REFERENCIAS BIBLIOGRÁFICAS / BIBLIOGRAPHICAL REFERENCES

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A.- Efficacy of Alexandrite Laser in the Treatment of Pigmented Actinic Keratoses: A Pivotal Study (2024).

B. - A Novel Treatment of Acne Keloidalis Nuchae by Long-Pulsed Alexandrite Laser (2018).

C.- Clinical Evaluation of Hair Removal Using an 810 Nm Diode Laser With a Novel Scanning Device (2016).

D.- Application of the Laser Diode With Central Wavelength 975 nm for the Therapy of Neurofibroma and Hemangiomas (2017).

E. Q-Switched Nd:YAG Laser for Cosmetic Tattoo Removal (2019).

F.- Q-S Laser Micro-Drilling and Multipass Full-Beam Q-S Laser for Tattoo Removal - A Case Series (2022).

G.- Intense Pulsed Light on Skin Rejuvenation: A Systematic Review (2022).

H.- Excimer Laser in the Treatment of Mycosis Fungoides (2014).

I.- Medium-Dose 308-Nm Excimer Laser for the Treatment of Psoriasis (2002).

J.- Use of 308 Nm Excimer Laser for the Treatment of Chronic Hand and Foot Eczema (2016).

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1.) [Laser surgery in esthetic surgery. Review]. 

2.) New Laser System Combines Erbium:YAG, CO2 

3.) Combined laser resurfacing with the 950-microsec pulsed CO2 + Er:YAG lasers. 

4.) Product Features of the Erbium-YAG/CO2 laser-DERMA K 

5.) Skin Resurfacing Improved with a New Dual Wavelength Er:YAG /CO2 Laser System: A Comparative Study. 

6.) New lasers for skin resurfacing: Erbium-YAG/CO2 systems Perspectives in Plastic Surgery Histologic and clinical evaluation of combined eyelid erbium: YAG and CO2 laser resurfacing. 

8.) Combination therapy: utilization of CO2 and Erbium:YAG lasers for skin resurfacing. 

9.) Combined CO2/Erbium:YAG Laser Resurfacing of Peri-Oral Rhytides and Side-By-Side Comparison with Carbon Dioxide Laser Alone1. 

10.) Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations. 

11.) Histologic analysis of the thermal effect on epidermal and dermal structures following treatment with the superpulsed CO2 laser and the erbium: YAG laser: an in vivo study. 

12.) Why Erbium Laser Resurfacing is Better than CO2 

13.) Erbium Laser Resurfacing 

14.) Erbium-(Er:YAG) Laser-Assisted Zona Drilling for Embryo Biopsy 

15.) Erbium laser resurfacing: current concepts. Plast Reconstr 

16.) Periorbital skin resurfacing using high energy erbium:YAG laser: results in 50 patients. 

17.) Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing. 

18.) Comparison of four carbon dioxide resurfacing lasers. A clinical and histopathologic evaluation. 

19.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 

20.) [Laser skin resurfacing. Er:YAG laser and cw-CO2 laser with scanner system in direct comparison]. 

21.) Skin resurfacing of facial rhytides and scars with the 90-microsecond short pulse CO2 laser. Comparison to the 900-microsecond dwell time CO2 lasers and clinical experience. 

22.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 

23.) Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. 

24.) Skin resurfacing of the face with the Erbium:YAG laser. 

25.) Skin resurfacing with the erbium:YAG laser. 

26.) Laser resurfacing of the neck with the Erbium: YAG laser. 

27.) Erbium:YAG laser skin resurfacing: preliminary clinical evaluation. 

28.) Efficacy of erbium:YAG laser ablation in Darier disease and Hailey-Hailey disease. 

29.) Treatment of photoaged neck skin with the pulsed Erbium:YAG laser. 

30.) Resurfacing of pitted facial scars with a pulsed Er:YAG laser. 

31.) Skin contraction following erbium:YAG laser resurfacing. 

32.) Computerized scanning erbium:YAG laser for skin resurfacing. 

33.) Laser skin resurfacing using a frequency doubled Nd:YAG laser after topical application of an exogenous chromophore. 

34.) Effects of pulsed laser systems on stapes footplate. 

35.) Erbium:YAG laser resurfacing in Asians. 

36.) Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. 

37.) Comparison of high-energy pulsed carbon dioxide laser resurfacing and dermabrasion in the revision of surgical scars. 

38.) Carbon dioxide laser resurfacing of peri-oral rhytids in scleroderma patients. 

39.) Skin contraction following erbium:YAG laser resurfacing. 

40.) A side-by-side comparison of carbon dioxide resurfacing lasers for the treatment of rhytides. 

41.) The Use of the Erbium:YAG Laser for the Treatment of Class III Rhytids. 

42.) A clinical study on the removal of gingival melanin pigmentation with the CO(2) laser

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1.) [Laser surgery in esthetic surgery. Review]. 

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Mund Kiefer Gesichtschir 1999 May;3 Suppl 1:S162-7 

Mang WL, Sawatzki K 

Abteilung fur HNO und plastische Operationen, Kreiskrankenhaus Lindau. 

Since the introduction of laser therapy was developed continuously. New  indications are possible in the aesthetic surgery. The laser is used for  the treatment of naevi, hemangiomas, wide port-wine-stains,  teleangiectasias, tattoos, epilations and skin resurfacing. To fulfill the  expectations of the patients and the remands of a plastic aesthetic surgeon  it is important to find the correct indication and choose the right laser.  Vascular and pigmental disorders can be successfully treated with the flash  lamp pumped pulsed dye laser.

Laser containing different wave lengths are  available. For the treatment of the aged skin the Ultrapuls-CO2-Laser  offers advantages in comparison with the Erbium-YAG-Laser. However these  lasers can not replace a facelift or blepharoplasty. 

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2.) New Laser System Combines Erbium:YAG, CO2 

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Bruce Jancin, Denver Bureau 

[Skin & Allergy News 29(8):21, 1998. © 1998 International Medical News Group.] 

SCOTTSDALE, ARIZ. -- An investigational new laser system for skin  resurfacing combines the distinct advantages of the erbium:YAG and CO2  lasers in a single device, Dr. Michael H. Gold said at the annual meeting  of the Noah Worcester Dermatological Society. 

ESC Medical Systems' Derma K laser system alternately fires erbium:YAG and  CO2 laser pulses in synchronized fashion. 

The Er:YAG laser's traditional strengths are precise control and minimal  side effects; each pass ablates a 25-nm-thick layer of skin with no thermal  contraction of surrounding tissue. Posttreatment erythema lasts only 2-10  days; the 6- to 12-month-long episodes of postinflammatory  hyperpigmentation common after CO2 laser skin resurfacing don't occur with  the Er:YAG laser. 

The Er:YAG laser is effective for the treatment of superficial wrinkles. It  provides a general facial rejuvenation comparable to a light chemical peel.  But it yields less than impressive results for the treatment of acne scars  and other deep dermal defects. That's where the alternating pulses of CO2  laser energy come in, continued Dr. Gold, a dermatologist in Nashville, Tenn. 

The CO2 laser component of the Derma K is designed to provide a subablative  thermal effect sufficient to achieve collagen remodelling and shrinkage  along with good hemostatic control without attaining the higher energy  levels that have caused long-term complications with conventional CO2  lasers. Dr. Gold, a paid speaker and investigator for ESC, is a principal  investigator in the clinical trials of the Derma K just under way. 

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3.) Combined laser resurfacing with the 950-microsec pulsed CO2 + Er:YAG lasers. 

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Dermatol Surg 1999 Mar;25(3):160-3 

Goldman MP, Manuskiatti W 

Dermatology Associates of San Diego County, Inc., La Jolla, California  92037, USA. 

INTRODUCTION: Laser resurfacing with the 950 microsec pulsed CO2 laser has  been proven to be efficacious in improving photodamaged skin and acne  scarring. Unfortunately, prolonged erythema and delayed wound healing are  common adverse sequelae, which require intensive patient education and  intervention.

These adverse effects may be due to the degree of nonspecific  thermal damage present after resurfacing with the CO2 laser. Since erbium:  YAG (Er:YAG) laser vaporization leaves far less thermal damage, it is  hypothesized that its use after CO2 laser resurfacing will decrease the  extent of nonspecific damage and result in improved wound healing.

METHODS:  Ten patients were randomized to receive laser resurfacing of one-half of  the face with the 950 Msec pulsed CO2 laser with 3 passes at 300 mJ,  utilizing the computer pattern generator (CPG) at settings of 596, 595,  584, and the other half of the face (randomly chosen) resurfaced with the  950 Msec pulsed CO2 laser 2 passes with the CPG at 300 mJ at settings of  596 and 595, followed by 2 passes with the Er:YAG laser (Derma-20 or  Derma-K, ESC Medical Systems, Inc., Needham, MA) with a 4 mm diameter spot  size at 1.7 J (approximately 14 J/cm2).

Patients were evaluated in a  "blinded" manner clinically and histologically before resurfacing,  immediately after resurfacing, 2 to 3 days postoperatively, 1 week  postoperatively, and, 4 to 8 weeks postoperatively.

RESULTS: There was  slightly less inflammation with the CO2/Er:YAG-treated patients. The  epidermis re-formed 1 to 2 days faster with combination (UPCO2)/Er:YAG  treatment than with UPCO2 laser treatment alone. In 7 of 10 patients,  Er:YAG erythema resolved within 2-3 weeks with CO2 x 3 erythema persisting  at the 8-week follow-up period in all patients. Three of 10 patients had no  difference in the degree of erythema between the 2 treatment areas.  Clinical findings correlated with histologic findings of vascularity.

There  was no difference in the extent or time of edema between techniques. The  usual demarcation line between cheek and neck at the mandibular angle was  less apparent when the UPCO2/Er:YAG combination was used. Two of 10  patients noted quicker healing with the combination laser technique. 

CONCLUSION: Treating a patient with the Er:YAG laser after treatment with  the UPCO2 laser results in a decreased incidence of adverse sequelae  without a noticeable difference in the degree of wrinkle improvement. 

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4.) Product Features of the Erbium-YAG/CO2 laser-DERMA K 

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SOURCE: ESC Medical Systems Ltd. 

Product Features 

Unique new method for skin rejuvenation: Derma K has the unique capability  to deliver both Er:YAG and CO2 beams simultaneously (K blend mode) to the  same tissue area for exceptional skin rejuvenation. The Er:YAG carries out  accurate ablation of superficial layers, opening the way for the CO2 to  affect the deeper tissue layers. 

Controlled Thermal Profile: Derma K combines the best of both the Er: YAG  and CO2 lasers for improved clinical efficacy. It replicates the precise  tissue ablation and minimal necrosis found in Er:YAG systems and  significantly controls the heating of deeper tissue layers, typical of CO2  systems. 

Hemostasis: The concurrent delivery of both wavelengths provides the  physician with enhanced control over hemostasis, (Dry Erbium technique)  thereby increasing the range of applications for Er:YAG laser. The CO2 mode  of the Derma K delivers sufficient thermal energy to seal small blood  vessels throughout the surgical procedure, creating the benefit of a clean,  dry surgical field. 

Reduced number of passes: Simultaneous operation of both the Erbium and CO2  lasers minimizes the number of passes required for a given procedure,  thereby minimizing erythema and decreasing the recovery time. At the same  time the dual wavelengths allow more overall energy to the tissue,  increasing ablation depth as it controls thermal impact. 

Versatility: Can also perform many standard CO2 surgical and aesthetic  procedures (like blepharoplasty). 

Less pain: No need for general anesthesia or intravenous sedation when  treating most body areas. 

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5.) Skin Resurfacing Improved with a New Dual Wavelength Er:YAG /CO2 Laser System: A Comparative Study. 

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Trelles MA, et al. 

J Clin Laser Med Surg 1999; 17(3): 99-104. 

Abstract: 

Objective: 

The efficacy of a new dual wavelength Erbium:YAG and CO2 laser system was  tested for skin resurfacing results on rabbits' ears and human facial skin.  The dual wavelength laser delivers simultaneous pulses of low-energy CO2  and high-energy Er:YAG energies. Theoretically, combining the strengths of  both laser types in one console should lead to improved clinical outcome. 

Summary Background Data: 

The use of the laser for skin resurfacing and remodeling has dramatically  increased over the past few years. The CO2 laser was the first laser to be  employed in this field, followed more recently by the Erbium:YAG laser.  Both lasers offer unique advantages and disadvantages. 

Methods: 

The present study consists of an ear chamber experiment, conducted on 8  rabbits, to examine vascular network formation, following laser resurfacing  with a standard CO2 laser and the Er:YAG/CO2 laser. Resurfacing was also  performed on human patients with the Er:YAG/CO2 laser and the results were  compared with previously published results of CO2 laser resurfacing. 

Results: 

Significant advantages, including an attenuation in the degree of edema and  erythema and a shorter re-epithelialization time compared to results with  conventional CO2 systems, were observed with the Erbium:YAG/CO2 system.  Improved tissue reorganization and good clinical results in 9 of the 10  patients (six ratings of "very good" and three "good") were observed. The  clinical outcome of the remaining patient was rated as "fair".

Minimal side  effects were reported and observed in only 3 patients. The learning curve  required to maximize the efficiency of the system is steep, however,  requiring a thorough understanding of the different laser/tissue  interactions associated with the two wavelengths. 

Conclusion: 

It is the authors' opinion that the dual wavelength Erbium:YAG /CO2 laser  system offers a particularly efficient and flexible system to perform  standard CO2 procedures for skin resurfacing with an improved clinical  outcome, as well as other applications with the CO2 or Er:YAG energy  delivered separately. 

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6.) New lasers for skin resurfacing: Erbium-YAG/CO2 systems Perspectives in Plastic Surgery 1999; 13(1): 57-82 (available as hard cover 

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Weinstein C. 

journal in September 1999) 

Abstract: 

Skin remodelling is an important component of facial rejuvenation. For  decades, chemical peeling and dermabrasion has been practiced to achieve  this purpose, but lack of precision has been a major drawback. Carbon  dioxide (wavelength 10,600 nm) laser resurfacing was introduced in the hope  of achieving more predictable skin rejuvenation.

Although many of the  results produced by the carbon dioxide laser were clearly excellent, the  morbidity and side effects due to thermal injury, limited its use in  aesthetic surgery. The Erbium:YAG (wavelength 2940 nm) laser was introduced  in an attempt to achieve greater precision in skin remodelling without the  nonspecific thermal effects, thereby leading to lower morbidity and fewer  complications.

Because the Erbium:YAG laser has a greater affinity (10  times) for water than the carbon dioxide laser, more accurate and stepwise  control of the depth of epidermal and dermal destruction is possible. 

Furthermore, the Erbium:YAG laser is capable of producing its own target  tissue, such as water within the dermis, as it stimulates the release of a  transudate from dermal blood vessels. This allows true and precise ablation  of dermal tissues, a phenomenon which the carbon dioxide laser is incapable  of producing. 

Long-term (greater than 1 year) results in over 700 patients using the  Erbium:YAG laser, demonstrate that this laser can eradicate both  superficial and deeper rhytids and can be safely used in all skin types in  both males and females, and all age groups.

The results with acne scarring,  and cutaneous pigmentary abnormalities have also been extremely  satisfactory. The morbidity and complications have been minimal compared to  the carbon dioxide laser and patient satisfaction greatly enhanced. 

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7.) Histologic and clinical evaluation of combined eyelid erbium: YAG and CO2 laser resurfacing. Am J Ophthalmol 1999 

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Millman AL; Mannor GE. 

May;127(5):614-6.  This study is a comparison of using the Derma 20 Er:YAG laser (ESC/Sharplan  ) followed by one pass of the NovaPulse CO2 laser (ESC/Sharplan ) versus  using the NovaPulse CO2 laser alone for eyelid resurfacing. It demonstrates  that the combined laser modality enhances clinical effects and reduces  morbidity. The benefits of this combined laser approach can be achieved  with a single device (Derma K Er:YAG/CO2 laser, ESC/Sharplan), which offers  the added advantage of simultaneous delivery of both laser energies. 

Abstract: 

Purpose: To report the histopathologic and clinical effects of eyelid  resurfacing that combines two different lasers. 

Method: A case series of 23 patients who underwent eyelid resurfacing with  two passes of the Erbium:YAG laser followed by one pass of the CO2 laser.  With the Student t test, we compared skin re-epithelialization time and  duration of erythema with those of a previous group of 25 patients who had  undergone eyelid resurfacing with only the CO2 laser (two passes). A  pathologist evaluated all skin biopsy specimens. 

Results: Combining both lasers shortened re-epithelialization time (7 vs 12  days, P = .04) and the duration of erythema (2.5 vs 7.0 weeks, P = .02).  Histopathologic examination disclosed less coagulative dermal damage with  the combined laser protocol. 

Conclusion: The different biophysical properties of these two lasers can be  combined in a periorbital resurfacing protocol to minimize both clinical  and histopathologic morbidity. 

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8.) Combination therapy: utilization of CO2 and Erbium:YAG lasers for skin  resurfacing. 

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Ann Plast Surg 1999 Jan;42(1):21-6 

Collawn SS 

Carraway Laser Center, Birmingham, AL, USA. 

Skin resurfacing with carbon dioxide (CO2) lasers is a commonly used method  for skin rejuvenation. With these lasers, there is substantial skin  improvement with lessening of rhytids and skin discoloration, and  noticeable skin tightening. However, there is also significant morbidity  associated with their use. To decrease the healing and erythema times,  other types of lasers have been developed.

The author discusses the  practice of combining the CO2 and Erbium:YAG lasers for limiting thermal  injury. For deeper rhytids in the periorbital, perioral, and forehead  regions, multiple passes with the CO2 laser are often the preferred  treatment.

For moderate rhytids, the CO2 laser can be used for the first  pass followed by one to multiple passes with the Erbium:YAG laser.  Erbium:YAG lasers when used alone are beneficial for removing fine wrinkles  and discolorations. Combining these lasers results in both rhytid  improvement and decreased morbidity. 

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9.) Combined CO2/Erbium:YAG Laser Resurfacing of Peri-Oral Rhytides and  Side-By-Side Comparison with Carbon Dioxide Laser Alone1. 

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Dermatol Surg 1999 Apr;25(4):285-293 

McDaniel DH, Lord J, Ash K, Md JN 

BACKGROUND: Laser resurfacing of facial rhytids has become a popular  treatment option for many patients with wrinkles, photoaging, and acne  scarring. Laser wavelength options and optimization of techniques continue  to evolve in an attempt to shorten the healing phase associated with laser  skin resurfacing.

OBJECTIVE: To prospectively study the clinical effects of  pulsed carbon dioxide (CO2) laser resurfacing of facial rhytids used alone,  compared with a combination of CO2 and the pulsed Erbium:YAG (Er:YAG)  laser.

METHODS: Forty treatment sites on 20 patients were randomized and  evaluated following treatment of the upper lip region with a combination of  CO2 laser resurfacing alone or with the same CO2 laser treatment followed  by 3 passes with the Er:YAG laser. Patient diaries were maintained to  assess erythema, crusting, pain, itching, swelling, pigmentary changes, and  the day of first make-up application.

Blinded objective grading of  improvement was independently assessed by 4 blinded observers at time  intervals 3, 6, and 10 days, and 1, 2, and 4 months. Chromometer  measurements of erythema were also analyzed and percentage moisture  recorded.

RESULTS: Subjectively, all patients reported, on average, 10 days  of redness and 2.4 days of pain, with no significant difference noted  between the two procedures. On average, patients were able to apply make-up  5.5 days postoperatively, regardless of which procedure used. However, the  combined CO2/Er:YAG laser treatment patients experienced reduced duration  of crusting, compared to the patients treated with CO2 alone. The duration  of crusting was reduced on average from 7.4 to 6.5 days, and also the  duration of itching was reduced in patients receiving combined treatment  from 5.5 to 4.8 days.

Chromometer measurements noted no significant  difference between techniques in the rate of resolution of erythema.  Blinded objective grading revealed that crusting was reduced on average  from 7.2 to 6.0 days, and swelling was reduced from 6.3 to 6.0 days in  patients receiving the combined procedure. No cases of permanent  hyperpigmentation, hypopigmentation, or scarring occurred in any patients. 

CONCLUSION: The addition of the Er:YAG laser following CO2 laser  resurfacing reduces the duration of crusting, swelling, and itching  postoperatively. Medium to deep (Grade III) facial rhytids were improved by  70% with both procedures with no significant difference noted between  techniques. 

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10.) Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative,  intraoperative, and postoperative considerations. 

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Plast Reconstr Surg 1999 Feb;103(2):619-32; discussion 633-4 

Alster TS 

Washington Institute of Dermatologic Laser Surgery and Georgetown  University Medical Center, DC, USA. 

The development and integration of pulsed and scanned CO2 and erbium:YAG  laser systems into mainstream surgical practice over the past years has  revolutionized cutaneous resurfacing.

These lasers are capable of  delivering to skin high peak fluences to effect controlled tissue  vaporization, while leaving an acceptably narrow zone of residual thermal  damage. The inherent technological differences that exist between the two  distant laser systems in terms of ablation depths, degree of thermal  coagulation, and postoperative side-effects and complications guide patient  selection and management.

This article reviews the basic principles of CO2  and erbium:YAG laser resurfacing, including preoperative, intraoperative,  and postoperative patient considerations. Side-effects and complications  encountered after laser resurfacing are discussed with specific guidelines  provided on their appropriate management. Anticipated future developments  and cutting-edge research endeavors in cutaneous laser resurfacing are also  briefly outlined. 

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11.) Histologic analysis of the thermal effect on epidermal and dermal  structures following treatment with the superpulsed CO2 laser and the  erbium: YAG laser: an in vivo study. 

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Lasers Surg Med 1999;24(2):93-102 

Utley DS, Koch RJ, Egbert BM 

Division of Otolaryngology/Head and Neck Surgery, Facial Plastic and  Reconstructive Surgery, Stanford University Medical Center, Palo Alto,  California 94305, USA. heartburn@california.com 

BACKGROUND AND OBJECTIVE: To compare the in vivo histologic effects of the  carbon dioxide (CO2) and erbium:yttrium aluminum garnet (Er:YAG) lasers. To  ascertain the effects of combining CO2 and Er:YAG laser modalities during a  single treatment session.

STUDY DESIGN/MATERIALS AND METHODS: Ten patients  underwent laser treatment to four left preauricular sites 7 days prior to  rhytidectomy as follows: CO2 alone, CO2/Er:YAG, Er:YAG alone, and  Er:YAG/CO2. The right preauricular area was identically treated 1 hour  prior to rhytidectomy. Laser treated skin was excised during rhytidectomy  and was evaluated histopathologically in a blinded manner.

RESULTS: After 7  days, all groups were reepithelialized and showed equal neo-collagen  formation. After 7 days, CO2/Er:YAG and Er:YAG alone had the least collagen  injury and thickest epidermis and papillary dermis of all groups. Specimens  lased 1 hour prior to excision showed the least collagen injury and thermal  necrosis when treated with CO2/Er:YAG and Er:YAG alone. Four passes with  CO2 removed 250 microm of tissue, while eight passes with the Er:YAG  removed 160 microm of tissue.

CONCLUSIONS: Limiting CO2 laser passes and  ending with Er:YAG produces less collagen injury, less thermal necrosis,  and more robust epithelial and dermal fibrous tissue regeneration. CO2  followed by Er:YAG has similar thermal necrosis and collagen injury as  Er:YAG alone, presumably due to Er:YAG removal of CO2 induced thermal injury. 

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12.) Why Erbium Laser Resurfacing is Better than CO2 

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By Dr. Daniel Fleming, 

AESCULAP-MEDITEC GMBH 

The Cosmetic and Laser Surgery Institute of Australia, Brisbane 

Studies at the Cosmetic and Laser Surgery Institute of Australia treated  volunteer patients with Erbium:YAG laser (AESCULAP-MEDITEC Dermablate) on  one side of the face and with CO2 laser (Sharplan Silk Touch) on the other. 

The results show the Erbium: YAG laser to be equally effective at removing  or improving wrinkles but with quicker healing time, less redness and less  oedema. The Erbium:YAG laser also had a lower incidence of late  hypopigmentation, the common and permanent sequala of CO2 laser resurfacing.  Various myths abound concerning the Erbium:YAG laser. It is often  suggested that it is only useful for superficial wrinkles, that it does not  tighten the skin like the CO2 laser and that bleeding prevents deeper 

ablation. 

To understand why these claims are incorrect it is crucial to understand  the central concept of any resurfacing procedure: this is the total depth  of injury. It is this that will determine both the beneficial effects of a  resurfacing process and the risks of unwanted effects such as scarring or  hypopigmentation. It does not matter whether the resurfacing was caused by  dermabrasion, chemical peel, CO2 laser or Erbium:YAG laser. The different  modalities simply give differing degrees of control over the depth of  injury. Only the total depth of injury matters to the result. 

With laser resurfacing the total depth of injury consists of an ablation  crater with a zone of thermally necrosed tissue immediately below it. There  are important 

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13.) Erbium Laser Resurfacing 

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SOURCE: NorthWest LaserDerm 

Erbium Laser ResurfacingTM has been a breakthrough in laser resurfacing.  This is a more complete renewal process than Cool Touch Treatment alone.  Erbium Laser Resurfacing gives us regeneration not only of the collagen  layer but a full regeneration of the skin surface layers as well. Erbium is  the "coldest" of the resurfacing lasers, and has shortened healing time to  usually 5 to 6 days after laser resurfacing.

Because the excellent  absorption of Erbium laser energy, there is very little heat penetration  into the skin so that redness after resurfacing is usually very little,  lasting on average 2 to 3 weeks. Erbium Lasers can be gentle enough to use  on the thin skin of the hands, neck or chest, and still give enough surface  effect to treat deeper thicker facial acne scars. Erbium Laser Treatment  can be combined with follow-up Cool Touch treatments to enhance the gains  of collagen renewal. 

Derma K Laser ResurfacingTM is a very exciting new laser process which  combines within a single laser both an Erbium laser beam and a Carbon  Dioxide laser beam. This blended beam has both the advantages of the  relative "coldness" of the pure Erbium laser beam as well as the advantages  that Carbon Dioxide laser has with enhanced skin tightening. This gives our  patients greater skin tightening especially around the eyes and mouth. 

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14.) Erbium-Yttrium-Aluminium-Garnet (Er:YAG) Laser-Assisted Zona Drilling for Embryo Biopsy 

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Source: 1996 ASRM Meeting 

F. Azem, J. B. Lessing, T. Schwartz, M. Ben-Haim, I. Yovel, A. Amit. IVF  Unit, Serlin Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler 

Faculty of Medicine, Tel Aviv University, Israel 

Objectives: Preimplantation genetic diagnosis is based on embryo biopsy and  the application of molecular biology techniques. The biopsy procedure can  be done through a hole made in the zona pellucida (ZP) either mechanically  or by drilling, using acid tyrodes or hyaluronidase. The aim of our study  was to evaluate the use of Er:YAG laser for embryo biopsy. 

Design: Randomized prospective observation of 3PN embryo development after  laser-assisted zona drilling for embryo biopsy. 

Materials and Methods: 3PN embryos at the six- to eight-cell stage were  collected. A hole was made in the ZP by using Er:YAG laser at a wave length  of 2.9 µm to create a 20-30 µm opening in the ZP. One or two blastomeres  adjacent to the opening were removed using the sequestration technique by  micromanipulation. The development of the biopsied embryos (group A) was  compared with a corresponding group of nonbiopsied, 3 PN embryos (group B). 

Results: Group A comprised 11 3PN embryos, compared with 9 embryos in group  B. In group A, five embryos developed until the blastocyst stage, compared  with four in group B. The development of the remaining embryos in group A  was arrested. The development of five embryos in group B was arrested at  the four- to eight-cell stage. 

Conclusions: The use of Er:YAG laser offers a simple and quick alternative  technique for embryo biopsy. It seems that the procedure does not decrease  the potential of embryo development. 

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15.) Erbium laser resurfacing: current concepts. Plast Reconstr 

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Weinstein CA. 

Surg 1999; 103(2): 602-16. 

Abstract: Laser skin resurfacing has enjoyed great popularity in recent  years with the introduction of computerized, pulsed carbon dioxide lasers.  However, the morbidity and side effects of carbon dioxide lasers have  stimulated a search for alternative methods of skin remodeling. The  erbium:YAG laser can be successfully used for skin resurfacing, with lower  morbidity than the carbon dioxide laser.

In a series of 625 patients who  had erbium:YAG resurfacing, the following conclusions were reached. (1)  Long-term (> 6 months) improvement in wrinkles and acne scars required  total fluences exceeding 20 J/cm2. Periocular wrinkles required total  fluences of between 20 and 40 J/cm2, depending on the depth of the wrinkles  and skin thickness.

Perioral rhytids required total fluences of between 40  and 80 J/cm2, whereas the cheeks and forehead required total fluences of 30  to 60 J/cm2. (2) Deeper wrinkles were best treated with a combination of  erbium and carbon dioxide lasers, which minimized the bleeding that occurs  with deeper erbium resurfacing. The simultaneous combined erbium with  carbon dioxide laser was particularly advantageous. (3) Complications were  relatively uncommon using the scanning erbium laser, and most adverse  effects occurred early in the series. Scarring occurred in 5 of the 625  patients (0.8 percent) and mostly resolved with intralesional steroids.  Hyperpigmentation occurred in 21 of the 625 patients (3.4 percent) and was  temporary in nature.

Hypopigmentation, which became evident after 6 months,  occurred in 25 of the 625 patients (4.0 percent) but was mild and not a  significant cosmetic problem, except in one patient who developed scarring  on the neck. Hypopigmentation seemed to be related to the depth of  resurfacing.

Four of the 625 patients (0.6 percent) developed temporary  scleral show, but no patients had permanent ectropion. Eight of the 625  (1.3 percent) developed synechiae under the lower eyelid, which required  minor correction. 

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16.) Periorbital skin resurfacing using high energy erbium:YAGlaser: results in 50 patients. 

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Weiss MA, et al. 

Lasers Surg Med 1999; 24(2): 81-6 

Objective: To evaluate Erbium:YAG regional periorbital laser resurfacing  clinically and histologically. 

Study Design/Materials And Methods: Photographic evaluation before and  after Erbium:YAG resurfacing with histologic evaluation of depth of injury.  Setting: Group private single specialty practice.

PATIENTS: Fifty patients  in the age range of 35-62 years, Fitzpatrick skin types I-III were treated  using Erbium:YAG for regional resurfacing of periorbital rhytides. Outcome  Measures: Patients were seen at days 1, 2, 3, 7, 14, 28, and at six months  and one year. Photographs were obtained prior to application of topical  anesthesia and were utilized to judge improvement of rhytides at all time  intervals.

Additional photographs were taken at each follow-up visit and  the results judged by an independent investigator. Results were graded into  five categories at all treatment intervals: no improvement, mild (grade 1:  up to 25%), moderate (grade 2: 25-50%), good (grade 3: 50-75%, or excellent  (grade 4: 75-100%). For histologic evaluation of depth of ablation and  thermal injury one, two, and three passes at 21.2 J/cm2 were performed on  four patients. 

Results: Re-epithelization in the periorbital region was rapid with a mean  duration of 2.65 days. Erythema ranged from a longest of six weeks to the  shortest of seven days with a mean duration of 15.4 days. Evaluation of  clinical results revealed that at two weeks mean improvement was 2.15  (between moderate and good).

At four weeks further improvement was noted  with a mean of 2.62. By six months, mean improvement score increased to  2.94. Minimal further improvement was noted between six months and one year  with a mean improvement score of 3.02 (good to excellent). Histology  revealed complete removal of the epidermis with one to three passes. Dermal  ablation of 5-10 microns accompanied by small increases (5-10 microns) in  dermal thermal injury occurred with each subsequent pass. 

Conclusion: We conclude that high energy Erbium:YAG periorbital resurfacing  is a safe and effective modality which achieves substantial therapeutic  effect. Most patients achieve approximately 75% improvement. Erythema fades  quickly, reepithelization is rapid and side effects are minimal. 

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17.) Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous 

resurfacing. 

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Lasers Surg Med 1999;24(2):87-92 

Alster TS 

Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037,  USA. 

BACKGROUND: Several erbium:YAG lasers are currently available for cutaneous  laser resurfacing. Although different laser systems are purported to  produce equivalent laser energies to produce similar laser-tissue  interactions, no comparative clinical or histologic studies have been  performed to objectively demonstrate their relative efficacies.

OBJECTIVE:  The purpose of the present study was to examine the in vivo clinical and  histopathologic effects of six different erbium:YAG resurfacing lasers. 

METHODS: A blinded, prospective study using six different erbium lasers  (Candela, Continuum Biomedical, HGM, MDLT, SEO, Sharplan/ESC) was  performed. The facial halves of 12 patients were randomly resurfaced with  one of the six laser systems by using an identical laser technique at 5.0  J/cm2.

Intraoperative skin biopsies were obtained after each of three laser  passes in two patients for blinded histologic determination of tissue  ablation level and presence of residual thermal damage. Clinical  assessments of reepithelialization rates, severity and duration of  erythema, side effects, and degree of clinical improvement were made at  0.5, 1, 2, 4, 12, 26, and 52 weeks postoperatively.

RESULTS: Irrespective  of the erbium laser system used, complete reepithelialization typically  occurred at 0.5 weeks and resolution of erythema was noted within 1-2 weeks  postoperatively.

A mean clinical improvement of 50% was observed, with  photodamaged skin showing greater improvement than scarred skin. The most  common postoperative side effect was hyperpigmentation, with all affected  patients having either darker skin tones or preceding dermal inflammation.  Three laser passes were needed to effect total epidermal ablation when  using any one of the erbium:YAG systems.

CONCLUSIONS: Equivalent clinical  and histologic results were seen after each of the six erbium:YAG lasers  studied. Erbium:YAG laser resurfacing can be used to significantly improve  mild cutaneous photodamage and atrophic scars. 

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18.) Comparison of four carbon dioxide resurfacing lasers. A clinical and  histopathologic evaluation. 

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Dermatol Surg 1999 Mar;25(3):153-8; discussion 159 

Alster TS, Nanni CA, Williams CM 

Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA. 

BACKGROUND: Several high-energy, pulsed and scanned carbon dioxide (CO2)  lasers are currently available for cutaneous resurfacing. Although each  laser system adheres to the same basic principles of selective  photothermolysis, there are significant differences between lasers with  respect to tissue dwell time, energy output, and laser beam profile. These  differences may result in variable clinical and histologic tissue effects. 

OBJECTIVE: The purpose of this study was to examine the in vivo clinical  and histopathologic effects of four different high-energy, pulsed or  scanned CO2 resurfacing lasers.

METHODS: A prospective study using four  different CO2 resurfacing lasers (Coherent UltraPulse, Tissue Technologies  TruPulse, Sharplan FeatherTouch, and Luxar NovaPulse) was performed. The  cheeks of seven patients were divided into four quadrants. Each quadrant  was randomly assigned to receive treatment with one of four CO2 lasers.  Skin biopsies were obtained intraoperatively from each quadrant, after each  of three laser passes, and at 1 and 3 months postoperatively. Blinded  clinical assessments of each laser quadrant were made at 1, 3, and 6 months  postoperatively by three physicians.

Degree of lesional improvement as well  as erythema severity, re-epithelialization rates, and presence of side  effects were recorded. Blinded histologic examination of laser-treated  quadrants was performed to determine the amount of tissue ablation,  residual thermal damage, inflammation, and new collagen synthesis.

RESULTS:  The four CO2 lasers produced equivalent clinical improvement of rhytides  and scars. Re-epithelialization occurred in all laser quadrants by day 7.  Postoperative erythema was most intense in the quadrants treated by  UltraPulse and NovaPulse; however, overall duration of erythema was  equivalent for all four laser systems (3 months). Postinflammatory  hyperpigmentation was the most frequently encountered side effect and  occurred with equal frequency in each quadrant.

No scarring,  hypopigmentation, or infections were observed. After one laser pass,  histologic examination revealed partial ablation of the epidermis with the  TruPulse laser and complete epidermal ablation using the UltraPulse,  NovaPulse, and FeatherTouch laser systems. The greatest degree of residual  thermal damage was seen after FeatherTouch and NovaPulse laser irradiation.  New collagen formation was greatest in the UltraPulse and FeatherTouch  laser-irradiated quadrants.

CONCLUSIONS: Equivalent clinical results were  observed using the FeatherTouch, NovaPulse, TruPulse, and UltraPulse CO2  lasers. While postoperative erythema intensity differed between laser  systems, total duration of erythema was equivalent. The four lasers under  study resulted in minimal residual thermal damage and stimulated new  collagen formation within 6 months after treatment. 

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19.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 

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Arch Dermatol 1999 Apr;135(4):391-7 

Khatri KA, Ross V, Grevelink JM, Magro CM, Anderson RR 

Department of Dermatology, Massachusetts General Hospital, Harvard Medical  School, Boston 02114, USA. 

OBJECTIVE: To compare the efficacy, adverse effects, and histological  findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in  removing facial rhytides. DESIGN: An intervention study of 21 subjects with  facial rhytides. All participants were followed up for 6 months. The end  points of the study were wrinkle improvement and duration of adverse  effects. SETTING: Academic referral center.

SUBJECTS: Nineteen female and 2  male volunteers with skin type I to III and wrinkle class I to III  participated in the study.

INTERVENTION: In all subjects, 1 side of the  face was treated with a CO2 laser and other side with an Er:YAG laser. Skin  biopsies were performed in 6 subjects before treatment and immediately, 1  day, 2 days, and 6 months after treatment. Observations were recorded by  subjects, investigators, and a blinded panel of experts.

MAIN OUTCOME  MEASURES: Improvement in wrinkles and severity and duration of adverse  effects.

RESULTS: The CO2 laser-treated side had relatively better wrinkle  improvement when evaluating all subjects (P<.03). However, in subjects  receiving more than 5 passes of Er:YAG laser, improvement scores were not  significantly different from those for 2 to 3 passes of CO2 laser  treatment.Posttreatment erythema was noted at 2 weeks in 14 subjects (67%)  on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2  laser-treated side.

The frequency of erythema was significantly less after  Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation  was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi2,  P<.05). Histological evaluation showed residual thermal damage of up to 50  microm on the Er:YAG-treated side and up to 200 microm on the CO2-treated  side.

CONCLUSIONS: Erbium:YAG laser is safe and effective in removing  facial rhytides. Subjects treated with Er:YAG laser recover more quickly  from the procedure than those receiving CO2 laser treatment. 

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20.) [Laser skin resurfacing. Er:YAG laser and cw-CO2 laser with scanner system in direct comparison]. 

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Hautarzt 1998 May;49(5):367-71 

[Article in German] 

Hohenleutner S, Hohenleutner U, Baumler W, Landthaler M 

Klinik und Poliklinik fur Dermatologie der Universitat Regensburg. 

We compared a cw carbon dioxide flash-scanning laser system to an Er:YAG  laser in laser skin resurfacing of facial rhytides. In all patients, CO2  laser treatment showed a better cosmetic result whereas erythema and  postinflammatory hyperpigmentation were less marked in Er:YAG laser therapy. 

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21.) Skin resurfacing of facial rhytides and scars with the 90-microsecond short pulse CO2 laser. Comparison to the 900-microsecond dwell time CO2 lasers and clinical experience. 

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Dermatol Surg 1998 Dec;24(12):1390-6 

Moy RL, Bucalo B, Lee MH, Wieder J, Chalet MD, Ostad A, Dishell WD 

UCLA Division of Dermatology, USA. 

BACKGROUND: Carbon dioxide lasers that produce either short pulses or  scanned continuous beams have been used for skin resurfacing to improve  wrinkles or scars. Using a high peak power, short pulse CO2 laser can  produce clinically effective results with minimal thermal damage. 

OBJECTIVE: To evaluate the effectiveness of skin resurfacing using the  90-microsecond pulse duration CO2 laser compared to other laser systems.  Erythema, healing time, complications, and histological measurement of the  depth of ablation and thermal damage per pass with this system were also  assessed.

METHODS: Forty-one patients with facial rhytides and scars  underwent resurfacing with a 90 microseconds pulse duration CO2 laser.  Using patient survey, patients were evaluated for effectiveness of therapy,  healing time, and complication rates. Comparisons of histologic and  clinical findings were made with different short pulse CO2 lasers.

RESULTS:  Healing time, duration of erythema, and post-operative pain were less with  the 90 microseconds pulse CO2 laser than with the 900-microsecond dwell  time and 950-microsecond pulse duration lasers, while effectiveness was  comparable.

Complications were few with the 90-microsecond pulse laser,  including three patients (9.1%) developing hyperpigmentation. One pass with  the 90-microsecond pulse duration CO2 laser produced 100 microns of  ablation with 17 microns of thermal damage. Ablation and damage were  additive so that, by six passes, ablation depth was 350 microns and depth  of thermal damage was 63 microns. This thermal damage is less than that  reported with lasers having a longer pulse duration or dwell time with  comparable depths of vaporization.

CONCLUSION: Treatment with the  90-microsecond pulse duration laser results in a more rapid healing time  and shorter duration erythema. The clinical improvements in wrinkles and  sun damage were comparable. The 90-microsecond pulse duration laser  provides an effective, predictable, and safe means of improving facial  rhytides and scars. 

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22.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 

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Arch Dermatol 1999 Apr;135(4):391-7 

Khatri KA, Ross V, Grevelink JM, Magro CM, Anderson RR 

Department of Dermatology, Massachusetts General Hospital, Harvard Medical  School, Boston 02114, USA. 

OBJECTIVE: To compare the efficacy, adverse effects, and histological  findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in  removing facial rhytides.

DESIGN: An intervention study of 21 subjects with  facial rhytides. All participants were followed up for 6 months. The end  points of the study were wrinkle improvement and duration of adverse  effects. SETTING: Academic referral center.

SUBJECTS: Nineteen female and 2  male volunteers with skin type I to III and wrinkle class I to III  participated in the study.

INTERVENTION: In all subjects, 1 side of the  face was treated with a CO2 laser and other side with an Er:YAG laser. Skin  biopsies were performed in 6 subjects before treatment and immediately, 1  day, 2 days, and 6 months after treatment. Observations were recorded by  subjects, investigators, and a blinded panel of experts.

MAIN OUTCOME  MEASURES: Improvement in wrinkles and severity and duration of adverse  effects.

RESULTS: The CO2 laser-treated side had relatively better wrinkle  improvement when evaluating all subjects (P<.03). However, in subjects  receiving more than 5 passes of Er:YAG laser, improvement scores were not  significantly different from those for 2 to 3 passes of CO2 laser  treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%)  on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2  laser-treated side.

The frequency of erythema was significantly less after  Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation  was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi2,  P<.05). Histological evaluation showed residual thermal damage of up to 50  microm on the Er:YAG-treated side and up to 200 microm on the CO2-treated  side.

CONCLUSIONS: Erbium:YAG laser is safe and effective in removing  facial rhytides. Subjects treated with Er:YAG laser recover more quickly  from the procedure than those receiving CO2 laser treatment. 

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23.) Complications of carbon dioxide laser resurfacing. An evaluation of 500  patients. 

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Dermatol Surg 1998 Mar;24(3):315-20 

Nanni CA, Alster TS 

Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA. 

BACKGROUND: Cutaneous laser resurfacing with high-energy, pulsed and  scanned carbon dioxide (CO2) lasers has become popularized for the  treatment of a variety of cutaneous indications, but potential  complications and side effects remain a large concern. Despite the recent  boom in cutaneous laser resurfacing procedures, there remains a relative  paucity of written information documenting laser complication rates. 

OBJECTIVE: The purpose of this study was to identify and report the  complications that occurred after cutaneous CO2 laser resurfacing within a  large patient population.

METHODS: A retrospective analysis and chart  review was performed in 500 consecutive patients who underwent cutaneous  laser resurfacing of 1589 facial regions with the UltraPulse CO2 laser by a  single operator. Side effects and complications relating to infection,  postoperative healing, pigmentary changes, and scarring were tabulated. 

RESULTS: The most common complication observed was postoperative erythema,  which occurred in all patients, lasting an average of 4.5 months.  Hyperpigmentation was seen in 37% of patients with a higher rate in darker  skin phototypes.

Acne flares, milia formation, and dermatitis occurred in  10-15% of patients. Postoperative infection with herpes simplex virus (HSV)  was observed in 7.4% regardless of prior HSV history. Hypopigmentation,  scarring, and other local or disseminated infections occurred in < 1% of  this study population.

CONCLUSIONS: Cutaneous CO2 laser resurfacing is a  relatively safe procedure with a low complication profile. Proper laser  treatment protocol and postoperative management is important in reducing  side effects and complications. 

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24.) Skin resurfacing of the face with the Erbium:YAG laser. 

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Dermatol Surg 1998 Jun;24(6):653-8; discussion 658-9 

Perez MI, Bank DE, Silvers D 

Center for Dermatology, Cosmetic, and Laser Surgery, Mt. Kisco, NY 15849,  USA. 

BACKGROUND: Laser resurfacing of facial skin is a very popular method of  rhytide and scar removal. Until recently, the most effective tool utilized  for these purposes was the pulsed char-free carbon dioxide laser. These  lasers, however, produce thermal damage related to prolonged wound healing.  The Erbium (Er): YAG laser, with its 2940-nm wavelength and maximal water  absorption, has been recently introduced for laser resurfacing of the  facial skin.

OBJECTIVE: In this study, specific parameters for Er:YAG laser  treatment of rhytides were evaluated clinically and histologically.  METHODS: Fifteen patients were treated with the Er:YAG laser. Perioral,  periorbital, and total face rhytides were treated.

All patients were  treated with 0.8-1.0 J, 5-mm spot size, with the final fluences of 4-5  J/cm2. Patients were evaluated daily after treatment for 7 days and weekly  for 2 months for erythema, healing time, improvement, and pigmentary  changes. Histologic evaluation of preauricular human facial ex vivo skin  was done to determine the penetration of multiple passes of Er:YAG laser in  human facial skin.

RESULTS: All patients showed some degree of improvement  of their rhytides. Reepithelialization occurred between 3 and 8 days.

All  evidence of erythema resolved between 3 and 6 weeks after treatment. The  level of tissue ablation was determined to be down to: the granular layer  after one pass; to the basal cell layer after two passes, to the papillary  dermis after three to four passes, and deeper into the papillary and  superficial reticular dermis after five to six passes.

CONCLUSION: The  Er:YAG laser plays a significant role in the treatment of superficial and  mid-depth rhytides. 

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25.) Skin resurfacing with the erbium:YAG laser. 

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Dermatol Surg 1997 Aug;23(8):685-7 

Teikemeier G, Goldberg DJ 

Laserzentrum Duesseldorf, Germany. 

BACKGROUND: Recent studies have shown that pulsed char-free carbon dioxide  lasers are effective in the treatment of rhytids. However, these lasers  produce thermal damage with the potential for prolonged wound healing. 

OBJECTIVE: In this study, we evaluated the role of the erbium (Er):YAG  laser in the treatment of rhytids. This laser, with a wavelength of 2940  nm, produces little thermal damage.

METHODS: Twenty patients were treated  with the Er:YAG laser. Perioral, periorbital, and forehead rhytids were  treated. Pulsed of energy varying between 400 and 800 mJ were used; spot  sizes between 2.5 and 5 mm were chosen. Patients were evaluated at 2 days,  1 month, and 2 months for erythema, time of healing, degree of improvement,  and pigmentary charges.

RESULTS: All 20 patients showed improvement of  their rhytids. Reepitheliation occurred between 4 and 10 days.  Postoperative of eythema resolved in less than 2 weeks. Clinical  improvement occurred between 3 and 8 weeks after laser treatment. 

CONCLUSION: The Er:YAG laser plays a role in the treatment of superficial  rhytids. 

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26.) Laser resurfacing of the neck with the Erbium: YAG laser. 

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Dermatol Surg 1999 Mar;25(3):164-7; discussion 167-8 

Goldman MP, Fitzpatrick RE, Manuskiatti W 

Dermatology Associates/Cosmetic Laser Associates of San Diego County, Inc,  USA. 

BACKGROUND: Laser resurfacing of the face is widely used to correct the  effects of photoaging. The neck also develops a similar degree of  photoaging, but is not usually treated because a higher incidence of  adverse effects can occur with laser treatment.

OBJECTIVE: To present a new  method for treating photoaged skin of the neck with an erbium:yttrium  aluminum garnet (Er:YAG) laser.

METHODS: Twenty patients underwent Er:YAG  laser resurfacing of the neck with one of two methods.

Method 1 consisted  of using the Er:YAG with a 5-mm diameter collimated beam at a fluence of  8.7 J/cm2 followed by a second pass using a 0.2 mm diameter non-collimated  spot at 1.7 J in a defocused mode with spot sizes ranging from about 5 to  10 mm in diameter (fluences from 2-9 J/cm2).

Method 2 consisted of treating  the entire neck with a single pass of the Er:YAG laser with a 4 mm diameter  non-collimated spot at 1.7 J (fluence of 13.5 J/cm2). A second pass at  identical settings was made on the upper half of the neck with a more  defocused pass using a 6-10 mm diameter spot (fluence of 2-6 J/cm2) on the  lower half of the neck. Patients were evaluated by two nontreating  physicians as to overall satisfaction and improvement in skin texture and  color.

RESULTS: Overall, 51% of patients were satisfied with their results.  Skin texture improved an average of 39%. Method 1 produced a 28%  improvement, Method 2 a 48% improvement. Skin color improved an average of  37%. Method 1 produced a 28% improvement, Method 2 a 45% improvement. 

CONCLUSION: Photoaged skin of the neck can be effectively treated with the  Er:Yag laser with minimal adverse effects. 

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27.) Erbium:YAG laser skin resurfacing: preliminary clinical evaluation. 

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Ann Plast Surg 1998 Apr;40(4):328-34 

Bass LS 

Institute of Reconstructive Plastic Surgery, NYU Medical Center, Manhattan  Eye Ear & Throat Hospital, New York, NY, USA. 

Each of the increasing number of resurfacing lasers uses a unique strategy  to produce tissue ablation. Erbium:YAG (Er:YAG) lasers have been used in  other applications for precise tissue removal with little thermal effect.  Recovery time, duration of erythema, and clinical improvement were  evaluated using an Er:YAG resurfacing laser (2.94-microm wavelength,  350-microsec pulse, 2 J, 3-5-mm spot).

Twenty-five patients were treated  with two passes to the full face and 3 to 5 passes to the most affected  aesthetic unit. At each follow-up visit, percent epithelialization,  erythema, and swelling were graded, and the presence or absence of  complications was noted.

Clinical improvement was evaluated at 6 months by  optical profilometry on a subset of patients. Er:YAG resurfacing produced a  transient whitening of dermis followed by a resumption of pink appearance.  The surgical end point was judged by elimination of visible rhytids or  presence of punctate bleeding. Bleeding from the dermal surface was  encountered less than customarily in dermabrasion, but more than seen with  carbon dioxide laser resurfacing. A moderate amount of tissue shrinkage was  observable during the treatment.

Mean period to full epithelialization was  6.9+/-0.97 days (range, 5-9 days). The mean duration of erythema  (4.24+/-1.5 weeks) was relatively short compared with carbon dioxide  resurfacing. Clinical improvement was 44+/-30% in the lateral canthal area  and 55+/-22% in the upper lip area. There were no infections or  hypertrophic scars. Hyperpigmentation and hypopigmentation was seen in 24%  and 12% of patients respectively.

Er:YAG resurfacing is a reliable means of  obtaining rhytid improvement with less recovery time and duration of  erythema compared with carbon dioxide resurfacing. The technique is  significantly different from carbon dioxide resurfacing in selection of end  point, number of passes, and energy settings. 

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28.) Efficacy of erbium:YAG laser ablation in Darier disease and Hailey-Hailey disease. 

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Arch Dermatol 1999 Apr;135(4):423-7 

Beier C, Kaufmann R 

Department of Dermatology, J.W. Goethe University, Frankfurt, Germany. 

BACKGROUND: Among different surgical approaches, dermabrasion and carbon  dioxide laser vaporization have been used to treat Hailey-Hailey disease  (HHD) (familial benign chronic pemphigus) and Darier disease (DD)  (keratosis follicularis), with various results.

Because of the erbium: YAG  laser's unique absorption characteristics in tissue water, erbium:YAG laser  ablation combines the advantages of both techniques, avoiding thermal  injury of vaporization and also allowing selectively deeper tissue removal  in the follicular lesions of DD. Therefore, good results should be expected  in both types of acantholytic disorders.

OBSERVATIONS: Four patients (2  with HHD and 2 with DD) with different affected areas were treated with  laser ablation.

During a follow-up period ranging from 8 to 20 months,  complete remission was achieved in 3 patients--2 with DD and 1 with  HHD--and significant improvement was achieved in 1 patient with HHD.  Histological examination of control biopsy specimens after ablation in 1  patient with DD revealed no signs of the disease and only a slight fibrosis  in the papillary dermis.

CONCLUSIONS: Erbium:YAG laser ablation effectively  removes lesions of both HHD and DD and can also yield excellent long-term  results in chronic, recalcitrant cases. 

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29.) Treatment of photoaged neck skin with the pulsed Erbium:YAG laser. 

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Dermatol Surg 1998 Jun;24(6):619-21 

Goldberg DJ, Meine JG 

Skin Laser Center, Pascack Valley Hospital, Westwood, NJ, USA. 

BACKGROUND: The Erbium (Er):YAG laser represents a new laser approach for  the treatment of rhytids and photodamaged skin. Because the Er:YAG laser's  2940-nm wavelength is at the peak of water absorption, this laser produces  minimal thermal damage.

OBJECTIVE: To document the Er:YAG laser's efficacy  in the treatment of neck rhytids.

METHODS: Ten patients with neck rhytids  were treated with the Er:YAG laser. All individuals were evaluated for  clinical improvement, scarring, and pigmentary changes. RESULTS: All  patients showed fair to excellent results with no scarring or pigmentary  changes at 6 months.

CONCLUSION: The Er:YAG laser may be used to improve  nonfacial photodamaged skin. 

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30.) Resurfacing of pitted facial scars with a pulsed Er:YAG laser. 

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Dermatol Surg 1997 Oct;23(10):880-3 

Kye YC 

Department of Dermatology, College of Medicine, Korea University, Seoul,  Korea. 

BACKGROUND: Laser resurfacing has beneficial effects for the treatment of  several skin conditions. Recently, the pulsed Er:YAG laser has been shown  to be a highly effective treatment for several kinds of pitted facial  scars.

OBJECTIVE: The purpose of this study was to assess the efficacy and  safety of pulsed Er:YAG laser skin resurfacing for pitted facial scars. 

METHODS: Four patients with small pox scars, five patients with chicken pox  scars, and 21 patients with acne scars were included in this study. All  patients were skin type III and IV.

All patients were instructed to use  tretinoin cream 0.05% nightly for 2-4 weeks prior to the laser treatment.  The pulsed Er:YAG laser with 2-mm handpiece at the setting of 500 mJ/pulse,  3.5-4.5 W was used. Two weeks after laser treatment, topical application of  hydroquinone 4%, tretinoin 0.05%, and hydrocortisone 1% cream was  recommended for 2-4 weeks.

Facial photographs were obtained at baseline and  2-week intervals postoperatively with a 35-mm single lense reflex camera  equipped with a lense mounted ring flash. The results of treatment were  evaluated for the changes of skin texture and color at 2 weeks, 1 month,  and 3 months. Three patients with acne scars agreed to skin biopsy. 

RESULTS: Three months after laser treatment, all patients with small pox  and chicken pox scars were improved about 55%, and patients with acne scars  were improved about 40% on average.

CONCLUSION: Pulsed Er:YAG laser skin  resurfacing is an effective and safe treatment for pitted facial scars. 

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31.) Skin contraction following erbium:YAG laser resurfacing. 

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Dermatol Surg 1998 Jan;24(1):109-11 

Hughes PS 

BACKGROUND: Resurfacing the skin with deep chemical peels, dermabrasion, or  lasers tightens the skin via dermal remodeling. The erbium (Er):YAG laser  is a new laser for resurfacing and it removes lesional tissue efficiently  with minimal residual thermal damage.

In this paper, I present the first  published study, to my knowledge, documenting and quantifying the cutaneous  contraction following Er:YAG laser resurfacing of human skin.

OBJECTIVE: To  document and measure the cutaneous contraction resulting from Er:YAG laser  resurfacing.

METHODS: Using lentigos as skin markers, square areas on human  forearm skin were resurfaced with the Er:YAG laser. The distance between  these skin markers was measured before, immediately after, at 3 days, and  weekly for 16 weeks after laser surgery.

RESULTS: After two to three passes  with the Er:YAG laser, there was an immediate 4% linear tightening of the  skin, which persisted at 3 days, increased to 8% at 1 weeks, was 11% at 2  and 4 weeks, 13% at 6 weeks, and 14% at 16 weeks.

CONCLUSION: Er:YAG laser  resurfacing produces measurable cutaneous contraction. This phenomenon may  contribute to the positive clinical tightening of human skin following  Er:YAG laser resurfacing. 

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32.) Computerized scanning erbium:YAG laser for skin resurfacing. 

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Dermatol Surg 1998 Jan;24(1):83-9 

Weinstein C 

Laser House, East Melbourne, Victoria, Australia. 

Laser skin resurfacing has become increasingly popular as a method of  facial rejuvenation. Although carbon dioxide (CO2) laser resurfacing is  extremely effective, there is considerable morbidity associated with this  procedure. Erbium (Er):YAG lasers, like CO2 lasers, are highly absorbed by  water, and are absorbed superficially in skin.

In our study of 141 patients  using the computerized scanning Er:YAG laser, we found that it was possible  to precisely ablate skin with less thermal injury than the currently  available scanning CO2 lasers. The scanning system allowed very precise and  homogeneous skin ablation.

It was possible to ablate epidermis and  superficial dermis, although deeper resurfacing led to pinpoint bleeding.  Furthermore, healing was more rapid than generally experienced using CO2  lasers.

Erythema was less marked, and disappeared usually within 3-4 weeks.  Histological studies confirmed the minimal degree of thermal injury, as was  evident clinically. Fluences of at least 20 J/cm2 were necessary to produce  new collagen formation. 

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33.) Laser skin resurfacing using a frequency doubled Nd:YAG laser after topical application of an exogenous chromophore. 

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Lasers Surg Med 1999;25(1):43-50 

Sumian CC, Pitre FB, Gauthier BE, Bouclier M, Mordon SR 

GALDERMA Research and Development, F-06902 Sophia Antipolis, France. 

BACKGROUND AND OBJECTIVES: Although laser skin resurfacing performed with  CO(2) or Er:YAG lasers is efficient, side effects such as prolonged  postoperative erythema, delayed healing, scarring, and pigmentation, have  been reported. These side effects are due to skin characteristics but also  to variations of the thermal effects associated with laser skin  resurfacing. The study aimed to evaluate a new laser resurfacing method  based on a previous topical application of an exogenous chromophore in  order to have reproducible thermal effects.

MATERIALS AND METHODS:  Exogenous chromophore consisted in carbon dispersed and mixed with  film-forming polymers and water. The resultant solution was applied to the  skin surface using an airbrush. Experimental evaluation was performed in  vivo on hairless rat skin using the following parameters (532 nm, 2.7 W, 1  mm, 50-200 ms, 17.2-68.8 J/cm(2), single pass).

Skin biopsies were taken to  evaluate histological changes and to quantify epidermis ablation and dermal  coagulation depth. Wound healing was followed up during 10 days.

RESULTS:  Total epidermis ablation was achieved with all pulse durations used. Dermal  coagulation depth increased as a function of exposure time. Scar formation  was correlated with dermal coagulation depth.

CONCLUSION: The concept of  applying a carbon-based solution onto skin in order to obtain laser light  conversion into heat followed by heat transfer to the tissue is valid for  laser skin resurfacing. By selecting exposure time, the thermal effects are  predictable and dermal coagulation depth can be either that observed with a  Er:YAG laser or that obtained with a CO(2) laser.

Moreover, frequency  doubled Nd:YAG laser, already used in dermatology for angiodysplasias  treatment, could be easily used for resurfacing of periorbital or perioral  zones. Copyright 1999 Wiley-Liss, Inc. 

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34.) Effects of pulsed laser systems on stapes footplate. 

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Lasers Surg Med 1997;21(4):341-50 

Jovanovic S, Schonfeld U, Prapavat V, Berghaus A, Fischer R, Scherer H,  Muller GJ 

ENT Department Benjamin Franklin Medical Center, Free University of Berlin,  Germany. 

BACKGROUND AND OBJECTIVE: The aim of the present study was to investigate  the tissue ablation capacity of various pulsed lasers at the stapes  footplate.

STUDY DESIGN/MATERIALS AND METHODS: Isolated human stapes and  bovine compact-bone platelets were used to determine the effective laser  parameters and appropriate application technique for achieving a  perforation measuring 500-600 microns in diameter. Of interest were also  the shape and quality of the perforations, the reproducibility of the  perforation effect, and the thermically altered marginal zones occurring at  the footplate.

Three pulsed laser systems were used: excimer, holmium:YAG  (Ho:YAG), and erbium:YSGG (Er:YSGG) lasers.

RESULTS: The tissue-ablating  effect of pulsed laser systems permits a precise and controlled management  of the stapes footplate through low and readily reproducible ablation  rates. The extent of thermic side effects at the footplate is lower in  comparison to the purely thermically acting cw and superpulse laser  systems.

The Er:YSGG laser exhibits the highest ablation rate at the stapes  and is thus the most effective laser for perforation of the stapes  footplate. Though somewhat less effective, the Ho:YAG laser also appears to  be suitable for stapedotomy. On the other hand, we do not consider the  applied excimer laser (308 nm) to be particularly appropriate at the stapes  because of its low ablation rates.

CONCLUSION: Thus, the erbium laser could  represent an alternative to the argon, KTP 532, and CO2 lasers, already  clinically successful in stapes surgery. However, further studies are  necessary to examine the transmission of thermic energy into the vestibule  and the acoustic stress to the inner ear during laser stapedotomy, to be  able to make a definitive statement about the safest and most effective  laser system for stapes surgery. 

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35.) Erbium:YAG laser resurfacing in Asians. 

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Dermatol Surg 1998 Dec;24(12):1303-7 

Polnikorn N, Goldberg DJ, Suwanchinda A, Ng SW 

Ramathibodi Hospital, Bangkok, Thailand. 

BACKGROUND: Although laser resurfacing has become increasingly popular in  the treatment of Caucasian skin, concerns about healing and  postinflammatory pigmentary changes have limited its use in Asian skin. 

OBJECTIVE: The purpose of this study was to determine the efficacy and  safety of the Erbium(ER):YAG laser used in the treatment of Asian skin. 

METHODS: Fifty Asian individuals with Rhytids, scars, pigmentary  alteration, and a variety of cutaneous growth were treated with the  Erbium:YAG laser. Patients were evaluated for clinical efficacy, wound  healing, post-operative erythema, and post-inflammatory pigmentary changes. 

RESULTS: Significant improvement was noted in all individuals. Shorter  periods for re-epithelization and erythema duration were noted when  compared to previously reported results following carbon dioxide laser  resurfacing.

CONCLUSION: The Erbium:YAG laser is safe and effective in the  treatment of Asian skin. 

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36.) Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. 

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Dermatol Surg 1996 Feb;22(2):151-4; discussion 154-5 

Alster TS, West TB 

Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA. 

BACKGROUND. Treatment of atrophic acne scars has been limited to the use of  such traditional treatments as dermabrasion and chemical peels for many  years. Recently, the addition of high-energy, pulsed carbon dioxide (CO2)  lasers to the treatment armentarium has created renewed enthusiasm for  cutaneous resurfacing due to their ability to create specific thermal  injury with limited side effects.

OBJECTIVE. To determine the effectiveness  of a high-energy, pulsed CO2 laser in eliminating atrophic facial scars and  to observe for side effects.

METHODS. Fifty patients with skin phototypes  I-V and moderate to severe atrophic facial acne scars were included in the  study. Each patient received one high-energy, pulsed CO2 laser treatment  using identical laser parameters by the same experienced laser surgeon. 

Baseline and 1-, 4-, 8-, 12-, and 24-week postoperative photographs and  clinical assessments were obtained in all patients. Textural analysis of  skin before and after laser irradiation were obtained in 10 patients to  confirm clinical impressions. Clinical evaluations were conducted  independently by two blinded assessors.

RESULTS. There was an 81.4% average  clinical improvement observed in acne scars following laser treatment. Skin  texture measurements of laser-irradiated scars were comparable to those  obtained in normal adjacent skin. Side effects were limited to transient  hyperpigmentation lasting an average of 3 months in 36% of patients.  Prolonged erythema (2 months average) was usual and considered to be a  normal healing response. No hypertrophic scarring was observed following  laser treatment.

CONCLUSION. High-energy, pulsed CO2 laser treatment can  safely and effectively improve or even eliminate atrophic facial scars and  provides many benefits over traditional treatment methods. 

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37.) Comparison of high-energy pulsed carbon dioxide laser resurfacing and  dermabrasion in the revision of surgical scars. 

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Dermatol Surg 1998 Jun;24(6):647-50 

Nehal KS, Levine VJ, Ross B, Ashinoff R 

Department of Dermatology, New York University Medical Center, NY 10016, USA. 

BACKGROUND: Both dermabrasion and high-energy pulsed carbon dioxide (CO2)  laser resurfacing can improve the appearance of surgical scars. Although  the results of these two procedures have been compared using historical  data, a prospective evaluation has never been performed in humans. 

OBJECTIVE: To prospectively compare the clinical effects of dermabrasion  and high-energy pulsed CO2 laser resurfacing in the revision of surgical  scars.

METHODS: Facial surgical scars in four patients were prospectively  revised using a split scar model. One half of the scar was dermabraded and  the other half was resurfaced with the high-energy pulsed CO2 laser.  Comparisons of the two treatment modalities were performed through clinical  assessment, photographic evaluation, and textural analysis of the scars. 

RESULTS: The high-energy pulsed CO2 laser-resurfaced halves of the scar  were bloodless with less postoperative crusting in comparison with the  dermabraded halves.

Reepithelialization time and degree and duration of  postoperative erythema were similar for both treatment halves. Photographic  evaluation and textural analysis showed comparable improvement in the  clinical appearance and surface texture of the scars with both treatment  modalities.

CONCLUSIONS: Both the high-energy pulsed CO2 laser and  dermabrasion can achieve comparable clinical improvement in the revision of  surgical scars. The high-energy pulsed CO2 laser offers the advantage of a  bloodless field and a more precise method of tissue ablation. Postoperative  erythema, however, is an expected finding with both treatment modalities. 

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38.) Carbon dioxide laser resurfacing of peri-oral rhytids in scleroderma patients. 

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Dermatol Surg 1998 May;24(5):517-9 

Apfelberg DB, Varga J, Greenbaum SS 

Department of Plastic Surgery, Stanford University Medical Center,  California, USA. 

BACKGROUND: The short pulse duration high-energy carbon dioxide (CO2)  lasers have been used in the past for treating cutaneous pathology and more  recently for cosmetic improvements of rhytids, photo-aging, and acne. 

OBJECTIVE: This study was undertaken to determine the benefits of CO2 laser  resurfacing on the severe peri-oral rhytidosis commonly seen in patients  with systemic scleroderma.

METHODS: Three patients were studied and  evaluated for satisfactory wound healing, improved cosmetic result, and  lack of complications.

RESULTS: All three patients experienced significant  improvement following laser resurfacing.

CONCLUSION: The study demonstrated  the safe and effective treatment for peri-oral rhytidosis in patients with  generalized scleroderma utilizing CO2 laser resurfacing. 

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39.) Skin contraction following erbium:YAG laser resurfacing. 

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Dermatol Surg 1998 Jan;24(1):109-11 

Hughes PS 

BACKGROUND: Resurfacing the skin with deep chemical peels, dermabrasion, or  lasers tightens the skin via dermal remodeling. The erbium (Er):YAG laser  is a new laser for resurfacing and it removes lesional tissue efficiently  with minimal residual thermal damage. In this paper, I present the first  published study, to my knowledge, documenting and quantifying the cutaneous  contraction following Er:YAG laser resurfacing of human skin.

OBJECTIVE: To  document and measure the cutaneous contraction resulting from Er:YAG laser  resurfacing.

METHODS: Using lentigos as skin markers, square areas on human  forearm skin were resurfaced with the Er:YAG laser. The distance between  these skin markers was measured before, immediately after, at 3 days, and  weekly for 16 weeks after laser surgery.

RESULTS: After two to three passes  with the Er:YAG laser, there was an immediate 4% linear tightening of the  skin, which persisted at 3 days, increased to 8% at 1 weeks, was 11% at 2  and 4 weeks, 13% at 6 weeks, and 14% at 16 weeks.

CONCLUSION: Er:YAG laser  resurfacing produces measurable cutaneous contraction. This phenomenon may  contribute to the positive clinical tightening of human skin following  Er:YAG laser resurfacing. 

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40.) A side-by-side comparison of carbon dioxide resurfacing lasers for the  treatment of rhytides. 

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J Am Acad Dermatol 1998 Oct;39(4 Pt 1):547-53 

Gross EA, Rogers GS 

Department of Surgery, Boston University School of Medicine, Massachusetts,  USA. 

BACKGROUND: The use of cutaneous resurfacing lasers to treat rhytides is  widely accepted. Several carbon dioxide lasers, many using fundamentally  different technologies, are available.

OBJECTIVE: The purpose of this study  was to compare the results obtained and side effects after treating  rhytides with 3 different carbon dioxide resurfacing lasers.

METHODS: We  performed a randomized, blinded, prospective study wherein 16 subjects had  either periorbital or perioral rhytides resurfaced with 1 of 3 carbon  dioxide lasers on either side of the face.

RESULTS: We were unable to  demonstrate any significant differences in improvement in rhytides, patient  satisfaction, posttreatment erythema, or other side effects.

CONCLUSION:  Our results suggest that operator technique and patient selection are more  important factors than laser type with respect to outcome. 

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41.) The Use of the Erbium:YAG Laser for the Treatment of Class III Rhytids. 

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Dermatol Surg 1999 Sep;25(9):713-715 

Goldberg DJ, Cutler KB 

[Record supplied by publisher] 

BACKGROUND: The erbium:YAG (Er:YAG) laser can be used for precise tissue  ablation with minimal thermally induced damage. Because of its ability to  superficially ablate tissue, the Er:YAG laser can be used to improve fine  rhytids with rapid epidermal reepithelialization. It has not been shown  that the Er:YAG laser can successfully treat deeper rhytids where some  thermal damage may lead to more optimal collagen remodeling.

OBJECTIVE: We  chose to evaluate the efficacy of multiple superficial Er:TAG laser  sessions in the treatment of deeper class III rhytids.

METHODS: Twenty  subjects were selected for this study. All treated subjects had class III  rhytids and were Fitzpatrick I-III skin phenotypes. All subjects were  treated with four Er:YAG laser passes at 5 J/cm2. Three months after the  initial treatment, a second treatment with similar parameters was repeated.  Six months after the initial treatment, a third laser session with  identical parameters was undertaken. Subjects were evaluated for laser  efficacy and postlaser complications.

RESULTS: Although no subjects showed  improvement after the first laser session, mild to excellent improvement  was noted 6 months after the third Er:YAG laser treatment.

CONCLUSION: The  Er:YAG may be used successfully in the treatment of class III rhytids.  Multiple sessions may be required. 

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42.) A clinical study on the removal of gingival melanin pigmentation with  the CO(2) laser. 

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Author 

Nakamura Y; Hossain M; Hirayama K; Matsumoto K 

Address 

Department of Endodontics, School of Dentistry, Showa University,  Kitasenzoku, Ohta-ku,  Tokyo 145-8515, Japan. yukio@senzoku.showa-u.ac.jp 

Source 

Lasers Surg Med, 25(2):140-7 1999 

Abstract 

BACKGROUND AND OBJECTIVE: In a previous study, the possibility of  removal of dog  gingival melanin pigmentation with CO(2) laser therapy was reported.  The present study was  designed to investigate the effect of the CO(2) laser on human  gingival pigmentation and  evaluate the clinical outcome.

STUDY DESIGN/MATERIALS AND METHODS: A  CO(2)  laser (output: 6-8 W, pulse duration: 0.2 seconds) was irradiated on  the melanin pigmented  gingival surface of 10 patients, aged 20-49 years. Follow-up clinical  and histopathological  evaluations were performed.

RESULTS: The CO(2) laser was effective in  removing melanin  pigmentation in all patients. In the histopathological study, no  pigmented-laden cells nor any  inflammatory cell infiltration was observed following laser  irradiation. No re-pigmentation was  seen in any case in the first year. However, four of seven cases  showed re-pigmentation at 24  months. The re-pigmentation was almost equal to the preoperative  state.

CONCLUSIONS:  The CO(2) laser has proved to be another effective, safe, and easily  applicable therapy for  the removal of gingival melanin pigmentation. 

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DATA-MÉDICOS/DERMAGIC-EXPRESS No 2 (80) 17/11/99 DR. JOSÉ LAPENTA R. 

UPDATED 10 JUNE 2025

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Produced by Dr. José Lapenta R. Dermatologist

Venezuela 1.998-2.025

Producido por Dr. José Lapenta R. Dermatólogo Venezuela 1.998-2.025

Tlf: 0414-2976087 - 04127766810