Combined CO2/Erbium : YAG laser resurfacing of peri-oral rhytides and side-by-side comparison with carbon dioxide laser alone

BACKGROUND. Laser resurfacing of facial rhytids has become a popular treatm ent option for many patients with wrinkles, photoaging, and acne scarring. Laser wavelength options and optimization of techniques continue to evolve in an attempt to shorten the healing phase associated with laser skin resur facing. OBJECTIVE. TO prospectively study the clinical effects of pulsed carbon dio xide (CO2) laser resurfacing of facial rhytids used alone, compared with a combination of CO2 and the pulsed Erbium:YAG (Er:YAG) laser. METHODS. Forty treatment sites on 20 patients were randomized and evaluated following treatment of the upper lip region with a combination of CO, lase r resurfacing alone or with the same CO? laser treatment followed by 3 pass es with the Er: YAG laser. Patient diaries were maintained to assess erythe ma, crusting, pain, itching, swelling, pigmentary changes, and the day of f irst make-up application. Blinded objective grading of improvement was inde pendently assessed by 4 blinded observers at time intervals 3, 6, and 10 da ys, and 1, 2, and 4 months. Chromometer measurements of erythema were also analyzed and percentage moisture recorded. RESULTS. Subjectively, all patients reported, on average, ence noted betwee n the two procedures. On average, patients were able to apply make-up 5.5 d ays postoperatively, regardless of which procedure used. However, the combi ned CO2/Er:YAG laser treatment patients experienced reduced duration of cru sting, compared to the patients treated with CO2 alone. The duration of cru sting was reduced on average from 7.4 to 6.5 days, and also the duration of itching was reduced in patients receiving combined treatment from 5.5 to 4 .8 days. Chromometer measurements noted no significant difference between t echniques in the rate of resolution of erythema. Blinded objective grading revealed that crusting was reduced on average from 7.2 to 6.0 days, and swe lling was reduced from 6.3 to 6.0 days in patients receiving the combined p rocedure. No cases of permanent hyperpigmentation, hypopigmentation, or sca rring occurred in any patients. CONCLUSION. The addition of the Er:YAG laser following CO2 laser resurfacin g reduces the duration of crusting, swelling, and itching postoperatively. Medium to deep (Grade III) facial rhytids were improved by 70% with both pr ocedures with no significant difference noted between techniques.