Skin Resurfacing Improved with a New Dual Wavelength Er:YAG/CO2 Laser System: A Comparative Study

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Abstract
The efficacy of a new dual wavelength Er:YAG and CO2 laser system was tested for skin resurfacing results on rabbits' ears and human facial skin. The dual wavelength laser delivers simultaneous pulses of low-energy CO2 and high-energy Er:YAG energies. Theoretically, combining the strengths of both laser types in one console should lead to improved clinical outcome. The use of the laser for skin resurfacing and remodeling has dramatically increased over the past few years. The CO2 laser was the first laser to be used in this field, followed more recently by the E:YAG laser. Both lasers offer unique advantages and disadvantages. The present study consists of an ear chamber experiment, conducted on eight rabbits, to examine vascular network formation, after laser resurfacing with a standard CO2 laser and the Er:YAG/CO2 laser. Resurfacing was also performed on human patients with the Er:YAG/CO2 laser and the results were compared with previously published results of CO2 laser resurfacing. Significant advantages, including an attenuation in the degree of edema and erythema and a shorter reepithelialization time compared to results with conventional CO2 systems, were observed with the Er:YAG/CO2 system. Improved tissue reorganization and good clinical results in nine of the ten patients (six ratings of "very good" and three "good") were observed. The clinical outcome of the remaining patient was rated as "fair." Minimal side effects were reported and observed in only three patients. The learning curve required to maximize the efficiency of the system is steep, however, requiring a thorough understanding of the different laser/tissue interactions associated with the two wavelengths. It is the authors' opinion that the dual wavelength Er:YAG/CO2 laser system offers a particularly efficient and flexible system to perform standard CO2 procedures for skin resurfacing with an improved clinical outcome, as well as other applications with the CO2 or Er:YAG energy delivered separately.