Laser has been available for use by surgeons of various specialties since the mid sixties. Recently, however, it has become user friendly with the advent of the ultrapulse mode, (known by various manufacturers as ultrapulse, novapulse, or superpulse).

The use of the CO2 short pulse laser is essential in the practice of cosmetic surgery. It is useful for skin resurfacing and ablation of skin lesions without excessive skin damage. Lesions can be vaporized without loss of skin texture or color. Large or small areas of skin can be resurfaced without excessive tissue charring.

Physical properties

Laser light emission are produced with the help of a photon pump raising millions of electrons to a higher energy level causing spontaneous emission. Mirrors are then used to reflect some of the released photons back into the active medium to generate a stimulated emission that, with the help of the mirrors, continue to amplify. Leakage of this generated light via specialized lenses is used to produce the surgical effects.

Clinical considerations

The development of short pulse CO2 lasers has provided equipment that can safely vaporize superficial layers of the skin. Theoretically, the results obtained by a peel or dermabrasion can also be duplicated with the laser. The short pulse CO2 is beneficial for the treatment of the following conditions:

Preparing for CO2 skin resurfacing

To minimize the risks associated with CO2 skin resurfacing, you will be instructed on how to prepare your skin before the procedure. Sometimes a Tretinoin such as Retin-A-a prescription medication derived from Vitamin A-is used to pretreat the skin. This thins out the skin’s surface layer, allowing the active solution to penetrate more deeply and evenly. Hydroquinone, a bleaching agent, is sometimes used in conjunction with Retin-A, especially if you have blotchy skin areas or pigmentation problems. You may have to spend a month or more in the pretreatment phase before you are scheduled for the procedure. This not only produces a firmer base for the procedure but also reduces wound healing time by three to four days.

Postoperative dressing and care

Specialized dressings like Silon and N-terface® are porous, polyethylene sheeting. These dressings seem to produce the best wound healing and most painless results. The dressing is placed on the face and left in place for five days. The outside dressing of 4×4 gauze pads and tube netting is changed daily.

You will be given detailed instructions to follow after this procedure. It is essential that you follow your doctor’s specific postoperative instructions.

Special precautions

Patients previously treated with Accutane® Isotretonoin have developed atypical midface hypertrophic scars (keloids). If you have undergone Accutane® treatment, a resting period of at least six months is recommended before resurfacing the skin.

Patients may hyperpigment postoperatively, particurly patients with dark skin complexion. If you have dark skin you should begin a bleaching program on the fifteenth to the twentieth postoperative day. The program should begin before any pigmentation has occurred. This defensive bleaching regimen will subsequently resolve any hyperpigmentation over a period of three to four months.

Acne flare-ups are common after full facial treatment. Small pustules or milia develop as healing matures. Conditioning lotions with vitamin A and glycolic acid and medical facials may be used to extract impacted lesions.

Persistent red pruritic streaks can progress to become keloid hypertrophic scars. These streaks should be treated with silicone gel sheeting such as Epi-Derm®.