Laser ablative resurfacing for photorejuvenation based on more than a decade's experience and 1200 patients: personal observations.

Background: Before lasers, the rejuvenation of photoaged skin, presented clinicians with many problems. Conventional methods, such as dermabrasion and various peels, gave inconsistent results with the potential for adverse side-effects. Lasers have dramatically changed resurfacing procedures and results, although the potential for severe side-effects still exists.

Methods: The author's experience of over a decade in the use of the pulsed and continuous wave CO(2), Er:YAG, and combined CO(2) and Er:YAG lasers in ablative resurfacing in more than 1200 patients is summarized. Parameters are discussed, and laser/tissue interactions are investigated.

Results: Among the CO(2) lasers used, the C/W system proved more effective in the long term than the pulsed system. For the Er:YAG laser, a novel dual-mode approach was developed which was seen to give better results than the usual ablative Er:YAG settings. The combined Er:YAG/CO(2) system proved, in the author's hands at least, to be an ideal laser ablative resurfacing system when used with the collimated hand-piece and a 50% overlap, which achieves a two-pass equivalence in a single pass. Representative case reports are presented.

Conclusions: Laser ablative resurfacing with the CO(2) or Er:YAG dual-mode lasers has the potential to produce excellent and long-lasting results, but at the cost of patient downtime and unpleasant side-effects. The combined Er: YAG/CO(2) system, in combination with good wound management techniques has helped reduce downtime and adverse effects.