Should We Trade in Our
CO2 Lasers?

T he CO2 laser has been the gold standard for ablating or resurfacing the skin. Two areas in which this type of technology has excelled are facial rejuvenation and scar revision. However, as you know, compared with non-ablative lasers for skin rejuvenation, patients must undergo much more down time for healing after treatment with an ablative laser. In addition, there’s more risk of scarring and hypopigmentation when using this type of laser. CO2 Lasers and Facial Rejuvenation Despite the downtime for healing and potential risks mentioned above, nothing competes with ablative resurfacing on the face for rhytides and severe photodamaged skin. For example, this technology is particularly effective for several specific areas, such as the perioral area (see photos on page 84). To decrease the risks of any adverse effects, we’ve evolved new techniques with the CO2 laser. Whereas we used to make two to three passes, now frequently I will use just one pass with the CO2 laser. You’ll see an example of a young woman we treated with one pass with the CO2 laser (see photos on page 84). She was very pleased with the results, and you can see that the procedure also resulted in good tightening of the skin. Other Uses for CO2 Lasers CO2 lasers have proved useful for a whole host of other treatments, including wart removal, psoriasis, benign tumor removal, actinic cheilitis, removal of certain tattoos and rhinophyma to name a few. In the photos, you’ll see an example of a young girl with tuberous sclerosis who has multiple angiomas over her face. We successfully treated her with a CO2 laser, and you can see the positive results we achieved about a week post-treatment. Another example of a condition for which I often use a CO2 laser is for removing actinic cheilitis lesions, and I’ve had much success treating even cases of marked actinic cheilitis. I’ve also used CO2 lasers for effectively treating epidermal nevi, as you can see in the photos. Tattoo Removal and CO2 Lasers When it comes to treating tattoos, we’ve all been educated that the Q-switched alexandrite, ruby, and neodynium:YAG lasers are best to remove tattoos. But there’s still a role for CO2 lasers in several types of cases. For example, consider the following scenarios: • patients who have skin-colored cosmetic tattoos • patients who have allergic reactions to tattoo pigments • patients with multiple-colored tattoos. For example, when some patients who have cosmetic tattoos undergo treatment with a Q-switched laser, their tattoos darken rather than diminish. As for patients who’ve had allergic reactions to tattoo pigments, I had a patient who’d experienced an allergic reaction to the red pigment in her tattoo. In a case like this, if you used the Q-switched laser to try to remove the tattoo, you run the risk that the patient can develop a systemic allergic reaction. In a situation such as this, if the patient was truly set on getting this tattoo removed, I’d use a CO2 laser. In some cases in which patients have multiple-colored tattoos, a CO2 laser can also be an appropriate option for pigment removal. We already know we have laser technology for removing the dark green, dark blue, black and red pigments, but when it comes to colors such as yellow, orange or lavender we don’t have laser technology that can effectively remove these pigments. In these cases, if the patient really wants the tattoo removed and can live with a scar, then I’d opt to use a CO2 laser to completely remove the tattoo. Treating rhinophyma Rhinophyma is still one of the best indications for the CO2 laser. If you look at the before and after photos taken 2 months apart, you’ll see the drastic improvement in one man’s rhinophyma after he underwent treatment with a CO2 laser. Also note the significant improvement in another patient whose rhinophyma was treated with a CO2 laser. Keeping Our CO2 Lasers Busy So, in summary, do I think we should trade in our CO2 lasers? My answer is no. I think there are still multiple indications for the use of them — including facial rejuvenation, for which CO2 lasers, in my opinion, are still the gold standard.