Paul Silverstein MD - Laser Resurfacing

News from the ASPS:
Laser Resurfacing's Long-Term Aesthetic Results

The study, "Long-Term Assessment of CO2 Facial Laser Resurfacing: Aesthetic Results and Complications," was designed to assess the long-term efficacy and safety of laser resurfacing using a CO2 laser. A panel of plastic surgery reviewers (none of whom performed the procedures), reviewed the results of 211 CO2 laser resurfacing procedures performed between September of 1994 and December of 1996. It was the first study to show long-term realistic results using lasers, with the lasers correcting about 2/3 of the fine wrinkles on a patient's face.

The reviewers studied primarily full-face procedures, assessing outcomes including rhytid (facial line) reduction, overall aesthetic improvement and considerable results and complications in the short-, medium- and long-term.

Of the 211 patients reviewed, 202 were women. Almost all of them were Caucasian (206) and five patients were Hispanic. In addition, two-thirds of the patients were between 40 and 60 years of age. A total of 141 patients had resurfacing performed on their entire face. Central resurfacing was performed on 46 patients in conjunction with other procedures, such as rhytidectomy (facelift).

Patients experienced various outcomes including 45 patients (21 percent) who developed postprocedure hyperpigmentation (excess coloration in bodily part or tissue). The overwhelming majority of this group were treated before the surgeons' usual postoperative antipigment regimen. In addition, facial line removal was more prominent in the cheeks; there was a 92 percent improvement at three months and 90 percent improvement at six months.

At one year, all aesthetic regions treated with the CO2 laser, had experienced some relapse. However, 56 percent of the patients experienced improvement in periorbital (tissues surrounding orbit of the eye) initial appearance, 59 percent in the perioral (tissues around the mouth) region, and 61 percent in the forehead.

"It should be noted that the face, richly vascularized and dense with skin appendages, is ideally suited for resurfacing," says Rod Rohrich, M.D., a co-author of the study. "Frequent follow-up, meticulous wound care, and attention to thickened or isolated prolonged red areas is extremely important for minimizing complications."

The periorbital region, which showed the least response, had improved 78 percent at three months. This, in addition to smoother skin texture and improvement of pigmentary changes, produced very positive overall aesthetic results.

"The CO2 laser provides pulse durations that are shorter than tissue thermal relaxation time," says A. Jay Burns, M.D. and co-author of the study. "Patient satisfaction was very high with the use of the CO2 laser, with improvements of 40-60 percent."