The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing

Ablative fractional lasers (CO2 and Er:YAG): A randomized controlled double‐blind split‐face trial of the treatment of peri‐orbital rhytides

“…In contrast to some claims in the literature [19], the present study failed to demonstrate appreciable differences between both methods in treating peri-orbital rhytides in a meticulously chosen experimental setting with randomized, blind allocation of treatment sites in a split-face design. Correspondingly, this confirms previous comparative reports about non-fractional skin resurfacing [4][5][6][7]. Basically, the efficacy of both methods was roughly equal, and whereas the discomfort was somewhat more pronounced after Er:YAG treatment during the first days (with the notable exception of bleeding), CO 2 treatment was perceived as more unpleasant in the later course of follow-up.…”

“…Bodendorf et al [18] found no difference between both modalities based on the published material and their own experience; this conclusion is in complete agreement with our own results. As for ablative fractional methods in general, the efficacy of various laser modalities for rhytide reduction has been demonstrated (e.g., [2,5,12,13,15,17,18]) but the effect of a single treatment session may not be comparable to conventional ablative methods. There is published material opposing this statement; for instance, Trelles et al [14] published very encouraging results about a single treatment with a fractional Er:YAG laser, albeit in a very inhomogeneous sample in terms of treated region and treatment parameters.…”

“…In contrast to CO 2 lasers (10,600 nm), the Er:YAG laser has a technical benefit because its wavelength of 2,940 nm is much closer to an absorption maximum of water (3,000 nm) [3][4][5], thus allowing for high precision yet superficial skin ablation. With the selection of appropriate parameters, however, the biophysics of CO 2 and Er:YAG laser -tissue interaction creates similar injuries and cosmetic results [4][5][6][7].…”

“…In contrast to CO 2 lasers (10,600 nm), the Er:YAG laser has a technical benefit because its wavelength of 2,940 nm is much closer to an absorption maximum of water (3,000 nm) [3][4][5], thus allowing for high precision yet superficial skin ablation. With the selection of appropriate parameters, however, the biophysics of CO 2 and Er:YAG laser -tissue interaction creates similar injuries and cosmetic results [4][5][6][7]. Conceivably, the shortcomings of both methods are very similar: while they produce clinically efficacious results, the intensity and depth of the thermal injury may require anesthesia and result in unwanted effects such as hypo-or hyperpigmentation, prolonged wound healing and even scarring [1,6,8,9].…”

“…Whereas several studies claim encouraging results of erbium lasers (e.g., [12][13][14]), the same holds true for fractional CO 2 ablation [15][16][17]. There is very little evidence on the comparative safety and efficacy of both methods, but the limited scope of the literature to date suggests a roughly equivalent status [18], just as it does for non-fractional applications [4][5][6][7]. However, claims that the fractional CO 2 laser is superior to fractional Er:YAG [19] call for evidence-based scrutiny, as do the extremely encouraging results of fractional erbium lasers [14,20].…”