Long-term wrinkle reduction from carbon dioxide laser resurfacing

Amanda Francoeur

Carbon dioxide laser resurfacing can help with long-term treatment of mild to severe wrinkles, solar aging, scars and even precancerous skin cells.

“It’s a very effective way of treating aging wrinkles and solar skin damage,” said Dr. Shan R. Baker, a professor at the University of Michigan, Ann Arbor. “It really sets the clock back as a result.”

A patient is shown before (left) and after (right) carbon dioxide laser resurfacing. By removing the outer layers of facial tissue and using heat to regenerate healthy skin, the treatment reduces wrinkles and solar aging, in addition to balancing skin tone.

By dissolving internal and external water molecules in cells, carbon dioxide lasers thermally damage facial tissue. The injury induces collagen production, giving the skin a more even appearance, Dr. P. Daniel Ward, another professor at the university, said.

Ward and Baker studied 45 male and female patients, with an average age of 52. The purpose of the study was to record and evaluate long-term effectiveness and adverse complications associated with CO₂ resurfacing.

The outpatient procedure takes about two hours to complete. The laser operates at 250 to 300 mJ with a wavelength of 10.6 μm and is passed over the face and eyelids three times. A general anesthetic is given, and after treatment, a dressing is applied that is left on for 48 hours. Healing time is anticipated to be about two weeks.

Compared with other laser resurfacing treatments, carbon dioxide lasers produce the best results for mild to severe wrinkles with one session, and improvements last much longer. Erbium laser treatment, a less invasive procedure, is effective only in reducing fine to moderate lines and wrinkles. Fraxel lasers are noninvasive; therefore, multiple sessions are needed to obtain the same results that CO₂ laser treatment provides.

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The study included a majority of patients with light skin tones. According to Baker, lighter complexions experience longer periods of redness — up to six months — as compared with an average of three months. However, patients with dark complexions are at greater risk of having obvious skin color discrepancy.

Of the 45 patients involved, 30 percent developed small white cysts or acne; 17 percent had hyperpigmentation, or darkening of the skin; 13 percent had hypopigmentation, or lightening of the skin; two percent developed an infection; and two percent experienced ectropion, sagging of the eyelids.

As for improvement of wrinkles, the mean improvement in the facial rhytid score at long-term follow-up was 45 percent. After an average follow-up of 2.3 years, the researchers deduced that most of the complications had resolved but that some cases of hypopigmentation were permanent.

A normal effect of the procedure is some degree of hypopigmentation. “We looked at all of our patients, and they all had some lightening of the skin,” Baker said. The effect is the result of the high energy level of the laser and, because of the severity of blemishes, of the deeper treatment needed to achieve sufficient rhytid improvement.

The CO₂ laser’s main disadvantage is the prolonged recovery time. The two-week downtime can make prospective patients apprehensive about choosing the procedure; subsequently, the treatment is used less frequently compared with less invasive laser resurfacing methods. “It’s a balancing act between greater results and a longer recovery time compared to smaller results and a shorter recovery time,” Ward said.

Archives of Facial Plastic Surgery, July/August 2008, pp. 238-243.