Carbon dioxide laser abrasion. Is it appropriate for all regions of the face?

OBJECTIVES: To evaluate the effectiveness of the carbon dioxide laser for treatment of facial acne scarring and to determine if certain regions of the face would respond more favorably to carbon dioxide laser resurfacing than other areas of the face. METHODS: Twenty-five patients with facial acne scarring were treated with the carbon dioxide laser with the flash-scanning attachment. Physician and patient evaluations were performed at postoperative follow-up. The face was evaluated for improvement by 5 anatomic regions: medial and lateral cheeks, perioral region, temple, and forehead. SETTING: Office ambulatory surgery center. RESULTS: Patients demonstrated overall improvement with the carbon dioxide laser. However, certain areas, such as the lateral cheek and temple, responded less favorably than other areas, such as the medial cheek, perioral region, and forehead. These findings were found to be statistically significant (P < .001) for physician and patient assessments. No long-term complications were reported. CONCLUSIONS: The carbon dioxide laser is an effective modality for the treatment of facial acne scarring. Physician and patient satisfaction is high. Nevertheless, multiple treatments may be necessary to achieve improvement, especially in the temple and lateral cheek areas; these anatomic sites respond less favorably to laser resurfacing than the medial cheek, perioral region, and forehead.

The carbon dioxide laser. An alternative for the treatment of actinically damaged skin.

BACKGROUND: The treatment of complex and diffuse actinic keratoses involving the face presents a problem in that they frequently recur despite traditional treatment modalities. The carbon dioxide (CO2) laser is an effective method for resurfacing actinically damaged facial skin. OBJECTIVE: The purpose of this study is to show the usefulness of the CO2 laser for the treatment of actinically damaged skin in patients with proven actinic keratoses and squamous cell carcinoma in situ of the face. METHODS: In an office surgery setting, the Sharplan 1030 or 40C CO2 laser with the SilkTouch flashscanner attachment was utilized to treat various regions of the face in 14 patients. RESULTS: All patients were satisfied with the aesthetic outcome of their laser procedures and no clinical evidence of residual or recurrent lesions have been noted. There were no long-term complications reported. CONCLUSIONS: Based on this preliminary report, the CO2 laser appears to be an excellent alternative for the surgical treatment of premalignant lesions of the face and can be used effectively without significant complications.

A comparison of wire brush and diamond fraise superficial dermabrasion for photoaged skin. A clinical, immunohistologic, and biochemical study.

BACKGROUND: Superficial dermabrasion has a proven beneficial effect on photoaged skin, but little is known about the differences between the two major modalities used in dermabrasion, the diamond fraise (DF) and the wire brush (WB). OBJECTIVE: We compared the clinical, immunohistologic, and biochemical changes after superficial dermabrasion with DF and WB. METHODS: Eight photoaged patients (mean age, 68 years; range, 49 to 80 years) underwent facial dermabrasion to the level of the papillary dermis. Clinical assessments were performed at baseline and at 3 and 12 weeks after dermabrasion. Biopsy specimens were taken from both dermabraded halves at the same time points and assessed by routine histologic and immunohistologic examinations, western blot analysis, and radioimmunoassay. Scoring of intracellular and extracellular transforming growth factor-beta 1 was based on a semiquantitative ordinal scale (0 = no staining to 4 = maximum staining) in half-unit increments. The score for each specimen represents the average of values obtained from four high-power fields. RESULTS: Both methods of dermabrasion resulted in significant resolution of actinic keratoses, lentigines, and wrinkling. No statistical significance was noted between the two methods in regard to clinical efficacy. Significantly fewer milia occurred after DF than after WB. Solar elastosis decreased with both the WB and DF. Immunohistologic examination demonstrated a highly significant increase in papillary dermal fibroblast staining for amino terminal procollagen I (type I pN-collagen) at 3 weeks for both DF and WB compared to baseline. Staining at 12 weeks had decreased from the peak noted at week 3, but was still significantly increased from baseline. Western blotting of type I pN-collagen demonstrated a 5.4-fold (p = 0.01) increase from baseline at 3 weeks and a 4.9-fold (p = 0.002) increase at 12 weeks after dermabrasion with the WB. Similarly, the DF produced a 4.9-fold (p = 0.006) increase at 3 weeks and a 5.1-fold (p = 0.008) increase at 12 weeks after dermabrasion. Western blotting of amino terminal procollagen III (type III pN-collagen) showed a 6.1-fold (p = 0.07) increase from baseline at 3 weeks and a 3.9-fold (p = 0.04) increase at 12 weeks after dermabrasion with the DF. The WB showed a 3.8-fold (p = 0.07) increase from baseline at 3 weeks and a 5.1-fold (p = 0.05) increase at 12 weeks. Transforming growth factor-beta 1 demonstrated a significant increase in extracellular staining with DF (3.3 +/- 0.2) and WB (3.7 +/- 0.2) from baseline (1.2 +/- 0.2, p < 0.001) at 3 weeks. CONCLUSION: Superficial dermabrasion with DF and WP appears to be similarly efficacious in the treatment of photoaged skin. Significant increases in type I pN-collagen, type III pN-collagen, and TGF-beta 1 occurred in the papillary dermis after both types of dermabrasion. These results suggest that increased fibroblast activity and consequent collagen I and III synthesis underlie the clinical improvement.