CO2 LASER HISTORY
author: hannah
2023-10-16
CO2 LASER HISTORY
CO2 laser was among the first lasers to be developed, and is also one of the most useful, not only in medicine.4 The first versions were used in the lips for the treatment of actinic cheilitis. 6 Extending this technique to the whole face became known as ablative resurfacing, which proved to be extremely effective.4 Nevertheless, the procedure was very painful, demanding a long post-operative period and intensive care that could last for months, as well as the suspension of personal activities. In addition, the percentage of adverse side effects – including infection, erythema, long-duration hyper and hypopigmentations, and scars – was considerable.
INDICATIONS
Fractional CO2 lasers are mostly indicated for cutaneous rejuvenation . It is a good option for treating facial aging, since it causes collagen to contract. It is also an option to treat pigmented lesions and improve actinic keratoses.10 The fractioning of the laser allows the treatment of extra-facial areas as such the neck, chest, arms and legs.
Fractional CO2 lasers are mostly indicated for cutaneous rejuvenation . It is a good option for treating facial aging, since it causes collagen to contract. It is also an option to treat pigmented lesions and improve actinic keratoses.10 The fractioning of the laser allows the treatment of extra-facial areas as such the neck, chest, arms and legs.
Other indications are: acne, chicken-pox and surgical scars. The same indications for traditional CO2 laser are valid, for it is possible to operate the equipment on the non-fractional method. The therapeutic indications are: seborrheic and actinic keratoses, warts, nevi acrochordons, rhinophyma, sebaceous hyperplasias, xanthelasmas, syringomas, actinic cheilitis, angiofibromas, keloids (adjuvating) and neurofibromas. CO2 laser is not recommended for the removal of tattoos and permanent makeup.
SIDE EFFECTS
Although the very frequent incidence of side effects with traditional CO2 laser decreased considerably with the new fractional technology, the effects of the new technique may have been initially underestimated.
Although the very frequent incidence of side effects with traditional CO2 laser decreased considerably with the new fractional technology, the effects of the new technique may have been initially underestimated.
POST-OPERATIVE EDEMA
Edema varies from light to moderate. In the periorbital region, it reaches its peak the morning after the procedure. In the rest of the face, the worst phase occurs between the second and third day after the procedure. It does not usually cause intense discomfort, and improves with daily sessions of infrared light emitting diodes (LEDs). In the most intense cases, oral (prednisone 40-60 mg/day, for 2 to 4 days) or intramuscular corticotherapy can be used. Cool chamomile tea compresses, thermal bags or thermal water spray can also relieve the discomfort.
Edema varies from light to moderate. In the periorbital region, it reaches its peak the morning after the procedure. In the rest of the face, the worst phase occurs between the second and third day after the procedure. It does not usually cause intense discomfort, and improves with daily sessions of infrared light emitting diodes (LEDs). In the most intense cases, oral (prednisone 40-60 mg/day, for 2 to 4 days) or intramuscular corticotherapy can be used. Cool chamomile tea compresses, thermal bags or thermal water spray can also relieve the discomfort.
ERYTHEMA
All patients experience temporary erythema after treatment with fractional CO2 laser.The intensity and persistence of the redness are proportional to the depth of the resurfacing (the higher the energy used, the deeper the action) and the number of passes (Figure 4).15 Persistent erythema is extremely rare with fractional lasers, and can be treated with dye laser or intense pulsed light (IPL).
All patients experience temporary erythema after treatment with fractional CO2 laser.The intensity and persistence of the redness are proportional to the depth of the resurfacing (the higher the energy used, the deeper the action) and the number of passes (Figure 4).15 Persistent erythema is extremely rare with fractional lasers, and can be treated with dye laser or intense pulsed light (IPL).
HYPOPIGMENTATION
Hypopigmentation is extremely rare after the use of fractional CO2 laser, and normally appears six months after treatment. There are two hypopigmentation types: true hypopigmentation and the pseudo-hypopigmentation. In the first, loss of melanin happens after very aggressive resurfacing, local infection or contact dermatitis. Abuse of hydroquinone before treatment may be another cause.Treatment is complex and can be carried out with non-ablative lasers, Excimer laser, melanocytes micrografts, or micropigmentation with permanent makeup. Pseudohypopigmentation means a lighter appearance of the treated skin compared to the adjacent skin.This condition can be minimized by avoiding the treatment of isolated facial aesthetic units and gradually reducing the density and energy in the transition areas (i.e., between the face and neck or the chest and neck).
Hypopigmentation is extremely rare after the use of fractional CO2 laser, and normally appears six months after treatment. There are two hypopigmentation types: true hypopigmentation and the pseudo-hypopigmentation. In the first, loss of melanin happens after very aggressive resurfacing, local infection or contact dermatitis. Abuse of hydroquinone before treatment may be another cause.Treatment is complex and can be carried out with non-ablative lasers, Excimer laser, melanocytes micrografts, or micropigmentation with permanent makeup. Pseudohypopigmentation means a lighter appearance of the treated skin compared to the adjacent skin.This condition can be minimized by avoiding the treatment of isolated facial aesthetic units and gradually reducing the density and energy in the transition areas (i.e., between the face and neck or the chest and neck).
