Aesthetic CO(2) laser surgery: evaluation of 907 patients

Resurfacing the skin to improve skin quality is an important concept in aesthetic plasticsurgery. Although time-honored methods (e.g., dermabrasion and chemical peel) are available for this purpose, they have several disadvantages. A newer method with a highenergy pulsed carbon dioxide laser provides a more controllable and more predictable method of resurfacing facial skin. In our study of 907 patients, monitored up to 2 years 868 laser resurfacing procedures were done for facial wrinkles. Eight hundred two of 868 (92.4%) achieved very good to excellent results (>75% removal of wrinkles in 92.4% of cases). Forty-six of 61 (75.4%) patients with acne scars also obtained very good to excellent results. Most patients with selected skin lesions (rhinophyma, actinic cheilitis, epidermal nevi, seborrheic keratoses, syringomas, xanthelasmas, and postsurgical scars) achieved good to excellent results, although these are admittedly more difficult to quantify. Major complications were uncommon. One hundred one of 907 (11.1%) patients had development of temporary hyperpigmentation, which resolved in an average of 2.6 weeks. Thirty-four of 907 (3.8%) patients had development of mild permanent hypopigmentation. Eight of 908 (0.9%) patients had development of some induration that resolved with use of intralesional steroids. Most of these (5 of 8) were in the perioral area. Three of 907 (0.3%) patients had development of a small persistent scar. Seven of 316 (2%) patients undergoing periorbital resurfacing had development of some mild scleral show. Early in our experience one patient developed ectropion that required surgical correction. We conclude that the new generation high-energy pulsed carbon dioxide laser is safe andeffective for resurfacing facial skin. However, this procedure is very technique dependent and requires a combination of didactic and hands-on training, conservative surgical judgment, and diligent patient follow-up to obtain optimal results with minimal complications.