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 treatment 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 resurfacing. Objective. To prospectively study the clinical effects of pulsed carbon dioxide (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 CO2 laser resurfacing alone or with the same CO2 laser treatment followed by 3 passes with the Er:YAG laser. Patient diaries were maintained to assess erythema, crusting, pain, itching, swelling, pigmentary changes, and the day of first make-up application. Blinded objective grading of improvement was independently assessed by 4 blinded observers at time intervals 3, 6, and 10 days, and 1, 2, and 4 months. Chromometer measurements of erythema were also analyzed and percentage moisture recorded. Results. Subjectively, all patients reported, on average, 10 days of redness and 2.4 days of pain, with no significant difference noted between the two procedures. On average, patients were able to apply make-up 5.5 days postoperatively, regardless of which procedure used. However, the combined CO2/Er:YAG laser treatment patients experienced reduced duration of crusting, compared to the patients treated with CO2 alone. The duration of crusting 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 techniques 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 swelling was reduced from 6.3 to 6.0 days in patients receiving the combined procedure. No cases of permanent hyperpigmentation, hypopigmentation, or scarring occurred in any patients. Conclusion. The addition of the Er:YAG laser following CO2 laser resurfacing reduces the duration of crusting, swelling, and itching postoperatively. Medium to deep (Grade III) facial rhytids were improved by 70% with both procedures with no significant difference noted between techniques.