Carbon dioxide laser resurfacing of the aged face

Aging of the skin of the face consists of an intrinsic aging process that is genotypically inherent and inevitable, which accounts for the thinness of tissue that is lax and redundant. It can include benign and premalignant neoplasms [1, 2]. While photoaging or extrinsic aging is environmentally mediated and is characterized by fine and deep facial skin wrinkling; it can, be characterized by thickened, coarse, yellow, sallow skin, that is studded with telangiectasia, macules of hyper-and hypopigmentation, benign, premalignant and malignant neoplastic lesions [1, 3-6]. There are many ways to rejuvenate aged skin, which include topical treatments with vitamin A acid [7, 8], alpha and beta hydroxy acids [9, 11] and various types of skin resurfacing either by chemical peelings of glycolic, trichloracetric or phenolic acids for superficial, medium to deep depth resurfacing respectively [12, 13], or by performing a mechanical dermabrasion [14, 17]. This presentation will highlight rejuvenating the photodamaged and aged skin of the face by the currently most popular modality of resurfacing, which is using a high energy carbon dioxide laser that is either pursed or flashscanned [18-23]. There are presently two systems being utilized for high energy CO2 laser skin resurfacing. One laser system produces a high energy, super (ultra) pulsed, collimated CO2 laser light beam, called the UltraPulse(R) laser which is manufactured by Coherent, Inc., Pare Alto, CA. The other laser system, manufactured by Sharplan Lasers, Inc., Allendale, NJ, known as Silk Touch(TM) technology, utilizes a high energy continuous wave, non-collimated CO2 laser beam that is processed by an optico-mechanical flash scanner that emits a light beam that is rapidly rotated or flashscanned over the surface of the skin, lasting less than one msec. The effects of the Silk Touch(TM) laser are similar to and the results are comparable to those of the UltraPulse(R) laser [24-26]. The word laser is the acronym for Light Amplification by the Stimulated Emission of Radiation. When an atom of either a solid, liquid or gas is excited by an external power source, it causes an electron of an atom of that element to jump its usual orbital into a suborbital, causing it to be in a higher energy or excited state. This energized, excited electron, as it returns to its usual orbital, emits its surplus energy in the form of a photon or light energy. As this light energy is emitted, it then collides with other nearby atoms stimulating them into an excited state. This results in the additional release of photons that continue to stimulate the additional release of photons. In an actual laser, this stimulation of energy occurs in a holding container or resonator cavity, in which the emitted photons resonate or bounce back and forth within this cavity, deflected internally by mirrors at either end of the container. At one particular end there are partially reflective mirrors. At this end, the laser light is allowed to escape out of the resonator cavity and into an angulated tube which contains additional reflective mirrors at various points along its sides. As the laser light travels through and down this articulated tube or arm, these mirrors then direct the laser light through a terminal focusing lens finally to exit through an aperture and onto a target [27].