chapter  10
22 Pages

Laser Resurfacing with the UPCO21Er:YAG Lasers

ByMitchel P. Goldman

Cutaneous rejuvenation through the use of laser vaporization of the skin has been demonstrated to be safe and effective since its introduction in 1994, with the ultrapulse CO2 laser (1). It is estimated that over one million patients have been treated with laser resurfacing (LR) with over 100 medical articles on this procedure having been published. Despite its demonstrated effectiveness in treating extensive cutaneous changes due to solar damage, including lentigines, precancerous lesions, and wrinkles, adverse effects can occur (2). Prolonged erythema, dyspigmentation, delayed healing, and potential complications of infection and scaring have been reported (3,4). These adverse effects have been sensationalized in the media leading to an increase in the public’s apprehension about this useful procedure. Many patients present with first-hand knowledge of friends, who have undergone the procedure only to be left with three to six months of erythema and permanent hypopigmentation (especially along the mandibular angle). Many of these erythematous and hypopigmented patients have been treated by physicians, who rent a LR machine and do not use optimal postoperative care or techniques to decrease nonspecific thermal damage. Fortunately, newer wound healing techniques, which limit nonspecific thermal damage by sequential use of erbium: YAG (Er:YAG) LR after carbon dioxide LR, as well as optimized postoperative dressings have dramatically reduced these adverse effects (5,6). Unfortunately, a less-than-optimal result provides far more publicity than an optimal result.