Ablative fractional lasers (CO₂ and Er:YAG): A randomized controlled double‐blind split‐face trial of the treatment of peri‐orbital rhytides

Abstract

Background and Objective: Ablative fractional lasers were introduced for treating facial rhytides in an attempt to achieve results comparable to traditional ablative resurfacing but with fewer side effects. However, there is conflicting evidence on how well this goal has generally been achieved as well as on the comparative value of fractional CO 2 and Er:YAG lasers. The present study compares these modalities in a randomized controlled double-blind split-face study design. Study Design/Materials and Methods: Twenty-eight patients were enrolled and completed the entire study. Patients were randomly assigned to receive a single treatment on each side of the peri-orbital region, one with a fractional CO 2 and one with a fractional Er:YAG laser. The evaluation included the profilometric measurement of wrinkle depth, the Fitzpatrick wrinkle score (both before and 3 months after treatment) as well as the assessment of side effects and patient satisfaction (1, 3, 6 days and 3 months after treatment). Results: Both modalities showed a roughly equivalent effect. Wrinkle depth and Fitzpatrick score were reduced by approximately 20% and 10%, respectively, with no appreciable difference between lasers. Side effects and discomfort were slightly more pronounced after Er:YAG treatment in the first few days, but in the later course there were more complaints following CO 2 laser treatment. Patient satisfaction was fair and the majority of patients would have undergone the treatment again without a clear preference for either method. Conclusions: According to the present study, a single ablative fractional treatment session has an appreciable yet limited effect on peri-orbital rhytides. When fractional CO 2 and Er:YAG lasers are used in such a manner that there are comparable post-operative healing periods, comparable cosmetic improvement occurs. Multiple sessions may be required for full effect, which cancels out the proposed advantage of fractional methods, that is, fewer side effects and less down time.

Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface

“…However, these lasers can also treat photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation. 40 Overall, patients can expect moderate down time and moderate risk of complications.…”

“…Similar to the comparison between nonfractionated CO 2 and Er:YAG lasers, the fractionated versions of these two laser types have similar postoperative and comparable cosmetic improvement. 40 …”

Ablative Fractional Laser Skin Resurfacing

“…Advantages of the CO 2 laser include better hemostasis (Holck and Ng 2003 ) and theoretically more tightening of facial rhytids (Biesman 1998 ). Nonetheless, a double-blind split-face study comparing the effects of ablative fractionated CO 2 laser to the periorbital region of one side of the face and Er:YAG laser to the periorbital area of the other half of the face demonstrated similar rhytid reduction (Karsai et al 2010 ). The minimum fl uence necessary to vaporize skin using the CO 2 laser is approximately 4-5 J/cm 2 (Biesman 1998 ;Holck and Ng 2003 ) (Table 169.1 ).…”

“…The most common indication is photoaging, specifi cally facial rhytids and dyschromias (Tierney et al 2011a , b ;Biesman 1998 ;Holck and Ng 2003 ;Karsai et al 2010 ;Roy 2005 ;Tierney and Hanke 2010 ;Alster and Lupton 2002 ). Other skin conditions amenable to resurfacing include acne scars (Hirsch and Lewis 2001 ), actinic keratosis, seborrheic keratosis, and rhinophyma (Biesman 1998 ).…”

Current Status of Fractional Laser Resurfacing

“…This is consistent with the reported histochemical effects of fractional resurfacing. 13 19 Consistent improvement was noted in skin texture, lentigines, pore size, and rhytids. In addition, it was noted that all 4 of the commonly used fractional devices resulted in statistically the same downtime and results.…”