Facial rhytides—subsurfacing or resurfacing? A review

Abstract

After critical review and assessment of current literature on the treatment of rhytides, we have found that non-ablative methods do not appear to be a comparable alternative to ablative skin resurfacing in terms of their efficacy and side effects.

Single-Pass Carbon Dioxide Laser Skin Resurfacing Combined With Cold-Air Cooling

“…2004;140:1333-1336 I N THE PAST, LASER SKIN RESURFACing by means of ablative techniques that use carbon dioxide (CO 2 ) and erbium:YAG lasers has proved to be a promising therapeutic option for treating cutaneous photodamage, perioral and periorbital wrinkles, and acne scars. [1][2][3][4] Heating dermal collagen has been shown to induce collagen shrinkage and reactive dermal neocollagen formation. [5][6][7] Despite excellent results, the major disadvantage of ablative treatment methods is that they can cause large surface erosions, which can lead to downtime of up to 2 weeks as well as long-lasting postoperative erythema.…”

“…These include subsurfacing with both nonablative lasers and intense pulsed light systems, approaches whose efficacy has never been completely convincing, especially with regard to reduction of wrinkles alone. 4,10,11 Another strategy is single-or double-pass CO 2 laser resurfacing, which has been reported to result in more rapid reepithelialization, fewer and less severe adverse effects, and good prospects of success. [12][13][14][15][16] The postoperative adverse effects of ablative wrinkle treatment are not the only important consideration in regard to patient satisfaction; preventing intraoperative pain is also a major factor.…”

Recent Advances in Fractional Laser Resurfacing: New Paradigm in Optimal Parameters and Post-Treatment Wound Care

“…1 Consequently, many clinicians hold the prevailing view that higher fluence or higher-density FNAR produces superior clinical outcome. 1,4,7 With higher settings, more side effects are expected. 7 Herein, we reviewed two recent articles concluding that low-fluence or lowdensity FNAR can produce comparable results with fewer side effects.…”

“…Many clinicians believe that higher microbream energy in FPT result in better clinical outcome. 1,4,7 Previous studies with AR devices popularize the thinking that increasing thermal damage is associated with higher efficacy for resurfacing. We reviewed two recent articles that cast doubt on this assumption.…”

“…Unfortunately, without epidermal injury, their efficacy was significantly limited. 4 FPT attempts to overcome the disadvantages of these two other classes of devices. Unlike both AR and NAR devices, which attempt to uniformly damage skin at varying depths, FPT induces pixilated microscopic columns of thermal injury.…”