The drive to attain cosmetic facial enhancement with minimal risk and rapid recovery
has inspired the field of nonsurgical skin rejuvenation. Laser resurfacing was introduced
in the 1980s with continuous wave carbon dioxide (CO(2)) lasers; however, because
of a high rate of side effects, including scarring, short-pulse, high-peak power,
and rapidly scanned, focused-beam CO(2) lasers and normal-mode erbium-doped yttrium
aluminium garnet lasers were developed, which remove skin in a precisely controlled
manner. The prolonged 2-week recovery time and small but significant complication
risk prompted the development of non-ablative and, more recently, fractional resurfacing
in order to minimize risk and shorten recovery times. Nonablative resurfacing produces
dermal thermal injury to improve rhytides and photodamage while preserving the epidermis.
Fractional resurfacing thermally ablates microscopic columns of epidermal and dermal
tissue in regularly spaced arrays over a fraction of the skin surface. This intermediate
approach increases efficacy as compared to nonablative resurfacing, but with faster
recovery as compared to ablative resurfacing. Neither nonablative nor fractional resurfacing
produces results comparable to ablative laser skin resurfacing, but both have become
much more popular than the latter because the risks of treatment are limited in the
face of acceptable improvement.
At the completion of this learning activity, participants should be familiar with
the spectrum of lasers and light technologies available for skin resurfacing, published
studies of safety and efficacy, indications, methodologies, side effects, complications,
and management.