eMedicine Specialties > Plastic Surgery > Skin

Skin Resurfacing, Erbium YAG Laser: Follow-up

Author: Meir Cohen, MD, MPS, Consulting Staff, Department of Plastic Surgery, Schneider Children's Medical Center of Israel, Tel Aviv University
Coauthor(s): Marvin Spann, MD, Staff Physician, Department of General Surgery, New York Hospital Queens; Martin I Newman, MD, FACS, Consulting Surgical Staff, Department of Plastic and Reconstructive Surgery, Associate Program Director and Educational Director of Plastic Surgery Resident Program, Department of Plastic Surgery, Cleveland Clinic Florida; William B Nolan, MD, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Cornell University Medical College
Contributor Information and Disclosures

Updated: Feb 16, 2009

Outcome and Prognosis

Improvement after Er:YAG resurfacing is related to the patient's skin type and the amount of photodamage. Patients categorized in Fitzpatrick and Glogau types I and II generally have 50% improvement in rhytides and atrophic scars.7,45,46

Patients with darker skin still have acceptable results, and the relatively lower risk of hyperpigmentation compared with more penetrating lasers makes the Er:YAG system the recommended modality.47

Future and Controversies

The versatility of the Er:YAG lasers suggests several potential modifications of the original operative technique. The laser can be used to ablate the epidermis, and then it can be reset to coagulate within the dermis at various levels to stimulate more collagen formation. The optimal depth within the dermis remains to be determined.

Another use under investigation is to ablate residual thermal damage after carbon dioxide laser resurfacing or even after deep Er:YAG lasing; removal of the proinflammatory coagulated tissue could result in less erythema and faster healing, but the tissue removed could be needed to stimulate new collagen formation. Preliminary work suggests that no significant difference is noted in the amount of collagen injury, inflammation, and new collagen formation between various combinations of the Er:YAG and carbon dioxide lasers soon after treatment.7,48,17

New Er:YAG lasers are being tested that produce high fluence values and smaller pulse durations, which, when used with a cryogen to cool the epidermis, allow the laser energy to spare the epidermis and only ablate and coagulate the dermis. Subepidermal laser resurfacing is attractive to patients who do not have a significant amount of photodamage because it reduces the erythema and edema associated with laser resurfacing. These nonablative techniques were introduced with Nd:YAG lasers and intense pulsed light systems, which are currently challenging the market share of the Er:YAG lasers.49

The latest innovation is fractional photothermolysis with Er:YAG laser (eg, PROfractional [Sciton Inc., Palo Alto, Calif], Pixel [Alma Lasers Ltd, Caesarea, Israel], Fraxel [Reliant Technologies, Mountain View, Calif]). This technique is based on creating spatially precise microscopic thermal wounds. The wounds created by the laser are narrow, sharply defined columns of skin known as microscopic thermal zones. According to preliminary reports, this resurfacing technique has been shown to be both safe and effective for improving facial and nonfacial photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation.50,51 Healing time is 3-6 days. Because only a fraction of the skin is treated during a single session, a series (typically, 4 treatments) of fractional resurfacing at 4-wk intervals is required for the best clinical improvement.50,51

These techniques, while becoming more popular because of the easier recovery, may fall into disfavor if the results are not long-lasting and if the complications of scarring increase. The results of ongoing and future clinical trials will establish the relative effectiveness and indications of the Er:YAG and other types of lasers.

Outward beauty is not enough, and the woman who would appear fair must not be content with any common manner. Words, wit, play, sweet talk and laughter, surpass the work of too simple nature. —Pliny the Elder

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Daniel N Ronel, MD, FAAP, FACS; Marvin Spann, MD; Martin Newman, MD, FACS; and William B Nolan, MD; to the development and writing of this article.



More on Skin Resurfacing, Erbium YAG Laser

Overview: Skin Resurfacing, Erbium YAG Laser
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Treatment: Skin Resurfacing, Erbium YAG Laser
Follow-up: Skin Resurfacing, Erbium YAG Laser
Multimedia: Skin Resurfacing, Erbium YAG Laser
References
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References

  1. Goldman MP, Fitzpatrick RE. Cutaneous Laser Surgery: The Art and Science of Selective Photothermolysis. 2nd ed. St. Louis, Mo: Mosby-Year Book; 1999:339-436.

  2. Daly CH, Odland GF. Age-related changes in the mechanical properties of human skin. J Invest Dermatol. Jul 1979;73(1):84-7. [Medline].

  3. Warren R, Gartstein V, Kligman AM, Montagna W, Allendorf RA, Ridder GM. Age, sunlight, and facial skin: a histologic and quantitative study. J Am Acad Dermatol. Nov 1991;25(5 Pt 1):751-60. [Medline].

  4. Gilchrest BA. A review of skin ageing and its medical therapy. Br J Dermatol. Dec 1996;135(6):867-75. [Medline].

  5. Uitto J, Bernstein EF. Molecular mechanisms of cutaneous aging: connective tissue alterations in the dermis. J Investig Dermatol Symp Proc. Aug 1998;3(1):41-4. [Medline].

  6. Taylor CR, Stern RS, Leyden JJ, Gilchrest BA. Photoaging/photodamage and photoprotection. J Am Acad Dermatol. Jan 1990;22(1):1-15. [Medline].

  7. Alster TS. Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg. Feb 1999;103(2):619-32; discussion 633-4. [Medline].

  8. Alster TS, Lupton JR. Erbium:YAG cutaneous laser resurfacing. Dermatol Clin. Jul 2001;19(3):453-66. [Medline].

  9. American Society of Plastic Surgeons. 2007 Statistics. Available at http://www.plasticsurgery.org/Media/Statistics/2007_Statistics.html. Accessed February 12, 2009.

  10. Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. Apr 29 1983;220(4596):524-7. [Medline].

  11. Bass LS. Erbium:YAG laser skin resurfacing: preliminary clinical evaluation. Ann Plast Surg. Apr 1998;40(4):328-34. [Medline].

  12. Walia S, Alster TS. Prolonged clinical and histologic effects from CO2 laser resurfacing of atrophic acne scars. Dermatol Surg. Dec 1999;25(12):926-30. [Medline].

  13. Alster TS. Erbium:YAG laser resurfacing and other skin resurfacing options. In: Alster TS, ed. Manual of Cutaneous Laser Techniques. 2nd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2000:135-45.

  14. Alster TS. Clinical and histologic evaluation of six erbium:YAG lasers for cutaneous resurfacing. Lasers Surg Med. 1999;24(2):87-92. [Medline].

  15. Alster TS. Cutaneous resurfacing with Er:YAG lasers. Dermatol Surg. Jan 2000;26(1):73-5. [Medline].

  16. Pozner JN, Roberts TL 3rd. Variable-pulse width ER:YAG laser resurfacing. Clin Plast Surg. Apr 2000;27(2):263-71, xi. [Medline].

  17. Jasin ME. Achieving superior resurfacing results with the erbium:YAG laser. Arch Facial Plast Surg. Oct-Dec 2002;4(4):262-6. [Medline].

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

  19. Zachary CB. Modulating the Er:YAG laser. Lasers Surg Med. 2000;26(2):223-6. [Medline].

  20. Trelles MA, Allones I, Luna R. One-pass resurfacing with a combined-mode erbium: YAG/CO2 laser system: a study in 102 patients. Br J Dermatol. Mar 2002;146(3):473-80. [Medline].

  21. Teikemeier G, Goldberg DJ. Skin resurfacing with the erbium:YAG laser. Dermatol Surg. Aug 1997;23(8):685-7. [Medline].

  22. Khatri KA, Ross V, Grevelink JM, Magro CM, Anderson RR. Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. Arch Dermatol. Apr 1999;135(4):391-7. [Medline].

  23. Goldman MP, Fitzpatrick RE, Manuskiatti W. Laser resurfacing of the neck with the Erbium: YAG laser. Dermatol Surg. Mar 1999;25(3):164-7; discussion 167-8. [Medline].

  24. Jimenez G, Spencer JM. Erbium:YAG laser resurfacing of the hands, arms, and neck. Dermatol Surg. Nov 1999;25(11):831-4; discussion 834-5. [Medline].

  25. Kaufmann R. Role of Erbium:YAG laser in the treatment of aged skin. Clin Exp Dermatol. Oct 2001;26(7):631-6. [Medline].

  26. Monheit GD. Facial resurfacing may trigger the herpes simplex virus. Cosmet Derm. 1995;8:9-16.

  27. Alster TS, Nanni CA. Famciclovir prophylaxis of herpes simplex virus reactivation after laser skin resurfacing. Dermatol Surg. Mar 1999;25(3):242-6. [Medline].

  28. West TB, Alster TS. Effect of pretreatment on the incidence of hyperpigmentation following cutaneous CO2 laser resurfacing. Dermatol Surg. Jan 1999;25(1):15-7. [Medline].

  29. Weiss RA, Harrington AC, Pfau RC, Weiss MA, Marwaha S. Periorbital skin resurfacing using high energy erbium:YAG laser: results in 50 patients. Lasers Surg Med. 1999;24(2):81-6. [Medline].

  30. Sriprachya-Anunt S, Fitzpatrick RE, Goldman MP, Smith SR. Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin. Dermatol Surg. Jul 1997;23(7):527-35; discussion 535-6. [Medline].

  31. Avram DK, Goldman MP. The safety and effectiveness of single-pass erbium:YAG laser in the treatment of mild to moderate photodamage. Dermatol Surg. Aug 2004;30(8):1073-6. [Medline].

  32. Pozner JN, Goldberg DJ. Superficial erbium:YAG laser resurfacing of photodamaged skin. J Cosmet Laser Ther. Jun 2006;8(2):89-91. [Medline].

  33. Khatri KA, Gordon J, Garamela L. Laser skin resurfacing with a novel portable erbium:YAG laser. J Cosmet Laser Ther. Apr 2006;8(1):23-5. [Medline].

  34. Alster TS, Doshi SN, Hopping SB. Combination surgical lifting with ablative laser skin resurfacing of facial skin: a retrospective analysis. Dermatol Surg. Sep 2004;30(9):1191-5. [Medline].

  35. Alster TS, West TB. Effect of topical vitamin C on postoperative carbon dioxide laser resurfacing erythema. Dermatol Surg. Mar 1998;24(3):331-4. [Medline].

  36. Walia S, Alster TS. Cutaneous CO2 laser resurfacing infection rate with and without prophylactic antibiotics. Dermatol Surg. Nov 1999;25(11):857-61. [Medline].

  37. Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg. Mar 1998;24(3):315-20. [Medline].

  38. Tanzi EL, Alster TS. Side effects and complications of variable-pulsed erbium:yttrium- aluminum-garnet laser skin resurfacing: extended experience with 50 patients. Plast Reconstr Surg. Apr 1 2003;111(4):1524-9; discussion 1530-2. [Medline].

  39. Bernstein LJ, Kauvar AN, Grossman MC, Geronemus RG. The short- and long-term side effects of carbon dioxide laser resurfacing. Dermatol Surg. Jul 1997;23(7):519-25. [Medline].

  40. Jeong JT, Kye YC. Resurfacing of pitted facial acne scars with a long-pulsed Er:YAG laser. Dermatol Surg. Feb 2001;27(2):107-10. [Medline].

  41. Sapijaszko MJ, Zachary CB. Er:YAG laser skin resurfacing. Dermatol Clin. Jan 2002;20(1):87-96. [Medline].

  42. Ando Y, Aoki A, Watanabe H, Ishikawa I. Bactericidal effect of erbium YAG laser on periodontopathic bacteria. Lasers Surg Med. 1996;19(2):190-200. [Medline].

  43. Perez MI, Bank DE, Silvers D. Skin resurfacing of the face with the Erbium:YAG laser. Dermatol Surg. Jun 1998;24(6):653-8; discussion 658-9. [Medline].

  44. Kim YJ, Lee HS, Son SW, Kim SN, Kye YC. Analysis of hyperpigmentation and hypopigmentation after Er:YAG laser skin resurfacing. Lasers Surg Med. Jan 2005;36(1):47-51. [Medline].

  45. Goldman MP, Marchell N, Fitzpatrick RE. Laser skin resurfacing of the face with a combined CO2/Er:YAG laser. Dermatol Surg. Feb 2000;26(2):102-4. [Medline].

  46. Marcells GN, Ellis DA. Laser facial skin resurfacing: discussion on erbium:YAG and CO2 lasers. J Otolaryngol. Apr 2000;29(2):78-82. [Medline].

  47. Polnikorn N, Goldberg DJ, Suwanchinda A, Ng SW. Erbium:YAG laser resurfacing in Asians. Dermatol Surg. Dec 1998;24(12):1303-7. [Medline].

  48. Utley DS, Koch RJ, Egbert BM. 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. [Medline].

  49. Kelly KM, Nelson JS, Lask GP, Geronemus RG, Bernstein LJ. Cryogen spray cooling in combination with nonablative laser treatment of facial rhytides. Arch Dermatol. Jun 1999;135(6):691-4. [Medline].

  50. Lapidoth M, Yagima Odo ME, Odo LM. Novel use of erbium:YAG (2,940-nm) laser for fractional ablative photothermolysis in the treatment of photodamaged facial skin: a pilot study. Dermatol Surg. Aug 2008;34(8):1048-53. [Medline].

  51. Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol. May 2008;58(5):719-37; quiz 738-40. [Medline].

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Further Reading

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Keywords

erbium, facial rejuvenation, laser skin surgery, facial wrinkle removal, CO2 laser, carbon dioxide laser, erbium:yttrium-aluminum-garnet laser, Er:YAG laser, pulsed laser surgery, selective photothermolysis, photothermolysis, scar removal, wrinkle removal rhytid removal, rhytide removal, photodamage, photo damage, acne scar treatment, varicella scar treatment, chicken pox scar, dyschromia, solar keratosis, melasma, lentigines, compound nevi, compound nevus, sebaceous hyperplasia, trichoepithelioma, miliary osteoma, syringoma, telangiectasia, rhinophyma, adenoma sebaceum, hidradenoma, xanthelasma, Hailey-Hailey disease, Darier's disease, Darier disease, keratosis follicularis, pemphigus, wrinkling, scaling, dyspigmentation, telangiectasia, skin laxity

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Contributor Information and Disclosures

Author

Meir Cohen, MD, MPS, Consulting Staff, Department of Plastic Surgery, Schneider Children's Medical Center of Israel, Tel Aviv University
Meir Cohen, MD, MPS is a member of the following medical societies: American Cleft Palate/Craniofacial Association and Plastic Surgery Research Council
Disclosure: Nothing to disclose.

Coauthor(s)

Marvin Spann, MD, Staff Physician, Department of General Surgery, New York Hospital Queens
Disclosure: Nothing to disclose.

Martin I Newman, MD, FACS, Consulting Surgical Staff, Department of Plastic and Reconstructive Surgery, Associate Program Director and Educational Director of Plastic Surgery Resident Program, Department of Plastic Surgery, Cleveland Clinic Florida
Martin I Newman, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Florida Medical Association, Florida Society of Plastic Surgery, International Confederation for Plastic and Reconstructive Surgery, Southeastern Society of Plastic and Reconstructive Surgeons, and Southeastern Surgical Congress
Disclosure: Nothing to disclose.

William B Nolan, MD, Assistant Professor, Department of Surgery, Division of Plastic Surgery, Cornell University Medical College
William B Nolan, MD is a member of the following medical societies: American Society for Surgery of the Hand
Disclosure: Nothing to disclose.

Medical Editor

Tolbert Wilkinson, MD, Consulting Staff, Department of Surgery, Southwest Texas Methodist Hospital
Tolbert Wilkinson, MD is a member of the following medical societies: American College of Surgeons, American Society for Aesthetic Plastic Surgery, Phi Beta Kappa, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Wayne Stadelmann, MD, Stadelmann Plastic Surgery, PC
Wayne Stadelmann, MD is a member of the following medical societies: Alpha Omega Alpha, New Hampshire Medical Society, Northeastern Society of Plastic Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Nicolas (Nick) G Slenkovich, MD, Director, Colorado Plastic Surgery Center
Nicolas (Nick) G Slenkovich, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and Colorado Medical Society
Disclosure: Nothing to disclose.

Chief Editor

Al Aly, MD, FACS, Consulting Surgeon, Iowa City Plastic Surgery
Disclosure: Ethicon  Consulting fee Consulting; QMP Royalty Book royalty; Insorb Stapler Consulting fee Consulting; Insorb Stapler Ownership interest None; Medicis Intellectual property rights None

 
 
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