ABSTRACTThe search for simpler techniques for skin resurfacing has led many groups to investigate the usefulness of lasers as precision tools for photodermabrasion. A new modality for superficial skin rejuvenation using a dye-assisted low-level energy CO2laser system is now available. Twenty patients have been treated during the last 18 months at the UCLA School of Medicine. Dye-assisted laser photodermabrasions have been performed to smooth out peri-oral or periorbital fine and deep rhytids in the treated patients. All subjects were females between the ages of 50 and 75 years with light to medium skin complexion and blue, green, and/or brown eyes. Patients with darker complexions and a history of hypertrophic/keloid scars or those on immunosuppressive therapy were excluded. All patients were treated only once and were followed in our clinic every 1–2 months for the last year, except for the patients who underwent adjunctive cosmetic procedures. The entire treatment with dye-assisted laser dermabrasion is performed in an office setting under topical/local anesthesia and lasts only 20–30 min. The LX-20 CO2laser (10.6 μm) was used in all patients at a low power output of 2–4 W in a pulsed mode (20 msec pulse, 20 Hz) and was defocused (hand-piece 3–5 cm from skin) using a painting or air-brush technique. The 1.4-mm-diameter tip was used at an average calculated power density (power/surface) fluctuating between 0.7 and 1.3 W/cm2and a CO2beam diameter that varied from 1.4 to 2.0 mm for an average energy density (power × time/surface) of 1.4–2.6 J/cm2after exposure for 2 sec. Superficial reepithelialization was observed within the first 10 to 14 days posttherapy and full healing was achieved within 2 months. No scarring or permanent hyper/hypopigmentation was observed in these 20 patients, although some laser abraded skin had a pinkish hue that gradually blended with the surrounding skin color after 6 to 8 weeks. This mild and temporary pink skin is easily masked with make-up. Significant improvement in skin texture, appearance, and elasticity was observed in all patients with a more uniform, smoother surface. Near complete regression of superficial rhytids (80 subjective improvement) and significant ablation of deep rhytids with at least 50 improvement was observed. The physician's learning curve with new CO2lasers is shorter and easier than with chemical or mechanical dermabrasion and results appear to be more uniform and predictable. A conservative treatment approach with test spots is highly recommended during the early stages of the learning curve and later with patients felt to be marginal candidates. The future potential of this technique is being explored using repeat CO2laser photodermabrasion at 2–4 month intervals and more intense treatment to the ret
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