FRACTIONATED CO2 LASER AND ERBIUM LASER TREATMENTS
The CO2 laser was invented by Prof. CK Patel at the Bell Laboratories in 1964 (https://www.youtube.com/watch?v=7v43P-SY0eU).
It is the laser that has been studied the most and cosmetic and reconstructive surgeons have the most experience with. Indeed, we know it so well, that it is the one laser that we know exactly what it can and cannot do and what the limitations are. A major advance after the laser had been used for several decades was the rather smart observation that “less is more”: to that end, surgeons began to deliver the laser in small spots, leaving adjoining tissue untreated. Contrary to what one might think, this did not give inferior results to full powered total CO2 laser ablation. Healing was noted to be faster as lasered skin heals from cells from appendages in untreated (and treated skin to a lesser degree) skin.
FRACTIONATED CO2 LASER AND ERBIUM LASER RESULTS
The results were not only almost as good as full ablation, but some side-effects like loss of pigment were markedly reduced. Of course, with everything delivered in a fractional manner, more than one treatment is needed.
These lasers can be safely used in Fitzpatrick typs I, II, III and in certain cases, type IV skin. Contrary to claims made by some surgeons, it is unwise to treat type V and VI skin without running the risk of marked pigmentary and scarring problems
Fractional CO2 lasers excel at treating deeper wrinkles, more severe textural changes from sun damage, wrinkles, blotchiness, acne scars, and surgical or traumatic scars. It can be used on the delicate eyelid skin and around the mouth. It is also a very effective treatment for sun damage and precancerous growths (actinic keratoses).
FRACTIONATED CO2 LASER AND ERBIUM LASER OUTCOMES
In the fractional mode, and with the correct duration and power, the fractionated CO2 laser may be used to improve texture, wrinkles, and blotchiness on the neck, chest, arms and legs: however, this is a powerful and effective laser and should only be done by experts because the risk of complications, including scarring, is higher in these areas. Dr. Patel learned all about this laser from Dr. Fitzpatrick in San Diego who took Professor Patel’s invention and came up with the machine we use today in cosmetic and reconstructive surgery. After training with Dr Fitzpatrick, Dr. Patel brought the technology to the Salt Lake City area (together with a couple of other physicians) and lectured and published on it widely.
WHAT WILL THE CO2 LASER NOT DO?
The CO2 laser, fully ablative, or fractionated, will not treat vessels and redness on the face and body or the blotchy change one sees on the sides of the neck, called Poikilodema of Cervatte. These changes are treated by using a number of other lasers we have including the 540 nm, 570 nm, 650 nm laser heads, the diolite 532 nm, the 940 nm for deeper and larger veins and the 1064 nm ndYag laser. Horses for courses
Although the laser will give tightening of tissues, it is not a substitute for proper lifting and repositioning of tissues like a properly performed face lift or a neck lift or a blepharoplasty.
WHICH BRAND OF THE CO2 LASER IS BEST?
FACT: there are more than 30 brands of CO2 laser, although the engine inside these machines is only made by two or three laser manufacturers. So this is an exercise in differentiation by deceipt or camouflage: lipstick, not necessarily on a pig, but there are some pig machines out there which are woefully underpowered.
There are several machines, when used by properly experienced surgeons, that give very good results.
The under-powered machines hurt less but give much less of a result!
The Rolls Royce (and Bentley and Aston Martin and Ferrari) of CO2 lasers is the Lumenis Ultrapulse CO2 fractionated laser, which also allows full ablation and cutting. We use this machine and have used various versions of this laser over the years to great acclaim.
Good equipment in incompetent hands will not help you! So it is wise to look at results and outcomes before undergoing ablative CO2 laser treatments.
WHAT IS THE DIFFERENCE BETWEEN THE CO2 AND ERBIUM FRACTIONATED LASERS?
The CO2 laser goes slights deeper and has a different way of shrinking collagen than the Erbium laser. Therefore, it generally gives a better result for deeper wrinkles, acne scars, upper lip lines, and crepiness around the eyes. The CO2 is best for patients who are late 40s to 70s with moderate to deep wrinkles/sun damage or with moderate to severe acne scarring. It also works well on crepy eyelid and neck skin when performed by an expert with the proper settings. But because the CO2 can go deeper, there is more “downtime” than with the Erbium laser. If you cannot take any time off from your normal activities, the CO2 laser on the face is not the right choice for you. Some off-face areas can be kept covered and may be fine.
Erbium lasers are best for the younger patients (approx 30-50ish) who have early wrinkles or mild to mod acne scarring or for those who truly can’t take any time off from work/children to have CO2 treatments.
HOW DOES THE FRACTIONAL CO2 LASER WORK?
The fractional CO2 laser takes the CO2 laser beam and fractionates, or pixellates that beam into thousands of tiny little shafts of light. These tiny shafts of light penetrate into the deeper layers of the skin. The skin then repairs those tiny shafts by pushing out the old sun damaged skin and replacing it with new skin. The “collateral” heat damage also helps to shrink existing collagen.
Can I do the fractional CO2 laser with other cosmetic treatments?
Not the same day generally. The CO2 laser is compatible long term with Botox, Juvederm, Restylane, Sculptra and other laser based technologies like hair removal, Erbium, advanced photofacial rejuvenation lasers, pulsed dye lasers, etc.
