Comparison of erbium : YAG and carbon dioxide lasers in resurfacing of facial rhytides

Objective: To compare the efficacy, adverse effects, and histological findi ngs of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in remo ving facial rhytides. Design: An intervention study of 21 subjects with facial rhytides; All part icipants were followed up for 6 months. The end points of the study were wr inkle improvement and duration of adverse effects. Setting: Academic referral center. Subjects: Nineteen female and 2 male volunteers with skin type I to III and wrinkle class I to III participated in the study. Intervention: In all subjects, 1 side of the face was treated with a CO2 la ser and other side with an Er:YAG laser. Skin biopsies were performed in 6 subjects before treatment and immediately, 1 day, 2 days, and 6 months afte r treatment. Observations were recorded by subjects, investigators, and a b linded panel of experts. Main Outcome Measures: Improvement in wrinkles and severity and duration of adverse effects. Results: The CO2 laser-treated side had relatively better wrinkle improveme nt when evaluating all subjects (P<.03). However, in subjects receiving mor e than 5 passes of Er:YAG laser, improvement scores were not significantly different from those for 2 to 3 passes of CO2 laser treatment. Posttreatmen t erythema was noted at 2 weeks in 14 subjects (67%) on the Er:YAG laser-tr eated side and 20 subjects (95%) on the CO2 laser-heated side. The frequenc y of erythema was significantly less after Er:YAG laser treatment at 2 (P = .001) and 8 (P = .03) weeks. Hypopigmentation was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi(2)., P<.05). Histological evaluati on showed residual thermal damage of up to 50 pm on the Er:YAG-treated side and up to 200 pm on the CO2-treated side. Conclusions: Erbium:YAG laser is safe and effective in removing facial rhyt ides. Subjects treated with Er:YAG laser recover more quickly from the proc edure than those receiving CO2 laser treament.