Lasers Offer Improved Safety, Shorter Recovery

This is part 2 of a 2-part series.

Part 1: The Laser Pendulum Swings

The old CO2 laser treatments came with an aggressive four-week healing window, followed by redness that persists for two to three months, according to Robb Brindley, vice president of North American sales and a board member at Sciton.

With today’s technology, recovery time from full-field erbium laser resurfacing is less than with the older CO2 lasers, but it’s still something for which patients need to be prepared. Most patients with moderate-to-severe facial lines need a single treatment with the full field ablative erbium resurfacing 2940 nm laser, but some with severe etching need two treatments, according to Dr. Cohen.

“The healing is about 10 to 12 days. Then, they can go back to activities, but they need to wear a tinted sunscreen and makeup over that to really try to camouflage that post-inflammatory redness. For full-field erbium, that post-inflammatory redness can sometimes last several weeks or even a couple of months,” he says.

Aesthetic physicians can recognize safety endpoints with full-field erbium 2940 nm resurfacing. That’s not always possible with full-field CO2.

“With full-field erbium, you can recognize pinpoint bleeding as the point to stop. So, I go back and efface these lines and wrinkles, but then I look at my overall depths, which will vary depending on the area of the lines that I’m treating. The fact that the erbium 2940 nm allows you to see that pinpoint bleeding and recognize that endpoint as the point to stop, even if you do see a little bit of a line that remains, is really helpful,” Dr. Cohen says.

Dr. Cohen controls patients’ pain with a topical anesthetic on the full face, then uses regional nerve blocks throughout the face. Around the mouth, he’ll do an infraorbital block.

“For the majority of patients, probably 90%, that’s enough,” he says.

Still, he has a patient-administered ProNox nitrous oxide unit in the office if patients need it during laser resurfacing.

Skin of Color

Dr. Cohen commonly treats patients with Fitzpatrick skin types 1 through 3 with the full-field ablative erbium resurfacing 2940 nm laser. For darker skin types, he’ll use that laser at lighter settings but more commonly uses fractional ablative erbium, as, he says, very deep etching in darker skin types is not common.

“Also, for darker skin types, I tend to use the Lutronic LaseMD Ultra thulium 1927 nm laser, which is the most popular overall non-ablative fractional laser in my practice for any skin type,” Dr. Cohen says.

Aesthetic laser technology still isn’t always ideal for skin of color and others with pigmentary concerns like melasma, but it does continue to improve with newer technologies, according to Dr. Kazin.

“If I determine it’s the best option for the patient, I tend to use a series of lighter lasers in skin of color patients — lasers that, when done in a series, have more of a cumulative effect, versus a more aggressive one-time laser,” Dr. Kazin says. “For example, I’ll use a low-power fractionated 1927 nm thulium device that can resurface gently, but when repeated on average four times, two to four weeks apart, can really help improve the appearance of the skin by improving discoloration and decreasing the appearance of pores and fine lines.”