Otolaryngology Laser Microsurgery

Fellow American Academy of Facial Plastic and Reconstructive Surgery

ULTRAPULSE CO2 LASER FACIAL REJUVENATION

Current advances in CO2 laser delivery systems allow very precise removal of micro-thin layers of skin quickly, without bleeding, and with minimal pain. This laser is therefore best suited for treatment of facial wrinkles (rhytids), skin contour abnormalities from scars, or sun damaged skin. Previously other modes of treatment included chemical and mechanical treatment options:

Dermabrasion healing varies from 7-14 days, there is bleeding and freezing of skin, both obscure the surgeon's visual field. Crusting and weeping are usually significant, dermal injury may extend to 350 microns and at 10 months, dermal thickness may be reduced from pretreatment levels.

Chemical peeling has poor visual feedback for the surgeon and appears only as a frosting of the skin as skin proteins are dissolved by the chemical agents. Most rhytids (wrinkles), except the fine ones are unaffected. Phenol peels have an inability to control the depth of penetration. Liver-kidney toxicity are disadvantages. Permanent pigment loss occur in all cases of chemical peel. Skin redness can last a minimum of 1-2 months, or up to 2 years. Phenol peeling can ablate the skin to a depth of up to 1000 microns.

Filling agents such as fibril and collagen provide only temporary improvement, for weeks to months, and require frequent retreatments and allergic reactions can occur and the cost is much more over time. Therefore the Ultrapulse CO2 laser offers advantages over these treatments.

The Ultrapulse CO2 laser offers important advantages. It delivers high pulse energy in short pulses causing immediate coagulation and vaporization of small volumes of tissue.

Quick healing of tissue reduces unwanted heat diffusion into surrounding tissue, reducing or eliminating the possibility of scarring associated with older CO2 lasers.

The Ultrapulse is a precision surgical tool where the surgeon operates in a dry unaltered surgical field. It is a very accurate and affective treatment mode for "crow's feet," lower lid lines, frown lines and lines around the mouth. Deeper and more dynamic wrinkles can be softened and reduced. Traumatic scars and acne scars can be greatly improved. Certain premalignant skin cancers and sun damaged skin can also be treated and improved.

The Ultrapulse CO2 laser gives reproducible and even ablation of tissue. The procedure can be accomplished in 1-3 passes with the laser, depending on depth of the skin lines. The first pass usually removes 100 - 120 microns of skin which removes the upper layer of skin (the epidermis) and creates a pink color. The second pass removes about 60 - 80 microns within the next layer of skin (the papillary dermis) and creates a gray color, accompanied by visible skin retraction and shrinkage felt secondary to collagen retraction. The third and fourth passes contribute about 30 - 40 microns of deeper skin removal which brings the skin layer to the deeper reticular dermis, which is a yellowish hue. The reticular dermis is considered the tissue end point. Any blemishes which remain cannot be improved further and the results is the "best possible" for the given problem.