Carbon Dioxide Laser Resurfacing Reduces Wrinkles
and Complications Disappear
In terms of results, carbon dioxide laser resurfacing
remains the gold standard
July 22, 2008 - Carbon dioxide laser resurfacing
appears to be an effective long-term treatment for facial wrinkles,
according to a report in the July/August issue of Archives of Facial
Plastic Surgery, one of the JAMA/Archives journals.
The carbon dioxide laser vaporizes water molecules
inside and outside of cells, causing thermal damage to the surrounding
tissue, the authors write. In response to this insult, the skin produces
more of the protein collagen, which fills in wrinkles.
In addition to structural changes, the healing
process frequently leads to pigmentary [coloring] changes, the authors
write.
These changes in skin pigmentation may be
desirable, such as when patients wish to remove solar evidence of aging;
however, changes in pigmentation after treatment can often be a
troubling adverse effect.
P. Daniel Ward, M.D., M.S., and Shan R. Baker,
M.D., of the University of Michigan, Ann Arbor, assessed 47 patients (42
women and five men, average age 52) who underwent carbon dioxide laser
resurfacing on their entire face between 1996 and 2004.
Twenty-one patients (45 percent) had no
complications following the procedure; of those who did,
● 14 (30 percent) had milia (small, white cysts) or acne;
● eight (17 percent) had hyperpigmentation (darkening of the skin);
● six (13 percent) had hypopigmentation (lightening of the skin);
● one (2 percent) developed an infection; and
● one (2 percent) developed sagging of the eyelids.
After an average of 2.3 years of follow-up, most of
these complications had resolved.
Patients scores on a scale measuring facial
wrinkles improved 45 percent, and were consistent over all areas of the
face.
With the exception of one case of
hyperpigmentation, which resolved within two years of treatment,
hypopigmentation was the only long-term adverse effect, the authors
write. This complication was present in six patients (13 percent). The
patients who developed hypopigmentation were more likely to have a
greater response to treatment.
The efficacy of treating facial rhytids [wrinkles]
with the carbon dioxide laser is well established, and the short- and
long-term utility of the carbon dioxide laser in treating solar facial
aging has previously been documented, they conclude. Our results
verify those of previous studies that found that carbon dioxide laser
resurfacing leads to long-term improvement in facial rhytidosis.
Commentary: Carbon dioxide laser resurfacing
still provides results
In terms of results, carbon dioxide laser
resurfacing remains the gold standard, writes Paul J. Carnoil, M.D., of
Summit, N.J., in an accompanying commentary.
The number of patients who undergo carbon dioxide
laser resurfacing has decreased since the 1990s, Dr. Carnoil writes.
Some of the factors contributing to this decrease
include the risk of delayed permanent hypopigmentation, prolonged
recovery with associated erythema (redness) and the associated risks of
other complications.
Overall, approximately 26 patients (55 percent) in
Ward and Bakers study had some type of complication. This relatively
high complication rate means that attentive post-operative treatment by
experienced physicians is important to minimize potential long-term
problems.
It has also led to an ongoing search for methods
of treating facial aging and scarring with lower complication rates.
Other treatments have been developed with shorter
recovery periods and lower complication rates, but may not yield results
equal to carbon dioxide laser resurfacing, Dr. Carnoil notes.
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