Data-Medicos 
Dermagic/Express No. 2-(83) 
17 Noviembre 1.999. 17 November 1.999. 

~ El Erbium, el Co2 y el Erbium/Co2 ~ 
~The Erbium, the Co2 and the Erbium/Co2~ 


EDITORIAL ESPANOL 
================= 
Hola amigos de la red, DERMAGIC hoy con el tema de los laser de ERBIUM, CO2 Y ERBIUM/CO2 (DERMA K), el cual es una combinacion de ERBIUM + CO2. Este parece ser superior a los anteriores, pues produce menos efectos secundarios y daño a la piel que los otros. 

Estas 42 referencias nos hablan sobre estos 3 tipos de LASER y su alcance terapéutico en DERMATOLOGIA, pues tambien han sido usado con exito en otras especialidades. La palabra YAG significa: Yttrium-Aluminium-Garnet. Efectos secundarios TIENEN TODOS los tipos de LASER, y cierro este DERMAGIC con las palabras de uno de mis PROFESORES EN DERMATOLOGIA. Dr. Marco Tulio Merida: "Se publican los exitos más no los fracasos"... 


Saludos a todos !!! 

Dr. Jose Lapenta R.,,, 

EDITORIAL ENGLISH 
================= 
Hello friends of the net, DERMAGIC today with the topic of the laser of ERBIUM, CO2 AND ERBIUM/CO2 (DERMA K), which is a combination of ERBIUM + CO2. This seems to be superior to the previous ones, because it produces less secondary effects and damage to the skin that the other ones. 

These 42 references speak us about these 3 types of LASER and their therapeutic reach in DERMATOLOGY, because they have also been used with success in other specialties. The word YAG means: Yttrium-Aluminium-Garnet. Secondary effects HAVE ALL the types of LASER, and I close this DERMAGIC with those words of one of my PROFESSORS IN DERMATOLOGY. Dr. Marco Tulio Mérida:  "The successes are published and not the failures"... 


Greetings to ALL, !! 
Dr. Jose Lapenta R.,,,

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REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES 
=================================================================== 
1.) [Laser surgery in esthetic surgery. Review]. 
2.) New Laser System Combines Erbium:YAG, CO2 
3.) Combined laser resurfacing with the 950-microsec pulsed CO2 + Er:YAG lasers. 
4.) Product Features of the Erbium-YAG/CO2 laser-DERMA K 
5.) Skin Resurfacing Improved with a New Dual Wavelength Er:YAG /CO2 Laser System: A Comparative Study. 
6.) New lasers for skin resurfacing: Erbium-YAG/CO2 systems Perspectives in Plastic Surgery Histologic and clinical evaluation of combined eyelid erbium: YAG and CO2 laser resurfacing. 
8.) Combination therapy: utilization of CO2 and Erbium:YAG lasers for skin 
resurfacing. 
9.) Combined CO2/Erbium:YAG Laser Resurfacing of Peri-Oral Rhytides and 
Side-By-Side Comparison with Carbon Dioxide Laser Alone1. 
10.) Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations. 
11.) Histologic analysis of the thermal effect on epidermal and dermal structures following treatment with the superpulsed CO2 laser and the erbium: YAG laser: an in vivo study. 
12.) Why Erbium Laser Resurfacing is Better than CO2 
13.) Erbium Laser Resurfacing 
14.) Erbium-(Er:YAG) Laser-Assisted Zona Drilling for Embryo Biopsy 
15.) Erbium laser resurfacing: current concepts. Plast Reconstr 
16.) Periorbital skin resurfacing using high energy erbium:YAGlaser: results in 50 patients. 
17.) Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing. 
18.) Comparison of four carbon dioxide resurfacing lasers. A clinical and histopathologic evaluation. 
19.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 
20.) [Laser skin resurfacing. Er:YAG laser and cw-CO2 laser with scanner system in direct comparison]. 
21.) Skin resurfacing of facial rhytides and scars with the 90-microsecond short pulse CO2 laser. Comparison to the 900-microsecond dwell time CO2 lasers and clinical experience. 
22.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 
23.) Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. 
24.) Skin resurfacing of the face with the Erbium:YAG laser. 
25.) Skin resurfacing with the erbium:YAG laser. 
26.) Laser resurfacing of the neck with the Erbium: YAG laser. 
27.) Erbium:YAG laser skin resurfacing: preliminary clinical evaluation. 
28.) Efficacy of erbium:YAG laser ablation in Darier disease and Hailey-Hailey disease. 
29.) Treatment of photoaged neck skin with the pulsed Erbium:YAG laser. 
30.) Resurfacing of pitted facial scars with a pulsed Er:YAG laser. 
31.) Skin contraction following erbium:YAG laser resurfacing. 
32.) Computerized scanning erbium:YAG laser for skin resurfacing. 
33.) Laser skin resurfacing using a frequency doubled Nd:YAG laser after topical application of an exogenous chromophore. 
34.) Effects of pulsed laser systems on stapes footplate. 
35.) Erbium:YAG laser resurfacing in Asians. 
36.) Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. 
37.) Comparison of high-energy pulsed carbon dioxide laser resurfacing and 
dermabrasion in the revision of surgical scars. 
38.) Carbon dioxide laser resurfacing of peri-oral rhytids in scleroderma patients. 
39.) Skin contraction following erbium:YAG laser resurfacing. 
40.) A side-by-side comparison of carbon dioxide resurfacing lasers for the treatment of rhytides. 
41.) The Use of the Erbium:YAG Laser for the Treatment of Class III Rhytids. 
42.) A clinical study on the removal of gingival melanin pigmentation with the CO(2) laser. 
============================================================ 
============================================================ 
1.) [Laser surgery in esthetic surgery. Review]. 
============================================================ 
Mund Kiefer Gesichtschir 1999 May;3 Suppl 1:S162-7 


Mang WL, Sawatzki K 
Abteilung fur HNO und plastische Operationen, Kreiskrankenhaus Lindau. 

Since the introduction of laser therapy was developed continuously. New 
indications are possible in the aesthetic surgery. The laser is used for 
the treatment of naevi, hemangiomas, wide port-wine-stains, 
teleangiectasias, tattoos, epilations and skin resurfacing. To fulfill the 
expectations of the patients and the remands of a plastic aesthetic surgeon 
it is important to find the correct indication and choose the right laser. 
Vascular and pigmental disorders can be successfully treated with the flash 
lamp pumped pulsed dye laser. Laser containing different wave lengths are 
available. For the treatment of the aged skin the Ultrapuls-CO2-Laser 
offers advantages in comparison with the Erbium-YAG-Laser. However these 
lasers can not replace a facelift or blepharoplasty. 

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2.) New Laser System Combines Erbium:YAG, CO2 
============================================================ 
Bruce Jancin, Denver Bureau 
[Skin & Allergy News 29(8):21, 1998. © 1998 International Medical News Group.] 


SCOTTSDALE, ARIZ. -- An investigational new laser system for skin 
resurfacing combines the distinct advantages of the erbium:YAG and CO2 
lasers in a single device, Dr. Michael H. Gold said at the annual meeting 
of the Noah Worcester Dermatological Society. 

ESC Medical Systems' Derma K laser system alternately fires erbium:YAG and 
CO2 laser pulses in synchronized fashion. 

The Er:YAG laser's traditional strengths are precise control and minimal 
side effects; each pass ablates a 25-nm-thick layer of skin with no thermal 
contraction of surrounding tissue. Posttreatment erythema lasts only 2-10 
days; the 6- to 12-month-long episodes of postinflammatory 
hyperpigmentation common after CO2 laser skin resurfacing don't occur with 
the Er:YAG laser. 

The Er:YAG laser is effective for the treatment of superficial wrinkles. It 
provides a general facial rejuvenation comparable to a light chemical peel. 
But it yields less than impressive results for the treatment of acne scars 
and other deep dermal defects. That's where the alternating pulses of CO2 
laser energy come in, continued Dr. Gold, a dermatologist in Nashville, Tenn. 

The CO2 laser component of the Derma K is designed to provide a subablative 
thermal effect sufficient to achieve collagen remodelling and shrinkage 
along with good hemostatic control without attaining the higher energy 
levels that have caused long-term complications with conventional CO2 
lasers. Dr. Gold, a paid speaker and investigator for ESC, is a principal 
investigator in the clinical trials of the Derma K just under way. 

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3.) Combined laser resurfacing with the 950-microsec pulsed CO2 + Er:YAG lasers. 
============================================================ 
Dermatol Surg 1999 Mar;25(3):160-3 

Goldman MP, Manuskiatti W 
Dermatology Associates of San Diego County, Inc., La Jolla, California 
92037, USA. 

INTRODUCTION: Laser resurfacing with the 950 microsec pulsed CO2 laser has 
been proven to be efficacious in improving photodamaged skin and acne 
scarring. Unfortunately, prolonged erythema and delayed wound healing are 
common adverse sequelae, which require intensive patient education and 
intervention. These adverse effects may be due to the degree of nonspecific 
thermal damage present after resurfacing with the CO2 laser. Since erbium: 
YAG (Er:YAG) laser vaporization leaves far less thermal damage, it is 
hypothesized that its use after CO2 laser resurfacing will decrease the 
extent of nonspecific damage and result in improved wound healing. METHODS: 
Ten patients were randomized to receive laser resurfacing of one-half of 
the face with the 950 Msec pulsed CO2 laser with 3 passes at 300 mJ, 
utilizing the computer pattern generator (CPG) at settings of 596, 595, 
584, and the other half of the face (randomly chosen) resurfaced with the 
950 Msec pulsed CO2 laser 2 passes with the CPG at 300 mJ at settings of 
596 and 595, followed by 2 passes with the Er:YAG laser (Derma-20 or 
Derma-K, ESC Medical Systems, Inc., Needham, MA) with a 4 mm diameter spot 
size at 1.7 J (approximately 14 J/cm2). Patients were evaluated in a 
"blinded" manner clinically and histologically before resurfacing, 
immediately after resurfacing, 2 to 3 days postoperatively, 1 week 
postoperatively, and, 4 to 8 weeks postoperatively. RESULTS: There was 
slightly less inflammation with the CO2/Er:YAG-treated patients. The 
epidermis re-formed 1 to 2 days faster with combination (UPCO2)/Er:YAG 
treatment than with UPCO2 laser treatment alone. In 7 of 10 patients, 
Er:YAG erythema resolved within 2-3 weeks with CO2 x 3 erythema persisting 
at the 8-week follow-up period in all patients. Three of 10 patients had no 
difference in the degree of erythema between the 2 treatment areas. 
Clinical findings correlated with histologic findings of vascularity. There 
was no difference in the extent or time of edema between techniques. The 
usual demarcation line between cheek and neck at the mandibular angle was 
less apparent when the UPCO2/Er:YAG combination was used. Two of 10 
patients noted quicker healing with the combination laser technique. 
CONCLUSION: Treating a patient with the Er:YAG laser after treatment with 
the UPCO2 laser results in a decreased incidence of adverse sequelae 
without a noticeable difference in the degree of wrinkle improvement. 

============================================================ 
4.) Product Features of the Erbium-YAG/CO2 laser-DERMA K 
============================================================ 
SOURCE: ESC Medical Systems Ltd. 

Product Features 
Unique new method for skin rejuvenation: Derma K has the unique capability 
to deliver both Er:YAG and CO2 beams simultaneously (K blend mode) to the 
same tissue area for exceptional skin rejuvenation. The Er:YAG carries out 
accurate ablation of superficial layers, opening the way for the CO2 to 
affect the deeper tissue layers. 

Controlled Thermal Profile: Derma K combines the best of both the Er: YAG 
and CO2 lasers for improved clinical efficacy. It replicates the precise 
tissue ablation and minimal necrosis found in Er:YAG systems and 
significantly controls the heating of deeper tissue layers, typical of CO2 
systems. 

Hemostasis: The concurrent delivery of both wavelengths provides the 
physician with enhanced control over hemostasis, (Dry Erbium technique) 
thereby increasing the range of applications for Er:YAG laser. The CO2 mode 
of the Derma K delivers sufficient thermal energy to seal small blood 
vessels throughout the surgical procedure, creating the benefit of a clean, 
dry surgical field. 

Reduced number of passes: Simultaneous operation of both the Erbium and CO2 
lasers minimizes the number of passes required for a given procedure, 
thereby minimizing erythema and decreasing the recovery time. At the same 
time the dual wavelengths allow more overall energy to the tissue, 
increasing ablation depth as it controls thermal impact. 

Versatility: Can also perform many standard CO2 surgical and aesthetic 
procedures (like blepharoplasty). 

Less pain: No need for general anesthesia or intravenous sedation when 
treating most body areas. 

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5.) Skin Resurfacing Improved with a New Dual Wavelength Er:YAG /CO2 Laser System: A Comparative Study. 
============================================================ 
Trelles MA, et al. 
J Clin Laser Med Surg 1999; 17(3): 99-104. 
Abstract: 

Objective: 
The efficacy of a new dual wavelength Erbium: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. 

Summary Background Data: 
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 
employed in this field, followed more recently by the Erbium:YAG laser. 
Both lasers offer unique advantages and disadvantages. 

Methods: 
The present study consists of an ear chamber experiment, conducted on 8 
rabbits, to examine vascular network formation, following 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. 

Results: 
Significant advantages, including an attenuation in the degree of edema and 
erythema and a shorter re-epithelialization time compared to results with 
conventional CO2 systems, were observed with the Erbium:YAG/CO2 system. 
Improved tissue reorganization and good clinical results in 9 of the 10 
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 3 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. 

Conclusion: 
It is the authors' opinion that the dual wavelength Erbium: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. 

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6.) New lasers for skin resurfacing: Erbium-YAG/CO2 systems Perspectives in Plastic Surgery 1999; 13(1): 57-82 (available as hard cover 
============================================================ 
Weinstein C. 
journal in September 1999) 
Abstract: 

Skin remodelling is an important component of facial rejuvenation. For 
decades, chemical peeling and dermabrasion has been practiced to achieve 
this purpose, but lack of precision has been a major drawback. Carbon 
dioxide (wavelength 10,600 nm) laser resurfacing was introduced in the hope 
of achieving more predictable skin rejuvenation. Although many of the 
results produced by the carbon dioxide laser were clearly excellent, the 
morbidity and side effects due to thermal injury, limited its use in 
aesthetic surgery. The Erbium:YAG (wavelength 2940 nm) laser was introduced 
in an attempt to achieve greater precision in skin remodelling without the 
nonspecific thermal effects, thereby leading to lower morbidity and fewer 
complications. Because the Erbium:YAG laser has a greater affinity (10 
times) for water than the carbon dioxide laser, more accurate and stepwise 
control of the depth of epidermal and dermal destruction is possible. 
Furthermore, the Erbium:YAG laser is capable of producing its own target 
tissue, such as water within the dermis, as it stimulates the release of a 
transudate from dermal blood vessels. This allows true and precise ablation 
of dermal tissues, a phenomenon which the carbon dioxide laser is incapable 
of producing. 

Long-term (greater than 1 year) results in over 700 patients using the 
Erbium:YAG laser, demonstrate that this laser can eradicate both 
superficial and deeper rhytids and can be safely used in all skin types in 
both males and females, and all age groups. The results with acne scarring, 
and cutaneous pigmentary abnormalities have also been extremely 
satisfactory. The morbidity and complications have been minimal compared to 
the carbon dioxide laser and patient satisfaction greatly enhanced. 

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7.) Histologic and clinical evaluation of combined eyelid erbium: YAG and CO2 laser resurfacing. Am J Ophthalmol 1999 
============================================================ 
Millman AL; Mannor GE. 
May;127(5):614-6. 

This study is a comparison of using the Derma 20 Er:YAG laser (ESC/Sharplan 
) followed by one pass of the NovaPulse CO2 laser (ESC/Sharplan ) versus 
using the NovaPulse CO2 laser alone for eyelid resurfacing. It demonstrates 
that the combined laser modality enhances clinical effects and reduces 
morbidity. The benefits of this combined laser approach can be achieved 
with a single device (Derma K Er:YAG/CO2 laser, ESC/Sharplan), which offers 
the added advantage of simultaneous delivery of both laser energies. 

Abstract: 

Purpose: To report the histopathologic and clinical effects of eyelid 
resurfacing that combines two different lasers. 

Method: A case series of 23 patients who underwent eyelid resurfacing with 
two passes of the Erbium:YAG laser followed by one pass of the CO2 laser. 
With the Student t test, we compared skin re-epithelialization time and 
duration of erythema with those of a previous group of 25 patients who had 
undergone eyelid resurfacing with only the CO2 laser (two passes). A 
pathologist evaluated all skin biopsy specimens. 

Results: Combining both lasers shortened re-epithelialization time (7 vs 12 
days, P = .04) and the duration of erythema (2.5 vs 7.0 weeks, P = .02). 
Histopathologic examination disclosed less coagulative dermal damage with 
the combined laser protocol. 

Conclusion: The different biophysical properties of these two lasers can be 
combined in a periorbital resurfacing protocol to minimize both clinical 
and histopathologic morbidity. 

============================================================ 
8.) Combination therapy: utilization of CO2 and Erbium:YAG lasers for skin 
resurfacing. 
============================================================ 
Ann Plast Surg 1999 Jan;42(1):21-6 
Collawn SS 
Carraway Laser Center, Birmingham, AL, USA. 

Skin resurfacing with carbon dioxide (CO2) lasers is a commonly used method 
for skin rejuvenation. With these lasers, there is substantial skin 
improvement with lessening of rhytids and skin discoloration, and 
noticeable skin tightening. However, there is also significant morbidity 
associated with their use. To decrease the healing and erythema times, 
other types of lasers have been developed. The author discusses the 
practice of combining the CO2 and Erbium:YAG lasers for limiting thermal 
injury. For deeper rhytids in the periorbital, perioral, and forehead 
regions, multiple passes with the CO2 laser are often the preferred 
treatment. For moderate rhytids, the CO2 laser can be used for the first 
pass followed by one to multiple passes with the Erbium:YAG laser. 
Erbium:YAG lasers when used alone are beneficial for removing fine wrinkles 
and discolorations. Combining these lasers results in both rhytid 
improvement and decreased morbidity. 

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9.) Combined CO2/Erbium:YAG Laser Resurfacing of Peri-Oral Rhytides and 
Side-By-Side Comparison with Carbon Dioxide Laser Alone1. 
============================================================ 
Dermatol Surg 1999 Apr;25(4):285-293 

McDaniel DH, Lord J, Ash K, Md JN 

BACKGROUND: Laser resurfacing of facial rhytids has become a popular 
treatment option for many patients with wrinkles, photoaging, and acne 
scarring. Laser wavelength options and optimization of techniques continue 
to evolve in an attempt to shorten the healing phase associated with laser 
skin resurfacing. OBJECTIVE: To prospectively study the clinical effects of 
pulsed carbon dioxide (CO2) laser resurfacing of facial rhytids used alone, 
compared with a combination of CO2 and the pulsed Erbium:YAG (Er:YAG) 
laser. METHODS: Forty treatment sites on 20 patients were randomized and 
evaluated following treatment of the upper lip region with a combination of 
CO2 laser resurfacing alone or with the same CO2 laser treatment followed 
by 3 passes with the Er:YAG laser. Patient diaries were maintained to 
assess erythema, crusting, pain, itching, swelling, pigmentary changes, and 
the day of first make-up application. Blinded objective grading of 
improvement was independently assessed by 4 blinded observers at time 
intervals 3, 6, and 10 days, and 1, 2, and 4 months. Chromometer 
measurements of erythema were also analyzed and percentage moisture 
recorded. RESULTS: Subjectively, all patients reported, on average, 10 days 
of redness and 2.4 days of pain, with no significant difference noted 
between the two procedures. On average, patients were able to apply make-up 
5.5 days postoperatively, regardless of which procedure used. However, the 
combined CO2/Er:YAG laser treatment patients experienced reduced duration 
of crusting, compared to the patients treated with CO2 alone. The duration 
of crusting was reduced on average from 7.4 to 6.5 days, and also the 
duration of itching was reduced in patients receiving combined treatment 
from 5.5 to 4.8 days. Chromometer measurements noted no significant 
difference between techniques in the rate of resolution of erythema. 
Blinded objective grading revealed that crusting was reduced on average 
from 7.2 to 6.0 days, and swelling was reduced from 6.3 to 6.0 days in 
patients receiving the combined procedure. No cases of permanent 
hyperpigmentation, hypopigmentation, or scarring occurred in any patients. 
CONCLUSION: The addition of the Er:YAG laser following CO2 laser 
resurfacing reduces the duration of crusting, swelling, and itching 
postoperatively. Medium to deep (Grade III) facial rhytids were improved by 
70% with both procedures with no significant difference noted between 
techniques. 

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10.) Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, 
intraoperative, and postoperative considerations. 
============================================================ 
Plast Reconstr Surg 1999 Feb;103(2):619-32; discussion 633-4 

Alster TS 
Washington Institute of Dermatologic Laser Surgery and Georgetown 
University Medical Center, DC, USA. 

The development and integration of pulsed and scanned CO2 and erbium:YAG 
laser systems into mainstream surgical practice over the past years has 
revolutionized cutaneous resurfacing. These lasers are capable of 
delivering to skin high peak fluences to effect controlled tissue 
vaporization, while leaving an acceptably narrow zone of residual thermal 
damage. The inherent technological differences that exist between the two 
distant laser systems in terms of ablation depths, degree of thermal 
coagulation, and postoperative side-effects and complications guide patient 
selection and management. This article reviews the basic principles of CO2 
and erbium:YAG laser resurfacing, including preoperative, intraoperative, 
and postoperative patient considerations. Side-effects and complications 
encountered after laser resurfacing are discussed with specific guidelines 
provided on their appropriate management. Anticipated future developments 
and cutting-edge research endeavors in cutaneous laser resurfacing are also 
briefly outlined. 

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11.) Histologic analysis of the thermal effect on epidermal and dermal 
structures following treatment with the superpulsed CO2 laser and the 
erbium: YAG laser: an in vivo study. 
============================================================ 
Lasers Surg Med 1999;24(2):93-102 

Utley DS, Koch RJ, Egbert BM 
Division of Otolaryngology/Head and Neck Surgery, Facial Plastic and 
Reconstructive Surgery, Stanford University Medical Center, Palo Alto, 
California 94305, USA. [email protected] 

BACKGROUND AND OBJECTIVE: To compare the in vivo histologic effects of the 
carbon dioxide (CO2) and erbium:yttrium aluminum garnet (Er:YAG) lasers. To 
ascertain the effects of combining CO2 and Er:YAG laser modalities during a 
single treatment session. STUDY DESIGN/MATERIALS AND METHODS: Ten patients 
underwent laser treatment to four left preauricular sites 7 days prior to 
rhytidectomy as follows: CO2 alone, CO2/Er:YAG, Er:YAG alone, and 
Er:YAG/CO2. The right preauricular area was identically treated 1 hour 
prior to rhytidectomy. Laser treated skin was excised during rhytidectomy 
and was evaluated histopathologically in a blinded manner. RESULTS: After 7 
days, all groups were reepithelialized and showed equal neo-collagen 
formation. After 7 days, CO2/Er:YAG and Er:YAG alone had the least collagen 
injury and thickest epidermis and papillary dermis of all groups. Specimens 
lased 1 hour prior to excision showed the least collagen injury and thermal 
necrosis when treated with CO2/Er:YAG and Er:YAG alone. Four passes with 
CO2 removed 250 microm of tissue, while eight passes with the Er:YAG 
removed 160 microm of tissue. CONCLUSIONS: Limiting CO2 laser passes and 
ending with Er:YAG produces less collagen injury, less thermal necrosis, 
and more robust epithelial and dermal fibrous tissue regeneration. CO2 
followed by Er:YAG has similar thermal necrosis and collagen injury as 
Er:YAG alone, presumably due to Er:YAG removal of CO2 induced thermal injury. 

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12.) Why Erbium Laser Resurfacing is Better than CO2 
============================================================ 
By Dr. Daniel Fleming, 
AESCULAP-MEDITEC GMBH 

The Cosmetic and Laser Surgery Institute of Australia, Brisbane 

Studies at the Cosmetic and Laser Surgery Institute of Australia treated 
volunteer patients with Erbium:YAG laser (AESCULAP-MEDITEC Dermablate) on 
one side of the face and with CO2 laser (Sharplan Silk Touch) on the other. 

The results show the Erbium: YAG laser to be equally effective at removing 
or improving wrinkles but with quicker healing time, less redness and less 
oedema. The Erbium:YAG laser also had a lower incidence of late 
hypopigmentation, the common and permanent sequala of CO2 laser resurfacing. 
Various myths abound concerning the Erbium:YAG laser. It is often 
suggested that it is only useful for superficial wrinkles, that it does not 
tighten the skin like the CO2 laser and that bleeding prevents deeper 
ablation. 
To understand why these claims are incorrect it is crucial to understand 
the central concept of any resurfacing procedure: this is the total depth 
of injury. It is this that will determine both the beneficial effects of a 
resurfacing process and the risks of unwanted effects such as scarring or 
hypopigmentation. It does not matter whether the resurfacing was caused by 
dermabrasion, chemical peel, CO2 laser or Erbium:YAG laser. The different 
modalities simply give differing degrees of control over the depth of 
injury. Only the total depth of injury matters to the result. 

With laser resurfacing the total depth of injury consists of an ablation 
crater with a zone of thermally necrosed tissue immediately below it. There 
are important 

============================================================ 
13.) Erbium Laser Resurfacing 
============================================================ 
SOURCE: NorthWest LaserDerm 

Erbium Laser ResurfacingTM has been a breakthrough in laser resurfacing. 
This is a more complete renewal process than Cool Touch Treatment alone. 
Erbium Laser Resurfacing gives us regeneration not only of the collagen 
layer but a full regeneration of the skin surface layers as well. Erbium is 
the "coldest" of the resurfacing lasers, and has shortened healing time to 
usually 5 to 6 days after laser resurfacing. Because the excellent 
absorption of Erbium laser energy, there is very little heat penetration 
into the skin so that redness after resurfacing is usually very little, 
lasting on average 2 to 3 weeks. Erbium Lasers can be gentle enough to use 
on the thin skin of the hands, neck or chest, and still give enough surface 
effect to treat deeper thicker facial acne scars. Erbium Laser Treatment 
can be combined with follow-up Cool Touch treatments to enhance the gains 
of collagen renewal. 

Derma K Laser ResurfacingTM is a very exciting new laser process which 
combines within a single laser both an Erbium laser beam and a Carbon 
Dioxide laser beam. This blended beam has both the advantages of the 
relative "coldness" of the pure Erbium laser beam as well as the advantages 
that Carbon Dioxide laser has with enhanced skin tightening. This gives our 
patients greater skin tightening especially around the eyes and mouth. 

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14.) Erbium-Yttrium-Aluminium-Garnet (Er:YAG) Laser-Assisted Zona Drilling for Embryo Biopsy 
============================================================ 
Source: 1996 ASRM Meeting 

F. Azem, J. B. Lessing, T. Schwartz, M. Ben-Haim, I. Yovel, A. Amit. IVF 
Unit, Serlin Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler 
Faculty of Medicine, Tel Aviv University, Israel 


Objectives: Preimplantation genetic diagnosis is based on embryo biopsy and 
the application of molecular biology techniques. The biopsy procedure can 
be done through a hole made in the zona pellucida (ZP) either mechanically 
or by drilling, using acid tyrodes or hyaluronidase. The aim of our study 
was to evaluate the use of Er:YAG laser for embryo biopsy. 

Design: Randomized prospective observation of 3PN embryo development after 
laser-assisted zona drilling for embryo biopsy. 

Materials and Methods: 3PN embryos at the six- to eight-cell stage were 
collected. A hole was made in the ZP by using Er:YAG laser at a wave length 
of 2.9 µm to create a 20-30 µm opening in the ZP. One or two blastomeres 
adjacent to the opening were removed using the sequestration technique by 
micromanipulation. The development of the biopsied embryos (group A) was 
compared with a corresponding group of nonbiopsied, 3 PN embryos (group B). 

Results: Group A comprised 11 3PN embryos, compared with 9 embryos in group 
B. In group A, five embryos developed until the blastocyst stage, compared 
with four in group B. The development of the remaining embryos in group A 
was arrested. The development of five embryos in group B was arrested at 
the four- to eight-cell stage. 

Conclusions: The use of Er:YAG laser offers a simple and quick alternative 
technique for embryo biopsy. It seems that the procedure does not decrease 
the potential of embryo development. 

============================================================ 
15.) Erbium laser resurfacing: current concepts. Plast Reconstr 
============================================================ 
Weinstein CA. 
Surg 1999; 103(2): 602-16. 

Abstract: Laser skin resurfacing has enjoyed great popularity in recent 
years with the introduction of computerized, pulsed carbon dioxide lasers. 
However, the morbidity and side effects of carbon dioxide lasers have 
stimulated a search for alternative methods of skin remodeling. The 
erbium:YAG laser can be successfully used for skin resurfacing, with lower 
morbidity than the carbon dioxide laser. In a series of 625 patients who 
had erbium:YAG resurfacing, the following conclusions were reached. (1) 
Long-term (> 6 months) improvement in wrinkles and acne scars required 
total fluences exceeding 20 J/cm2. Periocular wrinkles required total 
fluences of between 20 and 40 J/cm2, depending on the depth of the wrinkles 
and skin thickness. Perioral rhytids required total fluences of between 40 
and 80 J/cm2, whereas the cheeks and forehead required total fluences of 30 
to 60 J/cm2. (2) Deeper wrinkles were best treated with a combination of 
erbium and carbon dioxide lasers, which minimized the bleeding that occurs 
with deeper erbium resurfacing. The simultaneous combined erbium with 
carbon dioxide laser was particularly advantageous. (3) Complications were 
relatively uncommon using the scanning erbium laser, and most adverse 
effects occurred early in the series. Scarring occurred in 5 of the 625 
patients (0.8 percent) and mostly resolved with intralesional steroids. 
Hyperpigmentation occurred in 21 of the 625 patients (3.4 percent) and was 
temporary in nature. Hypopigmentation, which became evident after 6 months, 
occurred in 25 of the 625 patients (4.0 percent) but was mild and not a 
significant cosmetic problem, except in one patient who developed scarring 
on the neck. Hypopigmentation seemed to be related to the depth of 
resurfacing. Four of the 625 patients (0.6 percent) developed temporary 
scleral show, but no patients had permanent ectropion. Eight of the 625 
(1.3 percent) developed synechiae under the lower eyelid, which required 
minor correction. 

============================================================ 
16.) Periorbital skin resurfacing using high energy erbium:YAGlaser: results in 50 patients. 
============================================================ 
Weiss MA, et al. 
Lasers Surg Med 1999; 24(2): 81-6 

Objective: To evaluate Erbium:YAG regional periorbital laser resurfacing 
clinically and histologically. 

Study Design/Materials And Methods: Photographic evaluation before and 
after Erbium:YAG resurfacing with histologic evaluation of depth of injury. 
Setting: Group private single specialty practice. PATIENTS: Fifty patients 
in the age range of 35-62 years, Fitzpatrick skin types I-III were treated 
using Erbium:YAG for regional resurfacing of periorbital rhytides. Outcome 
Measures: Patients were seen at days 1, 2, 3, 7, 14, 28, and at six months 
and one year. Photographs were obtained prior to application of topical 
anesthesia and were utilized to judge improvement of rhytides at all time 
intervals. Additional photographs were taken at each follow-up visit and 
the results judged by an independent investigator. Results were graded into 
five categories at all treatment intervals: no improvement, mild (grade 1: 
up to 25%), moderate (grade 2: 25-50%), good (grade 3: 50-75%, or excellent 
(grade 4: 75-100%). For histologic evaluation of depth of ablation and 
thermal injury one, two, and three passes at 21.2 J/cm2 were performed on 
four patients. 

Results: Re-epithelization in the periorbital region was rapid with a mean 
duration of 2.65 days. Erythema ranged from a longest of six weeks to the 
shortest of seven days with a mean duration of 15.4 days. Evaluation of 
clinical results revealed that at two weeks mean improvement was 2.15 
(between moderate and good). At four weeks further improvement was noted 
with a mean of 2.62. By six months, mean improvement score increased to 
2.94. Minimal further improvement was noted between six months and one year 
with a mean improvement score of 3.02 (good to excellent). Histology 
revealed complete removal of the epidermis with one to three passes. Dermal 
ablation of 5-10 microns accompanied by small increases (5-10 microns) in 
dermal thermal injury occurred with each subsequent pass. 

Conclusion: We conclude that high energy Erbium:YAG periorbital resurfacing 
is a safe and effective modality which achieves substantial therapeutic 
effect. Most patients achieve approximately 75% improvement. Erythema fades 
quickly, reepithelization is rapid and side effects are minimal. 

============================================================ 
17.) Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous 
resurfacing. 
============================================================ 
Lasers Surg Med 1999;24(2):87-92 

Alster TS 
Washington Institute of Dermatologic Laser Surgery, Washington, DC 20037, 
USA. 

BACKGROUND: Several erbium:YAG lasers are currently available for cutaneous 
laser resurfacing. Although different laser systems are purported to 
produce equivalent laser energies to produce similar laser-tissue 
interactions, no comparative clinical or histologic studies have been 
performed to objectively demonstrate their relative efficacies. OBJECTIVE: 
The purpose of the present study was to examine the in vivo clinical and 
histopathologic effects of six different erbium:YAG resurfacing lasers. 
METHODS: A blinded, prospective study using six different erbium lasers 
(Candela, Continuum Biomedical, HGM, MDLT, SEO, Sharplan/ESC) was 
performed. The facial halves of 12 patients were randomly resurfaced with 
one of the six laser systems by using an identical laser technique at 5.0 
J/cm2. Intraoperative skin biopsies were obtained after each of three laser 
passes in two patients for blinded histologic determination of tissue 
ablation level and presence of residual thermal damage. Clinical 
assessments of reepithelialization rates, severity and duration of 
erythema, side effects, and degree of clinical improvement were made at 
0.5, 1, 2, 4, 12, 26, and 52 weeks postoperatively. RESULTS: Irrespective 
of the erbium laser system used, complete reepithelialization typically 
occurred at 0.5 weeks and resolution of erythema was noted within 1-2 weeks 
postoperatively. A mean clinical improvement of 50% was observed, with 
photodamaged skin showing greater improvement than scarred skin. The most 
common postoperative side effect was hyperpigmentation, with all affected 
patients having either darker skin tones or preceding dermal inflammation. 
Three laser passes were needed to effect total epidermal ablation when 
using any one of the erbium:YAG systems. CONCLUSIONS: Equivalent clinical 
and histologic results were seen after each of the six erbium:YAG lasers 
studied. Erbium:YAG laser resurfacing can be used to significantly improve 
mild cutaneous photodamage and atrophic scars. 

============================================================ 
18.) Comparison of four carbon dioxide resurfacing lasers. A clinical and 
histopathologic evaluation. 
============================================================ 
Dermatol Surg 1999 Mar;25(3):153-8; discussion 159 

Alster TS, Nanni CA, Williams CM 
Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA. 

BACKGROUND: Several high-energy, pulsed and scanned carbon dioxide (CO2) 
lasers are currently available for cutaneous resurfacing. Although each 
laser system adheres to the same basic principles of selective 
photothermolysis, there are significant differences between lasers with 
respect to tissue dwell time, energy output, and laser beam profile. These 
differences may result in variable clinical and histologic tissue effects. 
OBJECTIVE: The purpose of this study was to examine the in vivo clinical 
and histopathologic effects of four different high-energy, pulsed or 
scanned CO2 resurfacing lasers. METHODS: A prospective study using four 
different CO2 resurfacing lasers (Coherent UltraPulse, Tissue Technologies 
TruPulse, Sharplan FeatherTouch, and Luxar NovaPulse) was performed. The 
cheeks of seven patients were divided into four quadrants. Each quadrant 
was randomly assigned to receive treatment with one of four CO2 lasers. 
Skin biopsies were obtained intraoperatively from each quadrant, after each 
of three laser passes, and at 1 and 3 months postoperatively. Blinded 
clinical assessments of each laser quadrant were made at 1, 3, and 6 months 
postoperatively by three physicians. Degree of lesional improvement as well 
as erythema severity, re-epithelialization rates, and presence of side 
effects were recorded. Blinded histologic examination of laser-treated 
quadrants was performed to determine the amount of tissue ablation, 
residual thermal damage, inflammation, and new collagen synthesis. RESULTS: 
The four CO2 lasers produced equivalent clinical improvement of rhytides 
and scars. Re-epithelialization occurred in all laser quadrants by day 7. 
Postoperative erythema was most intense in the quadrants treated by 
UltraPulse and NovaPulse; however, overall duration of erythema was 
equivalent for all four laser systems (3 months). Postinflammatory 
hyperpigmentation was the most frequently encountered side effect and 
occurred with equal frequency in each quadrant. No scarring, 
hypopigmentation, or infections were observed. After one laser pass, 
histologic examination revealed partial ablation of the epidermis with the 
TruPulse laser and complete epidermal ablation using the UltraPulse, 
NovaPulse, and FeatherTouch laser systems. The greatest degree of residual 
thermal damage was seen after FeatherTouch and NovaPulse laser irradiation. 
New collagen formation was greatest in the UltraPulse and FeatherTouch 
laser-irradiated quadrants. CONCLUSIONS: Equivalent clinical results were 
observed using the FeatherTouch, NovaPulse, TruPulse, and UltraPulse CO2 
lasers. While postoperative erythema intensity differed between laser 
systems, total duration of erythema was equivalent. The four lasers under 
study resulted in minimal residual thermal damage and stimulated new 
collagen formation within 6 months after treatment. 

============================================================ 
19.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 
============================================================ 
Arch Dermatol 1999 Apr;135(4):391-7 

Khatri KA, Ross V, Grevelink JM, Magro CM, Anderson RR 
Department of Dermatology, Massachusetts General Hospital, Harvard Medical 
School, Boston 02114, USA. 

OBJECTIVE: To compare the efficacy, adverse effects, and histological 
findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in 
removing facial rhytides. DESIGN: An intervention study of 21 subjects with 
facial rhytides. All participants were followed up for 6 months. The end 
points of the study were wrinkle improvement and duration of adverse 
effects. SETTING: Academic referral center. SUBJECTS: Nineteen female and 2 
male volunteers with skin type I to III and wrinkle class I to III 
participated in the study. INTERVENTION: In all subjects, 1 side of the 
face was treated with a CO2 laser and other side with an Er:YAG laser. Skin 
biopsies were performed in 6 subjects before treatment and immediately, 1 
day, 2 days, and 6 months after treatment. Observations were recorded by 
subjects, investigators, and a blinded panel of experts. MAIN OUTCOME 
MEASURES: Improvement in wrinkles and severity and duration of adverse 
effects. RESULTS: The CO2 laser-treated side had relatively better wrinkle 
improvement when evaluating all subjects (P<.03). However, in subjects 
receiving more than 5 passes of Er:YAG laser, improvement scores were not 
significantly different from those for 2 to 3 passes of CO2 laser 
treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) 
on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2 
laser-treated side. The frequency of erythema was significantly less after 
Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation 
was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi2, 
P<.05). Histological evaluation showed residual thermal damage of up to 50 
microm on the Er:YAG-treated side and up to 200 microm on the CO2-treated 
side. CONCLUSIONS: Erbium:YAG laser is safe and effective in removing 
facial rhytides. Subjects treated with Er:YAG laser recover more quickly 
from the procedure than those receiving CO2 laser treatment. 

============================================================ 
20.) [Laser skin resurfacing. Er:YAG laser and cw-CO2 laser with scanner system in direct comparison]. 
============================================================ 
Hautarzt 1998 May;49(5):367-71 
[Article in German] 


Hohenleutner S, Hohenleutner U, Baumler W, Landthaler M 
Klinik und Poliklinik fur Dermatologie der Universitat Regensburg. 

We compared a cw carbon dioxide flash-scanning laser system to an Er:YAG 
laser in laser skin resurfacing of facial rhytides. In all patients, CO2 
laser treatment showed a better cosmetic result whereas erythema and 
postinflammatory hyperpigmentation were less marked in Er:YAG laser therapy. 

============================================================ 
21.) Skin resurfacing of facial rhytides and scars with the 90-microsecond short pulse CO2 laser. Comparison to the 900-microsecond dwell time CO2 lasers and clinical experience. 
============================================================ 
Dermatol Surg 1998 Dec;24(12):1390-6 

Moy RL, Bucalo B, Lee MH, Wieder J, Chalet MD, Ostad A, Dishell WD 
UCLA Division of Dermatology, USA. 

BACKGROUND: Carbon dioxide lasers that produce either short pulses or 
scanned continuous beams have been used for skin resurfacing to improve 
wrinkles or scars. Using a high peak power, short pulse CO2 laser can 
produce clinically effective results with minimal thermal damage. 
OBJECTIVE: To evaluate the effectiveness of skin resurfacing using the 
90-microsecond pulse duration CO2 laser compared to other laser systems. 
Erythema, healing time, complications, and histological measurement of the 
depth of ablation and thermal damage per pass with this system were also 
assessed. METHODS: Forty-one patients with facial rhytides and scars 
underwent resurfacing with a 90 microseconds pulse duration CO2 laser. 
Using patient survey, patients were evaluated for effectiveness of therapy, 
healing time, and complication rates. Comparisons of histologic and 
clinical findings were made with different short pulse CO2 lasers. RESULTS: 
Healing time, duration of erythema, and post-operative pain were less with 
the 90 microseconds pulse CO2 laser than with the 900-microsecond dwell 
time and 950-microsecond pulse duration lasers, while effectiveness was 
comparable. Complications were few with the 90-microsecond pulse laser, 
including three patients (9.1%) developing hyperpigmentation. One pass with 
the 90-microsecond pulse duration CO2 laser produced 100 microns of 
ablation with 17 microns of thermal damage. Ablation and damage were 
additive so that, by six passes, ablation depth was 350 microns and depth 
of thermal damage was 63 microns. This thermal damage is less than that 
reported with lasers having a longer pulse duration or dwell time with 
comparable depths of vaporization. CONCLUSION: Treatment with the 
90-microsecond pulse duration laser results in a more rapid healing time 
and shorter duration erythema. The clinical improvements in wrinkles and 
sun damage were comparable. The 90-microsecond pulse duration laser 
provides an effective, predictable, and safe means of improving facial 
rhytides and scars. 

============================================================ 
22.) Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. 
============================================================ 
Arch Dermatol 1999 Apr;135(4):391-7 

Khatri KA, Ross V, Grevelink JM, Magro CM, Anderson RR 
Department of Dermatology, Massachusetts General Hospital, Harvard Medical 
School, Boston 02114, USA. 

OBJECTIVE: To compare the efficacy, adverse effects, and histological 
findings of erbium:YAG (Er:YAG) and carbon dioxide (CO2) laser treatment in 
removing facial rhytides. DESIGN: An intervention study of 21 subjects with 
facial rhytides. All participants were followed up for 6 months. The end 
points of the study were wrinkle improvement and duration of adverse 
effects. SETTING: Academic referral center. SUBJECTS: Nineteen female and 2 
male volunteers with skin type I to III and wrinkle class I to III 
participated in the study. INTERVENTION: In all subjects, 1 side of the 
face was treated with a CO2 laser and other side with an Er:YAG laser. Skin 
biopsies were performed in 6 subjects before treatment and immediately, 1 
day, 2 days, and 6 months after treatment. Observations were recorded by 
subjects, investigators, and a blinded panel of experts. MAIN OUTCOME 
MEASURES: Improvement in wrinkles and severity and duration of adverse 
effects. RESULTS: The CO2 laser-treated side had relatively better wrinkle 
improvement when evaluating all subjects (P<.03). However, in subjects 
receiving more than 5 passes of Er:YAG laser, improvement scores were not 
significantly different from those for 2 to 3 passes of CO2 laser 
treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) 
on the Er:YAG laser-treated side and 20 subjects (95%) on the CO2 
laser-treated side. The frequency of erythema was significantly less after 
Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation 
was seen in 1 Er:YAG-treated (5%) and 9 CO2-treated (43%) sides (chi2, 
P<.05). Histological evaluation showed residual thermal damage of up to 50 
microm on the Er:YAG-treated side and up to 200 microm on the CO2-treated 
side. CONCLUSIONS: Erbium:YAG laser is safe and effective in removing 
facial rhytides. Subjects treated with Er:YAG laser recover more quickly 
from the procedure than those receiving CO2 laser treatment. 

============================================================ 
23.) Complications of carbon dioxide laser resurfacing. An evaluation of 500 
patients. 
============================================================ 
Dermatol Surg 1998 Mar;24(3):315-20 

Nanni CA, Alster TS 
Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA. 

BACKGROUND: Cutaneous laser resurfacing with high-energy, pulsed and 
scanned carbon dioxide (CO2) lasers has become popularized for the 
treatment of a variety of cutaneous indications, but potential 
complications and side effects remain a large concern. Despite the recent 
boom in cutaneous laser resurfacing procedures, there remains a relative 
paucity of written information documenting laser complication rates. 
OBJECTIVE: The purpose of this study was to identify and report the 
complications that occurred after cutaneous CO2 laser resurfacing within a 
large patient population. METHODS: A retrospective analysis and chart 
review was performed in 500 consecutive patients who underwent cutaneous 
laser resurfacing of 1589 facial regions with the UltraPulse CO2 laser by a 
single operator. Side effects and complications relating to infection, 
postoperative healing, pigmentary changes, and scarring were tabulated. 
RESULTS: The most common complication observed was postoperative erythema, 
which occurred in all patients, lasting an average of 4.5 months. 
Hyperpigmentation was seen in 37% of patients with a higher rate in darker 
skin phototypes. Acne flares, milia formation, and dermatitis occurred in 
10-15% of patients. Postoperative infection with herpes simplex virus (HSV) 
was observed in 7.4% regardless of prior HSV history. Hypopigmentation, 
scarring, and other local or disseminated infections occurred in < 1% of 
this study population. CONCLUSIONS: Cutaneous CO2 laser resurfacing is a 
relatively safe procedure with a low complication profile. Proper laser 
treatment protocol and postoperative management is important in reducing 
side effects and complications. 

============================================================ 
24.) Skin resurfacing of the face with the Erbium:YAG laser. 
============================================================ 
Dermatol Surg 1998 Jun;24(6):653-8; discussion 658-9 

Perez MI, Bank DE, Silvers D 
Center for Dermatology, Cosmetic, and Laser Surgery, Mt. Kisco, NY 15849, 
USA. 

BACKGROUND: Laser resurfacing of facial skin is a very popular method of 
rhytide and scar removal. Until recently, the most effective tool utilized 
for these purposes was the pulsed char-free carbon dioxide laser. These 
lasers, however, produce thermal damage related to prolonged wound healing. 
The Erbium (Er): YAG laser, with its 2940-nm wavelength and maximal water 
absorption, has been recently introduced for laser resurfacing of the 
facial skin. OBJECTIVE: In this study, specific parameters for Er:YAG laser 
treatment of rhytides were evaluated clinically and histologically. 
METHODS: Fifteen patients were treated with the Er:YAG laser. Perioral, 
periorbital, and total face rhytides were treated. All patients were 
treated with 0.8-1.0 J, 5-mm spot size, with the final fluences of 4-5 
J/cm2. Patients were evaluated daily after treatment for 7 days and weekly 
for 2 months for erythema, healing time, improvement, and pigmentary 
changes. Histologic evaluation of preauricular human facial ex vivo skin 
was done to determine the penetration of multiple passes of Er:YAG laser in 
human facial skin. RESULTS: All patients showed some degree of improvement 
of their rhytides. Reepithelialization occurred between 3 and 8 days. All 
evidence of erythema resolved between 3 and 6 weeks after treatment. The 
level of tissue ablation was determined to be down to: the granular layer 
after one pass; to the basal cell layer after two passes, to the papillary 
dermis after three to four passes, and deeper into the papillary and 
superficial reticular dermis after five to six passes. CONCLUSION: The 
Er:YAG laser plays a significant role in the treatment of superficial and 
mid-depth rhytides. 

============================================================ 
25.) Skin resurfacing with the erbium:YAG laser. 
============================================================ 
Dermatol Surg 1997 Aug;23(8):685-7 

Teikemeier G, Goldberg DJ 
Laserzentrum Duesseldorf, Germany. 

BACKGROUND: Recent studies have shown that pulsed char-free carbon dioxide 
lasers are effective in the treatment of rhytids. However, these lasers 
produce thermal damage with the potential for prolonged wound healing. 
OBJECTIVE: In this study, we evaluated the role of the erbium (Er):YAG 
laser in the treatment of rhytids. This laser, with a wavelength of 2940 
nm, produces little thermal damage. METHODS: Twenty patients were treated 
with the Er:YAG laser. Perioral, periorbital, and forehead rhytids were 
treated. Pulsed of energy varying between 400 and 800 mJ were used; spot 
sizes between 2.5 and 5 mm were chosen. Patients were evaluated at 2 days, 
1 month, and 2 months for erythema, time of healing, degree of improvement, 
and pigmentary charges. RESULTS: All 20 patients showed improvement of 
their rhytids. Reepitheliation occurred between 4 and 10 days. 
Postoperative of eythema resolved in less than 2 weeks. Clinical 
improvement occurred between 3 and 8 weeks after laser treatment. 
CONCLUSION: The Er:YAG laser plays a role in the treatment of superficial 
rhytids. 

============================================================ 
26.) Laser resurfacing of the neck with the Erbium: YAG laser. 
============================================================ 
Dermatol Surg 1999 Mar;25(3):164-7; discussion 167-8 

Goldman MP, Fitzpatrick RE, Manuskiatti W 
Dermatology Associates/Cosmetic Laser Associates of San Diego County, Inc, 
USA. 

BACKGROUND: Laser resurfacing of the face is widely used to correct the 
effects of photoaging. The neck also develops a similar degree of 
photoaging, but is not usually treated because a higher incidence of 
adverse effects can occur with laser treatment. OBJECTIVE: To present a new 
method for treating photoaged skin of the neck with an erbium:yttrium 
aluminum garnet (Er:YAG) laser. METHODS: Twenty patients underwent Er:YAG 
laser resurfacing of the neck with one of two methods. Method 1 consisted 
of using the Er:YAG with a 5-mm diameter collimated beam at a fluence of 
8.7 J/cm2 followed by a second pass using a 0.2 mm diameter non-collimated 
spot at 1.7 J in a defocused mode with spot sizes ranging from about 5 to 
10 mm in diameter (fluences from 2-9 J/cm2). Method 2 consisted of treating 
the entire neck with a single pass of the Er:YAG laser with a 4 mm diameter 
non-collimated spot at 1.7 J (fluence of 13.5 J/cm2). A second pass at 
identical settings was made on the upper half of the neck with a more 
defocused pass using a 6-10 mm diameter spot (fluence of 2-6 J/cm2) on the 
lower half of the neck. Patients were evaluated by two nontreating 
physicians as to overall satisfaction and improvement in skin texture and 
color. RESULTS: Overall, 51% of patients were satisfied with their results. 
Skin texture improved an average of 39%. Method 1 produced a 28% 
improvement, Method 2 a 48% improvement. Skin color improved an average of 
37%. Method 1 produced a 28% improvement, Method 2 a 45% improvement. 
CONCLUSION: Photoaged skin of the neck can be effectively treated with the 
Er:Yag laser with minimal adverse effects. 

============================================================ 
27.) Erbium:YAG laser skin resurfacing: preliminary clinical evaluation. 
============================================================ 
Ann Plast Surg 1998 Apr;40(4):328-34 

Bass LS 
Institute of Reconstructive Plastic Surgery, NYU Medical Center, Manhattan 
Eye Ear & Throat Hospital, New York, NY, USA. 

Each of the increasing number of resurfacing lasers uses a unique strategy 
to produce tissue ablation. Erbium:YAG (Er:YAG) lasers have been used in 
other applications for precise tissue removal with little thermal effect. 
Recovery time, duration of erythema, and clinical improvement were 
evaluated using an Er:YAG resurfacing laser (2.94-microm wavelength, 
350-microsec pulse, 2 J, 3-5-mm spot). Twenty-five patients were treated 
with two passes to the full face and 3 to 5 passes to the most affected 
aesthetic unit. At each follow-up visit, percent epithelialization, 
erythema, and swelling were graded, and the presence or absence of 
complications was noted. Clinical improvement was evaluated at 6 months by 
optical profilometry on a subset of patients. Er:YAG resurfacing produced a 
transient whitening of dermis followed by a resumption of pink appearance. 
The surgical end point was judged by elimination of visible rhytids or 
presence of punctate bleeding. Bleeding from the dermal surface was 
encountered less than customarily in dermabrasion, but more than seen with 
carbon dioxide laser resurfacing. A moderate amount of tissue shrinkage was 
observable during the treatment. Mean period to full epithelialization was 
6.9+/-0.97 days (range, 5-9 days). The mean duration of erythema 
(4.24+/-1.5 weeks) was relatively short compared with carbon dioxide 
resurfacing. Clinical improvement was 44+/-30% in the lateral canthal area 
and 55+/-22% in the upper lip area. There were no infections or 
hypertrophic scars. Hyperpigmentation and hypopigmentation was seen in 24% 
and 12% of patients respectively. Er:YAG resurfacing is a reliable means of 
obtaining rhytid improvement with less recovery time and duration of 
erythema compared with carbon dioxide resurfacing. The technique is 
significantly different from carbon dioxide resurfacing in selection of end 
point, number of passes, and energy settings. 

============================================================ 
28.) Efficacy of erbium:YAG laser ablation in Darier disease and Hailey-Hailey disease. 
============================================================ 
Arch Dermatol 1999 Apr;135(4):423-7 

Beier C, Kaufmann R 
Department of Dermatology, J.W. Goethe University, Frankfurt, Germany. 

BACKGROUND: Among different surgical approaches, dermabrasion and carbon 
dioxide laser vaporization have been used to treat Hailey-Hailey disease 
(HHD) (familial benign chronic pemphigus) and Darier disease (DD) 
(keratosis follicularis), with various results. Because of the erbium: YAG 
laser's unique absorption characteristics in tissue water, erbium:YAG laser 
ablation combines the advantages of both techniques, avoiding thermal 
injury of vaporization and also allowing selectively deeper tissue removal 
in the follicular lesions of DD. Therefore, good results should be expected 
in both types of acantholytic disorders. OBSERVATIONS: Four patients (2 
with HHD and 2 with DD) with different affected areas were treated with 
laser ablation. During a follow-up period ranging from 8 to 20 months, 
complete remission was achieved in 3 patients--2 with DD and 1 with 
HHD--and significant improvement was achieved in 1 patient with HHD. 
Histological examination of control biopsy specimens after ablation in 1 
patient with DD revealed no signs of the disease and only a slight fibrosis 
in the papillary dermis. CONCLUSIONS: Erbium:YAG laser ablation effectively 
removes lesions of both HHD and DD and can also yield excellent long-term 
results in chronic, recalcitrant cases. 

============================================================ 
29.) Treatment of photoaged neck skin with the pulsed Erbium:YAG laser. 
============================================================ 
Dermatol Surg 1998 Jun;24(6):619-21 

Goldberg DJ, Meine JG 
Skin Laser Center, Pascack Valley Hospital, Westwood, NJ, USA. 

BACKGROUND: The Erbium (Er):YAG laser represents a new laser approach for 
the treatment of rhytids and photodamaged skin. Because the Er:YAG laser's 
2940-nm wavelength is at the peak of water absorption, this laser produces 
minimal thermal damage. OBJECTIVE: To document the Er:YAG laser's efficacy 
in the treatment of neck rhytids. METHODS: Ten patients with neck rhytids 
were treated with the Er:YAG laser. All individuals were evaluated for 
clinical improvement, scarring, and pigmentary changes. RESULTS: All 
patients showed fair to excellent results with no scarring or pigmentary 
changes at 6 months. CONCLUSION: The Er:YAG laser may be used to improve 
nonfacial photodamaged skin. 

============================================================ 
30.) Resurfacing of pitted facial scars with a pulsed Er:YAG laser. 
============================================================ 
Dermatol Surg 1997 Oct;23(10):880-3 

Kye YC 
Department of Dermatology, College of Medicine, Korea University, Seoul, 
Korea. 

BACKGROUND: Laser resurfacing has beneficial effects for the treatment of 
several skin conditions. Recently, the pulsed Er:YAG laser has been shown 
to be a highly effective treatment for several kinds of pitted facial 
scars. OBJECTIVE: The purpose of this study was to assess the efficacy and 
safety of pulsed Er:YAG laser skin resurfacing for pitted facial scars. 
METHODS: Four patients with small pox scars, five patients with chicken pox 
scars, and 21 patients with acne scars were included in this study. All 
patients were skin type III and IV. All patients were instructed to use 
tretinoin cream 0.05% nightly for 2-4 weeks prior to the laser treatment. 
The pulsed Er:YAG laser with 2-mm handpiece at the setting of 500 mJ/pulse, 
3.5-4.5 W was used. Two weeks after laser treatment, topical application of 
hydroquinone 4%, tretinoin 0.05%, and hydrocortisone 1% cream was 
recommended for 2-4 weeks. Facial photographs were obtained at baseline and 
2-week intervals postoperatively with a 35-mm single lense reflex camera 
equipped with a lense mounted ring flash. The results of treatment were 
evaluated for the changes of skin texture and color at 2 weeks, 1 month, 
and 3 months. Three patients with acne scars agreed to skin biopsy. 
RESULTS: Three months after laser treatment, all patients with small pox 
and chicken pox scars were improved about 55%, and patients with acne scars 
were improved about 40% on average. CONCLUSION: Pulsed Er:YAG laser skin 
resurfacing is an effective and safe treatment for pitted facial scars. 

============================================================ 
31.) Skin contraction following erbium:YAG laser resurfacing. 
============================================================ 
Dermatol Surg 1998 Jan;24(1):109-11 

Hughes PS 
BACKGROUND: Resurfacing the skin with deep chemical peels, dermabrasion, or 
lasers tightens the skin via dermal remodeling. The erbium (Er):YAG laser 
is a new laser for resurfacing and it removes lesional tissue efficiently 
with minimal residual thermal damage. In this paper, I present the first 
published study, to my knowledge, documenting and quantifying the cutaneous 
contraction following Er:YAG laser resurfacing of human skin. OBJECTIVE: To 
document and measure the cutaneous contraction resulting from Er:YAG laser 
resurfacing. METHODS: Using lentigos as skin markers, square areas on human 
forearm skin were resurfaced with the Er:YAG laser. The distance between 
these skin markers was measured before, immediately after, at 3 days, and 
weekly for 16 weeks after laser surgery. RESULTS: After two to three passes 
with the Er:YAG laser, there was an immediate 4% linear tightening of the 
skin, which persisted at 3 days, increased to 8% at 1 weeks, was 11% at 2 
and 4 weeks, 13% at 6 weeks, and 14% at 16 weeks. CONCLUSION: Er:YAG laser 
resurfacing produces measurable cutaneous contraction. This phenomenon may 
contribute to the positive clinical tightening of human skin following 
Er:YAG laser resurfacing. 

============================================================ 
32.) Computerized scanning erbium:YAG laser for skin resurfacing. 
============================================================ 
Dermatol Surg 1998 Jan;24(1):83-9 

Weinstein C 
Laser House, East Melbourne, Victoria, Australia. 

Laser skin resurfacing has become increasingly popular as a method of 
facial rejuvenation. Although carbon dioxide (CO2) laser resurfacing is 
extremely effective, there is considerable morbidity associated with this 
procedure. Erbium (Er):YAG lasers, like CO2 lasers, are highly absorbed by 
water, and are absorbed superficially in skin. In our study of 141 patients 
using the computerized scanning Er:YAG laser, we found that it was possible 
to precisely ablate skin with less thermal injury than the currently 
available scanning CO2 lasers. The scanning system allowed very precise and 
homogeneous skin ablation. It was possible to ablate epidermis and 
superficial dermis, although deeper resurfacing led to pinpoint bleeding. 
Furthermore, healing was more rapid than generally experienced using CO2 
lasers. Erythema was less marked, and disappeared usually within 3-4 weeks. 
Histological studies confirmed the minimal degree of thermal injury, as was 
evident clinically. Fluences of at least 20 J/cm2 were necessary to produce 
new collagen formation. 

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33.) Laser skin resurfacing using a frequency doubled Nd:YAG laser after topical application of an exogenous chromophore. 
============================================================ 
Lasers Surg Med 1999;25(1):43-50 

Sumian CC, Pitre FB, Gauthier BE, Bouclier M, Mordon SR 
GALDERMA Research and Development, F-06902 Sophia Antipolis, France. 

BACKGROUND AND OBJECTIVES: Although laser skin resurfacing performed with 
CO(2) or Er:YAG lasers is efficient, side effects such as prolonged 
postoperative erythema, delayed healing, scarring, and pigmentation, have 
been reported. These side effects are due to skin characteristics but also 
to variations of the thermal effects associated with laser skin 
resurfacing. The study aimed to evaluate a new laser resurfacing method 
based on a previous topical application of an exogenous chromophore in 
order to have reproducible thermal effects. MATERIALS AND METHODS: 
Exogenous chromophore consisted in carbon dispersed and mixed with 
film-forming polymers and water. The resultant solution was applied to the 
skin surface using an airbrush. Experimental evaluation was performed in 
vivo on hairless rat skin using the following parameters (532 nm, 2.7 W, 1 
mm, 50-200 ms, 17.2-68.8 J/cm(2), single pass). Skin biopsies were taken to 
evaluate histological changes and to quantify epidermis ablation and dermal 
coagulation depth. Wound healing was followed up during 10 days. RESULTS: 
Total epidermis ablation was achieved with all pulse durations used. Dermal 
coagulation depth increased as a function of exposure time. Scar formation 
was correlated with dermal coagulation depth. CONCLUSION: The concept of 
applying a carbon-based solution onto skin in order to obtain laser light 
conversion into heat followed by heat transfer to the tissue is valid for 
laser skin resurfacing. By selecting exposure time, the thermal effects are 
predictable and dermal coagulation depth can be either that observed with a 
Er:YAG laser or that obtained with a CO(2) laser. Moreover, frequency 
doubled Nd:YAG laser, already used in dermatology for angiodysplasias 
treatment, could be easily used for resurfacing of periorbital or perioral 
zones. Copyright 1999 Wiley-Liss, Inc. 

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34.) Effects of pulsed laser systems on stapes footplate. 
============================================================ 
Lasers Surg Med 1997;21(4):341-50 

Jovanovic S, Schonfeld U, Prapavat V, Berghaus A, Fischer R, Scherer H, 
Muller GJ 
ENT Department Benjamin Franklin Medical Center, Free University of Berlin, 
Germany. 

BACKGROUND AND OBJECTIVE: The aim of the present study was to investigate 
the tissue ablation capacity of various pulsed lasers at the stapes 
footplate. STUDY DESIGN/MATERIALS AND METHODS: Isolated human stapes and 
bovine compact-bone platelets were used to determine the effective laser 
parameters and appropriate application technique for achieving a 
perforation measuring 500-600 microns in diameter. Of interest were also 
the shape and quality of the perforations, the reproducibility of the 
perforation effect, and the thermically altered marginal zones occurring at 
the footplate. Three pulsed laser systems were used: excimer, holmium:YAG 
(Ho:YAG), and erbium:YSGG (Er:YSGG) lasers. RESULTS: The tissue-ablating 
effect of pulsed laser systems permits a precise and controlled management 
of the stapes footplate through low and readily reproducible ablation 
rates. The extent of thermic side effects at the footplate is lower in 
comparison to the purely thermically acting cw and superpulse laser 
systems. The Er:YSGG laser exhibits the highest ablation rate at the stapes 
and is thus the most effective laser for perforation of the stapes 
footplate. Though somewhat less effective, the Ho:YAG laser also appears to 
be suitable for stapedotomy. On the other hand, we do not consider the 
applied excimer laser (308 nm) to be particularly appropriate at the stapes 
because of its low ablation rates. CONCLUSION: Thus, the erbium laser could 
represent an alternative to the argon, KTP 532, and CO2 lasers, already 
clinically successful in stapes surgery. However, further studies are 
necessary to examine the transmission of thermic energy into the vestibule 
and the acoustic stress to the inner ear during laser stapedotomy, to be 
able to make a definitive statement about the safest and most effective 
laser system for stapes surgery. 

============================================================ 
35.) Erbium:YAG laser resurfacing in Asians. 
============================================================ 
Dermatol Surg 1998 Dec;24(12):1303-7 

Polnikorn N, Goldberg DJ, Suwanchinda A, Ng SW 
Ramathibodi Hospital, Bangkok, Thailand. 

BACKGROUND: Although laser resurfacing has become increasingly popular in 
the treatment of Caucasian skin, concerns about healing and 
postinflammatory pigmentary changes have limited its use in Asian skin. 
OBJECTIVE: The purpose of this study was to determine the efficacy and 
safety of the Erbium(ER):YAG laser used in the treatment of Asian skin. 
METHODS: Fifty Asian individuals with Rhytids, scars, pigmentary 
alteration, and a variety of cutaneous growth were treated with the 
Erbium:YAG laser. Patients were evaluated for clinical efficacy, wound 
healing, post-operative erythema, and post-inflammatory pigmentary changes. 
RESULTS: Significant improvement was noted in all individuals. Shorter 
periods for re-epithelization and erythema duration were noted when 
compared to previously reported results following carbon dioxide laser 
resurfacing. CONCLUSION: The Erbium:YAG laser is safe and effective in the 
treatment of Asian skin. 

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36.) Resurfacing of atrophic facial acne scars with a high-energy, pulsed carbon dioxide laser. 
============================================================ 
Dermatol Surg 1996 Feb;22(2):151-4; discussion 154-5 

Alster TS, West TB 
Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA. 

BACKGROUND. Treatment of atrophic acne scars has been limited to the use of 
such traditional treatments as dermabrasion and chemical peels for many 
years. Recently, the addition of high-energy, pulsed carbon dioxide (CO2) 
lasers to the treatment armentarium has created renewed enthusiasm for 
cutaneous resurfacing due to their ability to create specific thermal 
injury with limited side effects. OBJECTIVE. To determine the effectiveness 
of a high-energy, pulsed CO2 laser in eliminating atrophic facial scars and 
to observe for side effects. METHODS. Fifty patients with skin phototypes 
I-V and moderate to severe atrophic facial acne scars were included in the 
study. Each patient received one high-energy, pulsed CO2 laser treatment 
using identical laser parameters by the same experienced laser surgeon. 
Baseline and 1-, 4-, 8-, 12-, and 24-week postoperative photographs and 
clinical assessments were obtained in all patients. Textural analysis of 
skin before and after laser irradiation were obtained in 10 patients to 
confirm clinical impressions. Clinical evaluations were conducted 
independently by two blinded assessors. RESULTS. There was an 81.4% average 
clinical improvement observed in acne scars following laser treatment. Skin 
texture measurements of laser-irradiated scars were comparable to those 
obtained in normal adjacent skin. Side effects were limited to transient 
hyperpigmentation lasting an average of 3 months in 36% of patients. 
Prolonged erythema (2 months average) was usual and considered to be a 
normal healing response. No hypertrophic scarring was observed following 
laser treatment. CONCLUSION. High-energy, pulsed CO2 laser treatment can 
safely and effectively improve or even eliminate atrophic facial scars and 
provides many benefits over traditional treatment methods. 

============================================================ 
37.) Comparison of high-energy pulsed carbon dioxide laser resurfacing and 
dermabrasion in the revision of surgical scars. 
============================================================ 
Dermatol Surg 1998 Jun;24(6):647-50 

Nehal KS, Levine VJ, Ross B, Ashinoff R 
Department of Dermatology, New York University Medical Center, NY 10016, USA. 

BACKGROUND: Both dermabrasion and high-energy pulsed carbon dioxide (CO2) 
laser resurfacing can improve the appearance of surgical scars. Although 
the results of these two procedures have been compared using historical 
data, a prospective evaluation has never been performed in humans. 
OBJECTIVE: To prospectively compare the clinical effects of dermabrasion 
and high-energy pulsed CO2 laser resurfacing in the revision of surgical 
scars. METHODS: Facial surgical scars in four patients were prospectively 
revised using a split scar model. One half of the scar was dermabraded and 
the other half was resurfaced with the high-energy pulsed CO2 laser. 
Comparisons of the two treatment modalities were performed through clinical 
assessment, photographic evaluation, and textural analysis of the scars. 
RESULTS: The high-energy pulsed CO2 laser-resurfaced halves of the scar 
were bloodless with less postoperative crusting in comparison with the 
dermabraded halves. Reepithelialization time and degree and duration of 
postoperative erythema were similar for both treatment halves. Photographic 
evaluation and textural analysis showed comparable improvement in the 
clinical appearance and surface texture of the scars with both treatment 
modalities. CONCLUSIONS: Both the high-energy pulsed CO2 laser and 
dermabrasion can achieve comparable clinical improvement in the revision of 
surgical scars. The high-energy pulsed CO2 laser offers the advantage of a 
bloodless field and a more precise method of tissue ablation. Postoperative 
erythema, however, is an expected finding with both treatment modalities. 

============================================================ 
38.) Carbon dioxide laser resurfacing of peri-oral rhytids in scleroderma patients. 
============================================================ 
Dermatol Surg 1998 May;24(5):517-9 

Apfelberg DB, Varga J, Greenbaum SS 
Department of Plastic Surgery, Stanford University Medical Center, 
California, USA. 

BACKGROUND: The short pulse duration high-energy carbon dioxide (CO2) 
lasers have been used in the past for treating cutaneous pathology and more 
recently for cosmetic improvements of rhytids, photo-aging, and acne. 
OBJECTIVE: This study was undertaken to determine the benefits of CO2 laser 
resurfacing on the severe peri-oral rhytidosis commonly seen in patients 
with systemic scleroderma. METHODS: Three patients were studied and 
evaluated for satisfactory wound healing, improved cosmetic result, and 
lack of complications. RESULTS: All three patients experienced significant 
improvement following laser resurfacing. CONCLUSION: The study demonstrated 
the safe and effective treatment for peri-oral rhytidosis in patients with 
generalized scleroderma utilizing CO2 laser resurfacing. 

============================================================ 
39.) Skin contraction following erbium:YAG laser resurfacing. 
============================================================ 
Dermatol Surg 1998 Jan;24(1):109-11 

Hughes PS 
BACKGROUND: Resurfacing the skin with deep chemical peels, dermabrasion, or 
lasers tightens the skin via dermal remodeling. The erbium (Er):YAG laser 
is a new laser for resurfacing and it removes lesional tissue efficiently 
with minimal residual thermal damage. In this paper, I present the first 
published study, to my knowledge, documenting and quantifying the cutaneous 
contraction following Er:YAG laser resurfacing of human skin. OBJECTIVE: To 
document and measure the cutaneous contraction resulting from Er:YAG laser 
resurfacing. METHODS: Using lentigos as skin markers, square areas on human 
forearm skin were resurfaced with the Er:YAG laser. The distance between 
these skin markers was measured before, immediately after, at 3 days, and 
weekly for 16 weeks after laser surgery. RESULTS: After two to three passes 
with the Er:YAG laser, there was an immediate 4% linear tightening of the 
skin, which persisted at 3 days, increased to 8% at 1 weeks, was 11% at 2 
and 4 weeks, 13% at 6 weeks, and 14% at 16 weeks. CONCLUSION: Er:YAG laser 
resurfacing produces measurable cutaneous contraction. This phenomenon may 
contribute to the positive clinical tightening of human skin following 
Er:YAG laser resurfacing. 

============================================================ 
40.) A side-by-side comparison of carbon dioxide resurfacing lasers for the 
treatment of rhytides. 
============================================================ 
J Am Acad Dermatol 1998 Oct;39(4 Pt 1):547-53 

Gross EA, Rogers GS 
Department of Surgery, Boston University School of Medicine, Massachusetts, 
USA. 

BACKGROUND: The use of cutaneous resurfacing lasers to treat rhytides is 
widely accepted. Several carbon dioxide lasers, many using fundamentally 
different technologies, are available. OBJECTIVE: The purpose of this study 
was to compare the results obtained and side effects after treating 
rhytides with 3 different carbon dioxide resurfacing lasers. METHODS: We 
performed a randomized, blinded, prospective study wherein 16 subjects had 
either periorbital or perioral rhytides resurfaced with 1 of 3 carbon 
dioxide lasers on either side of the face. RESULTS: We were unable to 
demonstrate any significant differences in improvement in rhytides, patient 
satisfaction, posttreatment erythema, or other side effects. CONCLUSION: 
Our results suggest that operator technique and patient selection are more 
important factors than laser type with respect to outcome. 

============================================================ 
41.) The Use of the Erbium:YAG Laser for the Treatment of Class III Rhytids. 
============================================================ 
Dermatol Surg 1999 Sep;25(9):713-715 

Goldberg DJ, Cutler KB 
[Record supplied by publisher] 


BACKGROUND: The erbium:YAG (Er:YAG) laser can be used for precise tissue 
ablation with minimal thermally induced damage. Because of its ability to 
superficially ablate tissue, the Er:YAG laser can be used to improve fine 
rhytids with rapid epidermal reepithelialization. It has not been shown 
that the Er:YAG laser can successfully treat deeper rhytids where some 
thermal damage may lead to more optimal collagen remodeling. OBJECTIVE: We 
chose to evaluate the efficacy of multiple superficial Er:TAG laser 
sessions in the treatment of deeper class III rhytids. METHODS: Twenty 
subjects were selected for this study. All treated subjects had class III 
rhytids and were Fitzpatrick I-III skin phenotypes. All subjects were 
treated with four Er:YAG laser passes at 5 J/cm2. Three months after the 
initial treatment, a second treatment with similar parameters was repeated. 
Six months after the initial treatment, a third laser session with 
identical parameters was undertaken. Subjects were evaluated for laser 
efficacy and postlaser complications. RESULTS: Although no subjects showed 
improvement after the first laser session, mild to excellent improvement 
was noted 6 months after the third Er:YAG laser treatment. CONCLUSION: The 
Er:YAG may be used successfully in the treatment of class III rhytids. 
Multiple sessions may be required. 

============================================================ 
42.) A clinical study on the removal of gingival melanin pigmentation with 
the CO(2) laser. 
============================================================ 
Author 
Nakamura Y; Hossain M; Hirayama K; Matsumoto K 
Address 
Department of Endodontics, School of Dentistry, Showa University, 
Kitasenzoku, Ohta-ku, 
Tokyo 145-8515, Japan. [email protected] 
Source 
Lasers Surg Med, 25(2):140-7 1999 
Abstract 
BACKGROUND AND OBJECTIVE: In a previous study, the possibility of 
removal of dog 
gingival melanin pigmentation with CO(2) laser therapy was reported. 
The present study was 
designed to investigate the effect of the CO(2) laser on human 
gingival pigmentation and 
evaluate the clinical outcome. STUDY DESIGN/MATERIALS AND METHODS: A 
CO(2) 
laser (output: 6-8 W, pulse duration: 0.2 seconds) was irradiated on 
the melanin pigmented 
gingival surface of 10 patients, aged 20-49 years. Follow-up clinical 
and histopathological 
evaluations were performed. RESULTS: The CO(2) laser was effective in 
removing melanin 
pigmentation in all patients. In the histopathological study, no 
pigmented-laden cells nor any 
inflammatory cell infiltration was observed following laser 
irradiation. No re-pigmentation was 
seen in any case in the first year. However, four of seven cases 
showed re-pigmentation at 24 
months. The re-pigmentation was almost equal to the preoperative 
state. CONCLUSIONS: 
The CO(2) laser has proved to be another effective, safe, and easily 
applicable therapy for 
the removal of gingival melanin pigmentation. 

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DATA-MEDICOS/DERMAGIC-EXPRESS No 2-(83) 17/11/99 DR. JOSE LAPENTA R. 
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