A study published in the July/August issue of Archives of Facial Plastic Surgery finds that carbon dioxide laser resurfacing is an effective long-term treatment for facial wrinkles.

In carbon dioxide laser resurfacing, a laser blasts water molecules inside and outside of cells, which vaporizes the water and causes heat damage to the surrounding tissue. The skin's response mechanism to this tissue damage is to produce more of the wrinkle-filling protein called collagen. Researchers P. Daniel Ward, M.D., M.S., and Shan R. Baker, M.D. (University of Michigan, Ann Arbor) write that, "In addition to structural changes, the healing process frequently leads to pigmentary [coloring] changes." Sometimes, the authors note, the changes in skin color are appreciated, "Such as when patients wish to remove solar evidence of aging; however, changes in pigmentation after treatment can often be a troubling adverse effect."

In their analysis, Ward and Baker studied 42 women and five men, 52 years of age on average, who received carbon dioxide laser resurfacing on their entire face between 1996 and 2004. They found that:
45% (21 patients) had no complications after the procedure 30% (14 patients) developed acne or small, white cysts called milia 17% (8 patients) developed skin darkening (hyperpigmentation) 13% (6 patients) developed skin lightening (hypopigmentation) 2% (1 patients) developed an infection 2% (1 patient) developed sagging of the eyelids Patients were followed up for 2.3 years, on average, and most complications had been resolved by follow up. In general, the patients saw a 45% improvement on a scale that measures facial wrinkles. "With the exception of one case of hyperpigmentation, which resolved within two years of treatment, hypopigmentation was the only long-term adverse effect," note the authors. "This complication was present in six patients (13 percent). The patients who developed hypopigmentation were more likely to have a greater response to treatment."

"The efficacy of treating facial rhytids [wrinkles] with the carbon dioxide laser is well established, and the short- and long-term utility of the carbon dioxide laser in treating solar facial aging has previously been documented," conclude the authors. "Our results verify those of previous studies that found that carbon dioxide laser resurfacing leads to long-term improvement in facial rhytidosis."

Paul J. Carnoil, M.D., of Summit, N.J. writes in an accompanying commentary that, ""In terms of results, carbon dioxide laser resurfacing remains the gold standard." However, he notes that since the 1990s, there has been a decrease in the number of patients who receive carbon dioxide laser resurfacing. "Some of the factors contributing to this decrease include the risk of delayed permanent hypopigmentation, prolonged recovery with associated erythema [redness] and the associated risks of other complications," he explains.

"Overall, approximately 26 patients (55 percent) in Ward and Baker's study had some type of complication. This relatively high complication rate means that attentive post-operative treatment by experienced physicians is important to minimize potential long-term problems. It has also led to an ongoing search for methods of treating facial aging and scarring with lower complication rates," concludes Carnoil. He adds that there are other treatments - not as good as carbon dioxide laser resurfacing in quality - that have shorter recovery periods and lower complication rates.

Long-term Results of Carbon Dioxide Laser Resurfacing of the Face
P. Daniel Ward, MD, MS; Shan R. Baker, MD
Archives of Facial Plastic Surgery (2008). 10[4]: pp. 238 - 243.
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Written by: Peter M Crosta