It is predominantly undertaken in the private health care industry by suitably trained plastic, dermatology and cosmetic surgeons and is an elective aesthetic procedure in a therapeutic environment.

This is not your average beauty therapists salon treatment.

It is predominantly an anti-ageing procedure aimed at reducing the signs of ageing such as sun damage, wrinkle, fine lines, blotches. It is also used to resolve issues resulting from acne scarring ( Fulton et al 1999).

It is also used with the aim of resolving such conditions as Epidermal Naevi ( congenital overgrowths on the skin that appear to be warts ), surgical scars ( Chen et al 2001), traumatic scars,some skin neoplasias, lymphangiomas, and acitinic cheilitis ( lip)

Ablative procedures are not to be confused with non-ablative photo-rejuvenation that uses Intense Pulsed Light ( IPL ) systems to stimulate a change and reduce superficial issues such as freckles or small patches of redness, as well as encouraging new collagen to form. These typically involve numerous visit to the aesthetic clinic as part of a program.

Ablative resurfacing refers to the removal of outer layers of the skin ( epidermis), with the aim of causing an injury/denaturing the skin , so that it is able to recover with the aimed result being improved “new “ skin growth.

The chromophore of target here is water. The aim here is that when the targeted tissue is irradiated, this heats the tissue up to 100℃, and thus vaporisation occurs.

• Full or partial facelift
• Deep tissue dermabrasion
• Intense chemical peels

Other less invasive methods used to encourage skin rejuvenation include:

• Chemical peels
• IPL non-invasive photo-rejuvenation
• Dermal roller therapies ( Fernandes 2002)
• Dermabrasion
• Bipolar/tri-polar Radio-frequency for non-surgical face-lift
• Laser photo rejuvenation targeting small areas of concern ( thread veins & age spots )
• LED Photo dynamic therapy
• Dermal fillers & Botox
• Skin Care regimes ( including exfoliation)

Laser Equipment used in ablative therapies

Carbon Dioxide laser ( CO2) 10,600 nm:

CO2 lasers emit at wavelength 10,600 nm & were the first ever laser to be used as a surgical tool.
Their aim is to remove all 5 layers of the epidermis down to the dermis, typically in a continuous Wave ( CW) beam. This is a purely photo-thermal effect. ( light converting to heat).

The CO2 laser can be focused to a very tiny beam ( useful for targeting small spot areas), and used almost as a scalpel would, or it can defocused to vaporise or ablate soft tissue.

Downtime is typically 7-10 days post-procedure

Superpulsed CO2 laser:

When power is increased with a CW laser, the thermal effect is also increased. However
using a super pulsed laser, you can increase the power without causing significant
increased thermal effect. A super pulsed laser results in less thermal damage

Fractional CO2:

Fractional Co2 Lasers deliver microdots of laser that penetrate into the dermis. Fractional refers to the method of delivery of the light into the skin. Tiny pinpoints are used to deliver the light in only a fraction of the area. These are referred to as Microthermal Zones ( MTZ). By using this method of delivery, It characteristically spares the tissue surrounding each microthermal treatment zone leading to fast epidermal repair ( Tannous, 2007).

Fractionated systems are deemed to be a safer and more comfortable method of delivery.

Erbium Yag ( Er:YAG ) 2940nm:

The Er:YAG is used in much the same fashion as the CO2 laser, but has a greater affinity with water than the CO2 ( 10-15 times ) , but was found to be less likely to cause the hypo pigmentation that was seen in some cases with CO2 laser procedures.(Tekemeier & Goldberg 1997 ). Er:YAG laser light is also absorbed readily by collagen.

The Er:YAG laser produces a pulse of 250-350 msec that is less than the thermal relaxation time of the skin, which is 1 msec. Also, the Er:YAG laser causes tissue ablation with very little tissue vaporisation and desiccation ( Kauffman et al 1994).

The results are achieved via a photo-mechanical interaction within the skin ( light converting to a mechanical interaction), this means in broad terms that it produces minimal

thermal damage, with some noise on occasions where fluence is high. HIgher fluence can result in more blood loss when compared to the CO2 laser.

The residual heat produced by CO2 laser causes immediate coagulation of the small blood vessels, in contrast, the lack of heat in the Er:YAG treated skin may result in spot bleeding. This can be resolved with topical solutions such as Aluminium Chloride or even adrenaline.

Collagen contraction is less than when comparing to CO2 treated counterparts, however ER:YAG is particularly useful for acne or chicken pox scarring due to its lack of contraction/ distortion of the skin ( Langdon 2004 ) Er:YAG can be also be fractional.
Downtime is typically 5-7 days post-procedure.

Er:YAG or CO2 laser?

Recent studies show that there is very little difference in the overall outcome for the client & that it is really the practitioners preference, and client selection that are key, as well as in in depth and comprehensive assessment of the client. ( Karsai et al).

Factors influencing choice of laser purchase would include:

• Laser premises
• Licensing
• Skills & Qualifications
• Clientele
• Treatments proposed
• There are many devices on the market.

Benefits of laser resurfacing:

• Immediate shrinking of damaged Skin
• No general anaesthetic required.
• Minimal down time ( 5-7 days)
• Ongoing neocollagenesis for up to 1 year ( Gold 2010)
• Softening of lines and wrinkles

References:

– Chen et al. (2001). A Comparison of Scar Revision with the Free Electron and Carbon Dioxide Resurfacing Lasers. Plastic & Reconstructive Surgery. 108 (5), p1268.
– Fernandes D. ( 2002). Percutaneous collagen induction: An alternative to laser resurfacing. Aesthetic Surg. Journal. 22 (3), 315-317.
– Fulton Jr JE, Silverton K., (1999). Resurfacing the Acne Scarred face. Dermatological Surgery 25(5), 353-9/
– Gold M.H., ( 2010). Update on Fractional Laser Technology. J Clin Aesthet. Dermatol. 3(1), 42-50.
– Goldberg DJ. & Tekemeier G. (1997) Skin resurfacing with the Erbium YAG Laser. Dermatological Surgery. 23( 8,) 685-687.
– Karsai, Syrus, et al. (2010). Ablative fractional lasers (CO2 and Er: YAG): A randomized controlled double-blind split-face trial of the treatment of peri-orbital rhytides. Lasers in surgery and medicine. 42 (2), 167.
– Kaufmann, Roland, Anke Hartmann, and Raimund Hibst. ( 1994). Cutting and Skin- Ablative Properties of Pulsed Mid-Infrared Laser Surgery. The Journal of Dermatologic Surgery and Oncology . 20 (2), 112-118.
– Langdon, R. (2004). 6. In: University Press of Mississippi Understanding cosmetic laser surgery. USA: University Press of Mississippi. p54-55.
– Perez, Maritza I., David E. Bank, and David Silvers. (1998). Skin resurfacing of the face with the erbium: YAG laser. Dermatologic surgery 24 (6), 653-660.
– Tannous, Z. (2007). Fractional resurfacing. Clinics in Dermatology 25 (5), 480-486.