Lasers

The lasers used for ablative resurfacing are the CO 2 laser (10,600 nm, scanned, superpulsed or ultrapulsed modes), Er:YAG laser (2940 nm) and a combination of the two. These high-energy pulsed lasers emit short pulses of light to remove thin layers of the skin precisely in a single pass, with minimal damage to surrounding tissue. The CO 2 laser removes approximately 30-50 microns leading to epidermal ablation, thermal dermal contraction, and stimulation of new collagen along with dermal remodeling. To reduce complications of pigmentary changes, especially in darker skin, single or few passes are done and the eschar is left in place as a natural dressing. Healing occurs in 7-10 days. The Er:YAG laser causes less thermal damage, removes 2-5 microns of tissue per pass and hence, requires two to three passes to ablate the epidermis. It also causes less collagen shrinkage and more bleeding. The advantage is that it causes less erythema and pigmentary changes, with a quicker recovery time as compared to the CO 2 laser. Full-face resurfacing in dark-skinned patients (such as those encountered in south India) is associated with a significant risk of postoperative pigmentation, which may persist for several weeks. Proper counseling of the patient is therefore essential. But now a days ablative fractional lasers are available and results are encouraging with these lasers without significant side effects.The techniques of subcision, punch excision techniques and resurfacing are sequentially combined to give optimal results. More often, resurfacing is done 6-8 weeks after punch excision techniques. However, the procedures may also be combined in a single session to shorten the total duration of treatment.