PEOPLE searching for ways to look younger for longer can now have their skin resurfaced by high-energy lasers. Clinical studies in the US and Australia suggest this is an almost painless way to get rid of wrinkles, scars and other blemishes. Lasers are also safer than other resurfacing treatments, although the long-term effects are still being evaluated.
The idea of using a high-energy pulsed CO2 laser as a skin treatment was pioneered in 1992 by Richard Fitzpatrick, associate professor of dermatology at the University of California in San Diego, and Laurence David, president of the International Society of Cosmetic Laser Surgeons. Fitzpatrick used the laser to remove warts and superficial skin cancers, while David tried it on wrinkles. A handful of doctors have since been working on the procedure, and their results are so convincing that interest in laser skin resurfacing seems to have blossomed overnight. In a recent trial on almost 900 people, 75 per cent of wrinkles were removed in over 90 per cent of patients.
With conventional techniques such as dermabrasion and chemical peels, it is difficult to control the thickness of skin removed and this increases the risk of permanent damage. Side effects can include scarring, thinning of the skin, loss of pigmentation, and in the case of chemical peels, dangerous heart and kidney problems. But in laser resurfacing, a high-energy pulsed CO2 laser vaporises a 75 micrometre layer of tissue with each pass and there should be no charring or bleeding if the operation is performed correctly.
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鈥淭he laser option is far more appealing than using caustic agents or abrasives on skin,鈥� says Brooke Seckel, chief of plastic and reconstructive surgery at Lahey Hitchcock Medical Center in Burlington and assistant professor of surgery at the Harvard Medical School in Cambridge, Massachusetts. 鈥淭hese [other] agents are too uncontrollable and potentially dangerous, particularly around the mouth and eyes.鈥�
Since the introduction of rapid pulsing, CO2 lasers can burn away skin without charring the underlying tissue. 鈥淯ltrapulsing鈥� lasers deliver 500 millijoules of energy per pulse so quickly that the treated surface is vaporised before it can conduct much heat to the skin underneath.
But what little thermal energy does reach the underlying skin has proved to be a bonus. It shrinks the skin鈥檚 collagen fibres by a third, tightening the skin. 鈥淭his is something we did not anticipate, but we can see it happening,鈥� says Fitzpatrick.
鈥淭he results are immediately apparent,鈥� says Seckel. 鈥淭he patient鈥檚 skin contracts and tightens after the second or third pass of the laser. It鈥檚 really quite remarkable.鈥�
Fitzpatrick also claims that heating the collagen encourages wound healing. 鈥淚f we can control the depth of penetration even more precisely, we can take advantage of this process,鈥� says Fitzpatrick.
But there is only a few degrees鈥� difference between rejuvenating collagen or killing it. 鈥淚f Type I collagen is heated to 58 掳C, the collagen bundle links and bonds,鈥� says Seckel. 鈥淏ut if heated to 61 掳C, it is irreversibly damaged.鈥� And other experts remain cautious about the long-term effects of the lasers. 鈥淪o far the lasers are being used wisely, but we don鈥檛 know what long-term changes are associated with this procedure,鈥� says R. Rox Anderson, associate professor of dermatology at Harvard University and a research leader at the Wellman Laboratories of Photomedicine of Massachusetts General Hospital.
Anderson also suspects that laser resurfacing could lead to different treatments. 鈥淐an we just shrink the collagen and still achieve the same effects? If so, maybe the surgeon doesn鈥檛 have to do all these other things to the skin鈥檚 surface,鈥� he says.
