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Resurfacing renaissance

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  • The CO2 laser deserves recognition for its role in opening the door to many innovative rejuvenative treatments, says one expert

Dr. Niamtu
RICHMOND, VA. — The introduction of less aggressive procedures coupled with the use of fractionated techniques has led to a renaissance of interest in use of the CO2 laser for facial skin resurfacing, according to Joe Niamtu, III, D.M.D.

Aggressive, high-fluence, multipass CO2 laser resurfacing is still the gold standard for skin rejuvenation. This patient underwent facelift with simultaneous aggressive resurfacing of the central oval of the face.
OPENING DOORS Dr. Niamtu tells Cosmetic Surgery Times that he believes the CO2 laser deserves recognition for its role in opening the door to many innovative rejuvenative treatments. While its downsides and the introduction of minimally ablative techniques led many cosmetic surgeons to abandon CO2 resurfacing procedures, he thinks a resurgence is underway. "The introduction of CO2 laser resurfacing allowed us for the first time in history to predictably and precisely vaporize controlled layers of the skin to induce neocollagenesis and provide significant improvement in the appearance of aging skin. However, with this technology, the landscape of cosmetic surgery quickly changed from one where lasers were hardly used to a situation of overuse, and because CO2 laser resurfacing had a steep learning curve, it was also associated with many unfavorable outcomes and unpleasant sequelae," notes Dr. Niamtu, a private practitioner in Richmond, Va., specializing in cosmetic facial surgery.

The Active FX laser treatment is a high-fluence, very low-density treatment that incorporates fractionated technology with the Lumenis CoolScan random pattern generation. This closeup of the corner of the mouth shows the spaced laser pulse sites with intact skin between.
FRIENDLIER PATIENT EXPERIENCE "Minimally ablative treatments generated significant interest, but their outcomes failed to meet up to the hype, causing surgeons to take a second look at CO2 laser technology. Now, experienced practitioners have used their expertise to harness the power of the laser by manipulating the settings, passes and dressings to reduce post-operative problems and create a friendlier CO2 experience," Dr. Niamtu adds. In his practice, CO2 laser resurfacing is performed using the Ultrapulse Encore laser (Lumenis) with four different approaches that he describes as "heavy," "medium," "lite" and "ultralight" (fractionated; Active FX, Lumenis). They represent a spectrum of aggressiveness and differ from each other with respect to the length of the post-treatment recovery period and the type of results that can be achieved. "These options extend the versatility of the CO2 laser to meet the needs of different patients based on the severity of their facial aging, desired level of improvement, and acceptable threshold for post-operative morbidity. However, it's important not to oversell the potential of the less aggressive procedures and to inform patients that they should consider multiple smaller procedures to increase their result," explains Dr. Niamtu. THE TREATMENT CONTINUUM CO2 "heavy," the most aggressive technique, involves two to four passes using high-fluence (7 J/cm2 to 8 J/cm2 )/high-density (30 percent overlap) settings to achieve reticular dermal injury and, consequently, improvement of even deep rhytids. Recovery takes 12 to 14 days.

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