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 April 2003.

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 pigmentation problems.

"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 CO₂ lite.

No significant 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 procedure.

Patients receive 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."

Post-operatively, the 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 resurfacing.

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 week.

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 article.