Laser resurfacing today and the 'cook book' approach: a recipe for disaster?

BACKGROUND

Laser ablative skin resurfacing achieves skin rejuvenation by precise ablation of photoaged skin and subsequent re-epithelialisation and dermal remodelling. Carbon dioxide (CO(2)) and Erbium:YAG (Er:YAG) lasers are the established choice. A wide range and many sets of parameters have been proposed as the gold standard for each system but results have varied.

AIMS: To show that this single system 'cook book' approach must be rejected in favour of a more comprehensive approach.

SUBJECTS AND

METHODS

The author has experience of ablative skin resurfacing in over 1200 patients and has used both systems. A more flexible approach, using a combined wavelength system, is presented. It comprises precise ablation of the epidermal with the Er: YAG (to create an epidermal window), followed instantaneously with subablative heating of the exposed dermis with the CO(2) laser.

RESULTS

Since adopting the dual wavelength/dual modality approach, more than 600 patients have been treated, with excellent results and a very high patient satisfaction index, currently around 90%, obtained from the sum of the very satisfied and satisfied patients using a five-grade scale. Possible resurfacing-related complications have included prolonged erythema, hyper or hypopigmentation, scarring and viral infections, which were more common with single system resurfacing. The author's complication rate remains under 1%, without any prophylactic use of antiviral agents.

CONCLUSIONS

The cook book approach, whereby a particular set of fixed laser resurfacing parameters for a specific single laser system are adopted and rigidly applied in all patients, will not achieve the best treatment effects and may even produce a bad result and dissatisfied patients. The dual modality approach allows a combination of the favourable elements of each of the two wavelengths with excellent and consistent results.