Lasers for facial rejuvenation.

Laser and laser-like assisted facial rejuvenation has become very popular during the last decade. Although a myriad of techniques are available, such approaches can be divided into four basic approaches. There are those that (i) ablate the epidermis, cause dermal wounding, and provide a significant thermal effect (CO(2) lasers); (ii) ablate the epidermis, cause dermal wounding, and minimal thermal effects (short pulsed Erbium:Ytrrium-Aluminum-Garnet [Er:YAG] lasers); (iii) ablate the epidermis, cause dermal wounding, and provide variable thermal effects (combined CO(2)/Er:YAG lasers, variable pulsed Er:YAG lasers, and ablative radiofrequency devices); and (iv) do not ablate the epidermis, cause dermal wounding, and provide minimal thermal effects (non-ablative lasers and light sources). Each of the four modalities has now been shown to be effective in promoting facial rejuvenation. As would be expected, each has some advantages and disadvantages.CO(2) lasers, because they ablate the epidermis, cause a dermal wound, and provide a significant thermal effect, appear to be most useful for those individuals with advanced photoaged skin. Such lasers provide the greatest degree of skin tightening for these individuals. However, it is that very same thermal effect that leads to the possibility of delays in healing sometimes noted with these systems. Short pulsed Er:YAG lasers, because they promote so little thermal damage, when used in a superficial manner, lead to the possibility of quicker healing than is seen with CO(2) lasers. However, less clinical improvement and more bleeding may be noted. Combined CO(2)/Er:YAG lasers, variable pulsed Er:YAG lasers, and ablative radiofrequency devices lead to an effect somewhere in between that of pulsed CO(2) lasers and short pulsed Er:YAG lasers. The newest group of systems includes the non-ablative devices that do not ablate the epidermis, cause dermal wounding, and provide for a minimal thermal effect. This area of technology is still evolving. Although such techniques, because they do not ablate the epidermis, are cosmetically elegant, the clinical results are usually not quite as good as the more aggressive ablative techniques.