Carbon dioxide laser skin resurfacing with a cooled handpiece

Background and Objective: Carbon dioxide (CO2) laser skin resurfacing has b ecome an accepted procedure for the rejuvenation of aged and wrinkled facia l skin. The benefits of this technique have been limited by the prolonged p ostoperative erythema, delayed re-epithelialization, and potential changes in pigmentation. We investigated the effects of coupling a pulsed CO2 laser to a zinc selenide handpiece at various temperatures to cool and conduct h eat from the skin surface. We compared the heat conducting handpiece to sta ndard techniques used to determine the effects on epithelial preservation, depth of thermal damage, and new collagen growth. Study Design/Materials and Methods: The dorsal aspect of piglets was treate d with four handpiece arrangements: no thermally conducting window; a zinc selenide thermally conducting window at room temperature; and the zinc sele nide thermally conducting window cooled to 10 and 5 degreesC. Intensities w ere measured to account for reflections from the surface of the handpiece. With the CO2 laser in scanning mode and a spot size of 1 mm, each handpiece was used at intensities ranging from 8-30 W in one pass. Biopsies for hist opathologic analysis and determination of the degree of epithelial damage a nd the depth of thermal damage were taken on days 0, 2, and 16. Results: All specimens revealed complete re-epithelialization by day 16. Th e addition of a cooled handpiece did not affect either the amount of epithe lial preservation or the depth of thermal damage. Conclusions: There is no significant advantage in using a cooled or room te mperature zinc selenide handpiece for epithelial preservation or decreasing the inflammatory response in CO2 laser resurfacing. (C) 2001 Wiley-Liss, I nc.