What is a laser?
A LASER (light amplification by stimulated emission of radiation) works by emitting a wavelength of high energy light, which when focused on a certain skin condition will create heat and destroy diseased cells.
Various kinds of lasers are available that are differentiated by the medium that produces the laser beam. The medium amplifies the light of a particular wavelength as it passes through it.
What is a carbon dioxide laser?
The active laser medium is a mixture of 3 gases consisting of 10–20% carbon dioxide, 10–20% nitrogen, and the remainder is helium.
The carbon dioxide laser produces a specific wavelength of light in the infrared spectrum (10,600 nm).
How does a carbon dioxide laser work?
Carbon dioxide laser beams penetrate the top skin layers reaching into the dermis. It creates tiny microscopic areas of thermal damage that stimulate new collagen production and replace damaged skin surface by new epidermal cells.
Traditional ablative carbon dioxide laser resurfacing has been largely replaced by fractional carbon dioxide lasers, which provide excellent results with fewer complications.
What is carbon dioxide laser used for?
The US Food and Drug Administration (FDA) has approved a range of carbon dioxide laser machines to treat skin disorders. These include SmartSkin™ ablative skin laser (Cynosure, Massachusetts, USA), AcuPulse™ ablative carbon dioxide laser (Lumensis Inc. California, USA), UltraPulse® (Lumensis Inc. California, USA), FRAXEL® (Solta Medical, California, USA) and QuadraLASE™ (Candela, California, USA). Individual machines are designed to treat specific skin problems.
The following skin disorders can be treated with carbon dioxide laser beams.
- Raised birthmarks
- Viral warts
- Acne scarring
- Keloid and hypertrophic scars
- Skin ageing
- Facial lines and wrinkles
- Stretch marks
- Actinic keratosis
- Uneven pigment (brown spots and freckles, lentigines, melasma)
- Pearly penile papules
Patient selection and contraindications
Carbon dioxide laser treatment may be unsuitable in the following circumstances:
- Patients with unrealistic expectations, such as those who seek complete eradication of wrinkles or scars.
- Patients with a tendency to form keloid and hypertrophic scars
- People that have taken isotretinoin within the previous 6 months
- Active cutaneous bacterial skin infections or herpes simplex (cold sores) in the area to be treated
- Prior ionising radiation to the area to be treated
- Connective tissue diseases
- Previous deep chemical peel or dermabrasion
- Fitzpatrick skin phototypes 5 or 6 (darkly pigmented skin)
- Human immunodeficiency virus (HIV) or hepatitis C infections
To reduce the risk of infection, patients may be prescribed:
Are there any side effects of carbon dioxide laser resurfacing?
Side effects from carbon dioxide laser treatment may include:
Mild side effects
Moderate side effects
- Localised bacterial skin infections, herpes simplex or candida
- Prolonged redness
- Transient postinflammatory hyperpigmentation
- Delayed hypopigmentation (pale patches)
Severe side effects
- Fibrosis (scarring)
- Hypertrophic scarring
- Disseminated herpes simplex or staphylococcal skin infections
- Ectropion (permanently dropped eyelid)
Benefits of carbon dioxide laser treatment
For selected skin conditions, carbon dioxide laser treatment offers:
- High-precision, tissue-selective treatment
- Low cost of consumables
- Less invasive than dermabrasion and chemical peeling
- Short downtime – recovery time is about 2 weeks
Carbon dioxide versus erbium lasers
- Erbium:YAG laser resurfacing is used to remove superficial and moderately deep lines and wrinkles on the face, hands, neck, or chest.
- Erbium:YAG laser resurfacing has faster recovery time and fewer side effects than carbon dioxide laser but is less effective for the deeper line and wrinkles.