Ablative Laser Resurfacing

In the simplest sense, ablative laser skin resurfacing describes the process of removing the epidermal and superficial dermal layers of the skin to reduce cutaneous signs of photoaging. Other indications for ablative laser skin resurfacing include scarring, actinic keratoses, seborrheic keratoses, and facial wrinkles. The use of lasers for ablating and resurfacing is based upon the concept of selective thermolysis of the epidermal and dermal layers of the skin through the delivery of light energy. Light energy emitted by the laser is absorbed by the skin's two main chromophores, melanin, and water, which then emit thermal energy, destroying the surrounding tissue.  Laser resurfacing technology has benefited from a number of breakthroughs in the last few decades, with the use of continuous-wave carbon dioxide (CO2) lasers beginning in the 1980s. The implementation of pulsed delivery of CO2 laser energy and the subsequent development of the erbium-doped yttrium aluminum garnet (Er:YAG) laser, which gained popularity in the late 1990s, further improved the precision and depth of cutaneous ablation and reduced the incidence of adverse effects. Additional refinement in skin resurfacing occurred in the early 2000s with the advent of fractional lasers, which are lasers that use narrow, microscopic columns of light to treat a specific portion of the skin. This less destructive modality further reduced the incidence of adverse events and increased the degree of therapeutic control while still seemingly providing comparable results to non-fractional modalities. Depending on the indication, the technician may choose to employ a specific ablative laser (e.g., CO2 or Er:YAG) with a multitude of different settings, including fractional versus non-fractional, to achieve the desired result and, more importantly, minimize laser-associated complications such as scarring, persistent erythema, and dyspigmentation. All in all, ablative lasers represent a safe and effective tool for skin resurfacing, some nuances of which will be discussed herein.