Modulating the Er : YAG laser

Background and Objectives: In the past 2 years, there has been some controv ersy about the optimal laser system, or combination of systems, for cutaneo us resurfacing. Initially, it seemed that the Er:YAG laser would have signi ficant advantages over the CO2 laser. In practice, some of those who jumped early onto the Er:YAG bandwagon have been unimpressed with the degree of s kin tightening that can be achieved with this system. Also, the excessive b leeding induced by the Er:YAG lasers prevented deeper vaporization. During the past 18 months, three new "modulated" Er:YAG lasers have been produced that are said to be able to achieve CO2 laser-like effects, while maintaini ng the Er:YAG laser advantages. The purpose of this article is to examine t hese new systems and to discuss their potential benefits, if any, over the "conventional" Er:YAG lasers, and the CO2 lasers. Study Design/Materials and Methods: The author has collected data from his own experience and that of his colleagues in the department of dermatology at University of California at San Francisco. The author has used all three types of modulated Er:YAG laser on patients presenting for cosmetic laser resurfacing and the treatment of many benign conditions over an 18-month pe riod. Results: All three modulated forms of Er:YAG lasers have been demonstrated to provide better coagulation than the conventional Er:YAG lasers. The Derm a-K and the Contour Er:YAG lasers were able to induce tissue contraction/de siccation similar to the CO2 laser. The author and his colleagues have indu ced only two cases of permanent hypopigmentation in over 50 cases during th e past 18 months while using the Er:YAG laser, significantly less than migh t be expected with the CO2 lasers. Conclusions: If a laser surgeon is happy with the results obtained with a h igh-energy, short-pulse CO2 laser, then there seems little reason to consid er changing to an Er:YAG laser. The modulated Er:YAG lasers have definite a dvantages over the conventional Er:YAG; lasers. They exhibit better control of hemostasis and can ablate tissue to a greater depth than the convention al Er:YAG lasers. The Er:YAG lasers might induce less permanent hypopigment ation than the CO2 lasers. (C) 2000 Wiley-Liss, Inc.