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Laser resurfacing with a CO2 laser can be a painful procedure and traditional methods of pain control can be achieved using local injectable anesthesia or i.v. medications. The CoolAnalgesiaÂ© device is a novel technology that can significantly reduce the pain felt from such a resurfacing procedure and is very welcomed by patients.
Maxwell S.C. Murison, M.D., of the department of plastic surgery at Morriston Hospital, conducted a study with the CoolAnalgesia device in conjunction with a CO2 laser in 20 patients receiving laser resurfacing therapy.
Each patient was asked to assess the level of pain on a visual analogue scale from 1 to 10, every two minutes during lasering. Researchers used a luminous 5000 c laser, which is an ultra-pulse CO2 laser that emits very short pulses so there is no thermal buildup in the skin during treatment.
"Our patients were generally very satisfied with the treatment in respect to pain perceived. The problem with laser treatments is that it can be very painful without any form of anesthesia.
The cooling head of the device is mounted on the laser handpiece and has a Teflon foot with a square frame, which is equivalent to the square-scan pattern of the laser. This is placed on the skin. The device is connected to a refrigeration system that supplies a liquid coolant in a completely enclosed system circulating through the head. It can cool to minus 10 degrees.
Using the device
When using the device, Dr. Murison says this laser only works at the epidermal level, as does the cooling device. When treatment is started, the cooling does not occur at the center where the laser is going to fire, it is crucial to keep moving while firing the laser to cool the area of skin just immediately prior to firing the laser.
"We found in all our patients that this reduced the pain of the treatment to the point where it was easily bearable without requiring any additional form of oral or injectable anesthesia," Dr. Murison tells Dermatology Times.
"Because we are now able to perform a relatively pain-free laser resurfacing, we can now treat more areas in one sitting. Also, we are able to circumvent the problems associated with general anesthesia, another major advantage of this cooling device," he says.
The CoolAnalgesia device allows the physician to adjust the temperature according to the needs of the patient, as well as the speed rate of treatment and the speed rate of the scanning of the laser. Dr. Murison warned, though, that if the system is too cold, the head will freeze to the skin.
"If you are doing a second pass, some exudates may develop, and this will freeze to the head of the device. Here, there is a risk of causing a freeze-burn to the patient. To avoid this, it is important not to treat one area for too long, and keep moving," Dr. Murison says.
The laser therapy produces a heating effect and the skin will remain hot for approximately 45 minutes post-treatment. Directly following the treatment, Dr. Murison applies EMLA. He finds that it gave the patients an hour of pain relief, so deeper heating is not a factor. The effect of the EMLA is almost immediate, because following the CO2 laser treatment, the epidermis is absent and the cream can take effect almost immediately.