO₂ laser treatment results in persistent erythema in a majority of patients, lasting much longer than the immediate recovery period – in some patients, this can be six months or more. Other side effects include delayed-onset posttreatment hypopigmentation and scarring, which can be especially devastating for both patient and treating physician, given the aesthetic nature of the procedure itself.

While the ablative laser remains a very useful tool in capable hands, patient and physician dissatisfaction with the previously mentioned issues caused a trend among most aesthetic physicians in the early 2000s toward nonablative skin rejuvenation. Like the high-energy, short-pulse CO₂ laser, these devices employed the concept of selective photothermolysis, as described by Anderson and Parrish in 1983.