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Laser skin resurfacing has become increasingly popular. The carbon dioxide (CO 2 ) laser seemingly remains the most commonly used laser modality for skin resurfacing. Many surgeons still promote the CO 2 laser as being superior to the erbium:YAG laser, particularly for individuals with deeper lines. However, further experience with the erbium:YAG laser has shown the converse to be true. The erbium:YAG laser can be used to treat deep rhytids successfully, many times achieving results superior to those seen with the CO 2 laser, particularly in the perioral region. The theory behind this relates to the 10-fold greater absorption of the erbium:YAG wavelength by water. The greater absorption produces more efficient vaporization, even at low fluences, with greatly reduced adjacent thermal injury. Ablation can be carried to deeper levels of the dermis than is consistently safe with the CO 2 laser. Deliverance of total fluences in the range of 100 to 150 J/cm 2 , or more, produces a marked reduction or elimination of deeper rhytids. Clinically, experience with more than 300 cases indicates collagen remodeling occurs to a similar degree with the erbium:YAG laser as with the CO 2 laser, as improvement in rhytids can be seen for 2 to 3 months after surgery. It would appear that superior results can be obtained without the "heat effect" of the CO 2 laser. The erbium:YAG laser is capable of achieving superior resurfacing results, while offering many advantages to the patient, eg, reduced anesthetic requirements, shorter healing time, reduced erythema, less risk of pigmentary change, and more flexibility for resurfacing the skin off of the face.

D uring the past decade, cutaneous laser resurfacing has evolved into a primary treatment modality for photoinduced facial rhytides, lentigines, facial dyschromias, and atrophic scars. Major advances in laser technology during the past 15 years have made possible the ability to perform safe and reliable laser resurfacing of facial skin. In fact, cutaneous laser resurfacing has become so popular in North America that more than 150000 procedures were performed in 1999 alone. Fortunately, most adverse reactions associated with laser resurfacing are mild and, when recognized early, are easily treated. Serious complications may result after laser resurfacing, however, and may be due to various factors, including surgeon inexperience, inappropriate or inadequate postoperative wound management, and individual patient characteristics (skin phototype, UV light exposure, and postoperative compliance). For these reasons, laser surgeons must be aware of all potential adverse effects associated with cutaneous laser resurfacing, so that when one does occur, appropriate interventions can be promptly initiated to prevent further cutaneous damage.

While skin resurfacing using pulsed carbon dioxide lasers appears to have a skin-tightening effect clinically, the debate continues over its actual effects on dermal collagen.To provide quantitative measures of skin elasticity changes associated with pulsed carbon dioxide laser skin resurfacing and to introduce to the facial plastic surgery community the Cutometer SEM 575 skin elasticity meter, an instrument that is useful in the measurement of skin elasticity.University-based facial plastic surgery clinic and wound healing laboratory.Intervention.Measurements taken prior to and 6 months after procedure.Thirty-two patients undergoing pulsed carbon dioxide full-face laser skin resurfacing participated. There were 12 test sites measured in 6 aesthetic units per participant. The Cutometer SEM 575 skin elasticity meter was used to measure skin elasticity changes accompanying this procedure. This device measures skin deformation with an accuracy of 10 microns.The change in elastic recovery (Ur/Ue) was determined. At all 6 of the facial sites, there was a statistically significant increase in skin elasticity (P.001). Overall, there was an 18.2% improvement in skin elasticity. Site-specific changes ranged from 9% (forehead) to 22% (prejowl and periorbital).Skin resurfacing with the pulsed carbon dioxide laser produces a true skin-tightening effect. The Cutometer is a valuable instrument that permits accurate quantification of skin elasticity and may be useful in the evaluation of other facial plastic procedure results.

To compare clinical and histological results of 2 different protocols for cosmetic laser skin resurfacing.Masked comparison of 2 cohort groups.Forty-eight carefully selected patients who met specific inclusion and exclusion criteria for cosmetic laser skin resurfacing. Age, sex, and skin type were matched in both groups.Twenty-five patients had undergone cosmetic skin resurfacing with 2 impacts of a carbon dioxide laser. Another 23 patients underwent a different protocol involving 2 initial impacts of an erbium:YAG laser to ablate the epidermis followed by a single impact with a carbon dioxide laser. Skin punch biopsy specimens were obtained 1 to 2 weeks after the procedure in both groups of patients.Time to reepithelialization, duration of erythema, and patient acceptance were compared among 2 patients groups via Student t test. Patients were examined daily until reepithelialization, then weekly for 6 weeks, and then monthly for 6 months.Mean skin reepithelialization time was 7 days (range, 4-9 days) in the combined laser group vs 12 days (range, 9-15 days) in the carbon dioxide laser-only group (P = .04). Mean duration of erythema was 2.5 weeks (range, 1.5-3 weeks) in the combined laser group vs 7 weeks (range, 5-13 weeks) in the carbon dioxide laser-only group (P = .02). All 23 patients (100%) in the combined group but only 15 (60%) of 25 in the carbon dioxide laser-only group were willing to repeat their cosmetic laser surgery (P = .04). There were greater and deeper coagulative changes in the dermis of patients in the carbon dioxide laser-only group compared with those of patients in the combined laser group.The combined laser protocol showed less significant clinical and histological morbidity than the carbon dioxide laser-only protocol. Patients preferred the combined protocol. Combining these 2 lasers is a safe and patient-friendly alternative to using only the carbon dioxide laser.