Nonablative skin remodeling: selective dermal heating with a mid-infrared laser and contact cooling combination

Many of the microscopic changes associated with photodamage reside in the dermis. It follows that subsurface heating of the skin might allow for cosmetic enhancement without loss of the epidermis. Accordingly, we investigated the clinical and microscopic changes produced by a mid-infrared laser coupled with a contact cooling device.

Nine patients were treated with an erbium glass laser and sapphire cooling handpiece in contact with the skin. Postauricular sites were irradiated with pulse energies varying from 400-1,200 mJ and numbers of pulses from 4 to 40. Outcome measures included pain, edema, and erythema at predetermined postoperative intervals. Biopsies were performed just after treatment and 2 months postoperatively for selected pulse energy-pulse number combinations.

Erythema, edema, and pain increased with pulse energy and number of pulses. Likewise, immediate epidermal necrosis and subsequent scarring were observed for larger pulse energy-pulse number combinations. At sites with epidermal preservation, on biopsy, immediate dermal thermal damage was observed in a band-like pattern. The deep boundaries of this band were dependent on pulse energy and pulse number. After 8 weeks, biopsies showed dermal fibroplasia roughly correlating to the band of immediate dermal thermal damage.

Selective dermal heating can be achieved with a mid-infrared laser coupled to a contact surface cooling device. In this study, the range of fibroplasia and lack of clinically substantial cosmetic enhancement suggest that the dermal thermal damage achieved may be too deep and that the injury should be confined to more superficial levels to alter the most severely photodamaged dermis. Lasers Surg. Med. 26:186-195, 2000. Published 2000 Wiley-Liss, Inc.