Full-Field Erbium:YAG Laser Resurfacing: Complications and Suggested Safety Parameters

Abstract

Background Laser skin resurfacing with erbium-doped yttrium aluminum garnet (Er:YAG) lasers is a newer alternative to CO2 laser treatment, and was developed to reduce common complications. Although Er:YAG lasers have been available for years, safety parameters for efficacious resurfacing with these devices have not previously been available. Objectives The aim of this study was to utilize one practice’s laser treatment settings and outcomes data to identify complication rates for various energies and areas of the face and to offer safe energy/depth parameters for treating each area. Methods A retrospective chart review was performed for full-field confluent laser resurfacing patients treated with a Sciton Contour Tunable Resurfacing Er:YAG laser by the senior author. The data were retroactively analyzed with a time range of 8 years (January 2007-December 2015). Results The overall complication rate for MicroLaserPeels (ablation of 50 µm or less) was 10.1% (20 of 198 treatments) and the rate for deep resurfacing treatments was 26.5% (71 of 268 cases). In MicroLaserPeel treatments the cheek area had the highest complication rate, followed by the forehead, nose, perioral, and eyelid areas, in that order (complication rate range, 0%-9.1%). In deep resurfacing treatments the perioral area had the highest complication rate, 38.6% of 145 cases. This was followed by the lids, cheek, nose, and forehead, in that order (complication rate range, 15.2%-20.9%). There is a correlation between increased depth of ablation and increased rate of complication. Conclusions The study confirmed the efficacy of Er:YAG resurfacing and provides guidance for a safer approach to excellent outcomes. Level of Evidence: 4

Helium Plasma Dermal Resurfacing With and Without Concurrent Aesthetic Surgery of the Face and Neck: A Retrospective Review

“… AEs observed in this study compared with similar AEs in two recent facial skin resurfacing studies including HPDR (lower energy, single pass treatment; Holcomb et al) and dual mode erbium YAG laser skin resurfacing (Weniger et al 23 ). a Number of patients determined based on percentage observed and total patients treated.…”

“…No new AEs unique to this technology were identified—all AE types recorded in this study have also been observed with other full-field facial skin resurfacing treatments including nitrogen plasma skin regeneration and laser skin resurfacing (CO 2 and Erbium YAG). 20-22 Similar AEs were observed in a recent clinical study using the updated helium plasma device wherein only a single pass at a lower power setting (20%) was performed 13 ; more severe AEs were observed in a recent clinical study using the Erbium YAG laser for deep resurfacing 23 (see comparison of AEs; Table 3 ).…”

“…If a second pass is performed, the superficially coagulated tissue is gently removed via wiping with moistened gauze. 19 Second and subsequent passes do not result in enough superficial tissue desiccation to warrant further tissue removal between successive passes; therefore, the overall depth of tissue ablation with multi-pass HPDR treatment as performed in this study is likely to be significantly less than that with the deep erbium YAG laser resurfacing treatments described by Weniger et al 23 A more superficial depth of tissue injury with HDPR treatment could account for the differences in AEs and is consistent with findings of the preclinical animal study comparing depth of tissue injury with the predicate nitrogen plasma skin regeneration device. 12 …”

“…Comparison of AEs between HPDR with 3 passes (mean) at 35% power (mean) with erbium YAG deep laser resurfacing reveals a much higher incidence of prolonged erythema for the latter (approximately 15% vs approximately 3%) as well as higher incidences of hypopigmentation and hypertrophic scarring with the laser treatment ( Table 3 ). Acne/milia, hyperpigmentation, and slow healing were either not observed or not recorded as AEs by Weniger et al 23 Additional AEs that were observed by Weniger et al with erbium YAG laser deep resurfacing but not with HPDR include bacterial infection, cold sores, and yeast infection. 23 …”

“…Acne/milia, hyperpigmentation, and slow healing were either not observed or not recorded as AEs by Weniger et al 23 Additional AEs that were observed by Weniger et al with erbium YAG laser deep resurfacing but not with HPDR include bacterial infection, cold sores, and yeast infection. 23 …”