Dallas - "CO2
laser is still a viable alternative for light facial
resurfacing," according to Dr. Niamtu, who described his
experiences with a single-pass "CO2 lite" technique
of CO2 skin resurfacing at the ASLMS meeting in
The CO2 lite
technique is a quick-healing, low-risk, non-debrided laser
resurfacing procedure that produces a laser facial peel. Like
a medium-depth chemical peel, the procedure improves only
minor skin wrinkling, but is very effective in addressing
"The CO2 lite
technique is ideal for patients who have minimal rhytides but
significant actinic damage and dyschromias, such as lentigos,"
said Dr. Niamtu. "If patients truly want noticeable
improvement of skin tightening and rhytid effacement, then
there is still no better treatment than aggressive
CO2 laser resurfacing, but the CO2 lite
technique is an excellent middle ground procedure with rapid
recovery and little complication."
Dr. Niamtu is currently
following a cohort of 50 consecutive patients who received
full or partial face resurfacing procedures using
complications have been observed in this group. One patient
experienced an inflammatory erythema lasting six weeks after
applying an "unknown" homeopathic cream on her face for a
week. The most common adverse event, experienced by several
patients, is local inflammation resulting from their picking
at the skin as it peels.
In his practice, Dr. Niamtu
uses the UltraPulse® Encore CO2laser (Lumenis,
Santa Clara, CA), which has a dedicated CO2 lite
setting of 3-3.5 J/cm2 at 600 Hz with a square pattern and a
density of 6. Appropriate settings may differ slightly
according to the specific laser, power and spot size; for
example, on the Coherent 5000c the settings would be higher
due to the larger spot size compared to the Encore laser.
Before treatment, Dr.
Niamtu explains the procedure to the patient and photographs
the treatment area under ultraviolet light. A UV digital
picture taken before the laser treatment not only lets the
patient visualize the extent of the skin damage before laser
treatment, but also allows the surgeon to identify dermal
melanin that might not respond to the resurfacing.
Comparison of the
pre-treatment photo with a similar digital UV photo taken
after the laser treatment illustrates the effectiveness of the
antibiotics and antivirals before the procedure, as they would
with any ablative laser procedure. The CO2 laser
resurfacing is usually performed with the patient under IV
sedation using Propfol, Ketamine and Versed. The laser is set
to the appropriate settings and a single pass is made over the
entire face, including the eyelids.
The eschar is not debrided
with gauze, as in conventional resurfacing; debridement is not
necessary and would only lengthen the healing process.
"Many patients also desire
more aggressive resurfacing of the lower lids for
dermatochalasis," said Dr. Niamtu. "In this case the laser is
set to conventional settings for that area."
treated area is covered with a petrolatum ointment, and the
subsequent healing process is very similar to that of a
medium-depth chemical peel. The healing process is much faster
with CO2 lite and does not lead to extended
erythema seen with aggressive, multipass, debrided laser
At about the fourth of
fifth post-operative day, the treated skin becomes brown and
begins to slough. Dr. Niamtu reported that 95 percent of
patients are able to wear makeup and return to work in a
The CO2 lite
settings are also excellent for ablating larger solitary
lentigenes and dyschromias., according to Dr. Niamtu.
"Compared to liquid
nitrogen, CO2 lite ablation is gentler and more
predictable, and the treated areas (dime- to quarter-sized)
heal within seven-10 days, with minimal erythema and no
scarring or hypopigmentation."
Dr. Niamtu reports no
conflicts of interest related to any company mentioned in this