Information from Lumenis About Their CO₂ Laser for Acne Scars and Wrinkles

April 10th, 2008

As today’s image-conscious population matures, greater numbers of patients
are seeking procedures to eradicate or minimize acne scarred skin,
photodamaged skin and wrinkles. Fortunately, there are several
technologies to meet the aesthetic needs of your patients, from the
gold-standard of laser resurfacing.

CO₂ laser resurfacing continues to be an ideal method for
eliminating acne scars, moderate to deep lines and creases due to aging
and photodamage. With the ActiveFX peel using the CO₂ lite
feature, it is now the ideal method for a lighter minimal downtime peel.

Skin resurfacing with heavier settings is a tried and true approach to skin
rejuvenation precisely removing layers of skin to correct fine lines and
wrinkles, acne scars and smooth skin, soften pucker marks, and repair
skin discoloration. The results of laser resurfacing are generally quite
dramatic and long-lasting.

UltraPulse high-energy, short-pulsed carbon dioxide laser technology creates
a precise wound by means of thin layer ablation and controlled dermal
coagulation, with a predictable zone of residual thermal damage. Clinically,
there is global improvement in the appearance of the skin, with a reduction in
solar lentigines, actinic keratoses and rhytids, and an improvement in overall
pigmentation and skin tone. Histologically, there is cytologic and architectural
normalization of the epidermis, and the formation of a dermal repair zone
consisting of youthful dense, parallel arrays of collagen bundles in an expanded
papillary and reticular dermis.

The depth of dermal heating from residual thermal damage dictates the degree
of clinical and histologic improvement that will result, along with the duration
of wound healing and postoperative erythema. With ActiveFX moderate to deep
resurfacing, occlusive or open wound care techniques are employed and
reepithelialization occurs over a 7- to 10-day period postoperatively. Erythema
typically endures for 3-4 months following the procedure.

Years of experience and an extensive reference base including dozens for
peer-reviewed research papers have standardized the UltraPulse laser resurfacing
treatment protocol, ensuring safe, repeatable and consistent results. This
collective experience has not only amplified the merits of CO₂
technology but broadened its utility as well. Since the introduction of laser
resurfacing in 1994 we have learned that:

• CO₂ delivers the best effect for deep wrinkles
  and acne scars due to its superior ability to provide continued
  histologic improvement over time.
• Fewer passes yield the same results with less chance for
  complications.
• CO₂ can be used less invasively for treating
  milder indications or for when a shorter recovery time is desired.
• Darker skin tones can be treated safely and effectively
  when treatment is superficial.
• Upon long term follow-up, physician, patient and
  histologic evaluations have proven that clinical benefits persist.

Q: How does laser skin resurfacing work?

A: The CO₂ laser is designed to offer the versatility of
both deep and light – minimal downtime, skin resurfacing.  The wavelength of
light emitted by a CO₂ laser is very well absorbed by water in the
skin.  “Ultrapulses” of the laser vaporize lines, wrinkles, acne scars,
dark spots and other irregularities, layer by layer. This process also
stimulates the formation over time of new, underlying collagen to provide better
elasticity and support for the skin.

With upper eyelid blepharoplasty, the CO₂ laser removes loose
skin, and if present, fat pads. On the lower lid, fat pads are removed with no
visible incision and no stitches. Because the laser beam seals blood vessels as
it touches them, the technician can clearly judge how much tissue to remove, and
there is less swelling and bruising than with traditional eyelifts.

Q: Can CO₂ laser technology be used less invasively for
treating milder indications?

A:With Lumenis’ CO₂ laser technology, skin resurfacing is
so precise that you can tailor treatment according to the nature and extent of
acne scarring, photodamage, wrinkling, skin type and
individual requirements for recovery time. For instance, the Active-FX peel
using the unique CO₂ Lite feature allows you to achieve a superficial
laser peel with just one pass.  CO₂ Lite utilizes fluences that are
below the ablation threshold and with a single pass imparts intraepidermal
coagulation that is confined to the epidermis with little to no thermal injury
in the dermis.  In addition, the CoolScan program on the CPG places pulses in
such a manner as to minimize thermal conduction of heat to deeper tissues and
reduce the recovery period.  The epidermis is typically left intact and serves
as a natural wound dressing. The coagulated epidermis sloughs off in 3-5 days.
Downtime is typically 4-7 days and offer substantial results.

Q: What results can I expect, and how long will the benefits of treatment
last?

A: Laser resurfacing can restore your skin to a healthy state, similar
to that of skin that has not experienced sun damage or scarring. With proper sun
protection, results can persist for more than five years. In areas where muscle
activity is strong, lines may begin to reappear sooner. After laser eyelid
surgery, the cosmetic improvement is usually sustained. Typically, only one
blepharoplasty procedure is needed to remove excess skin and fat pads. With
cosmetic laser surgery you will have definitively ‘turned back the clock.’

Q: What are the advantages of using authentic CO₂ vs. erbium
lasers with extended pulse widths?

A: A bilateral study comparing resurfacing with long pulse erbium:YAG
followed by traditional short-pulse erbium ablation to CO₂ followed
by short-pulse erbium ablation (Rostan E, Goldman M, Fitzpatrick R. Laser
Resurfacing With a Dual-Mode, Long-Pulse Erbium:YAG Laser Compared to the 950-µs
Pulsed CO₂ Laser. Am J Cosmetic Surg. 2000; 17(4):227-231.) found
that there was no statistical difference in healing between the two sides and in
5 patients (26%), greater clinical improvement in periorbital lines, perioral
lines, or both was noted on the CO₂ side. (A reprint of this article
can be ordered from the Lumenis web site, Lumenis Lit. # 5448).

The value of utilizing authentic CO₂:

• When addressing moderate to severe acne scarring
  and wrinkles, true high-energy short-pulsed CO₂ technology
  has proven to be the superior modality.
• Physicians report that continued, progressive improvement
  in solar elastosis is seen post UltraPulse CO₂ laser resurfacing.
• The hemostatic effect only afforded by CO₂
  provides superior visualization of clinical endpoints.
• For surgical incisions, the cutting ability of CO₂
  is unsurpassed.

For more information about Lumenis and their products, visit
www.lumenis.com

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