Ablative laser resurfacing is used to target the cutaneous signs of photodamage that progressively increase with age and occur most prominently in individuals with fair skin. Through the ablation of the epidermis and portions of the superficial dermis as well as the induction of collagen remodeling in the deeper dermis, ablative laser resurfacing can reduce rhytides (wrinkles), dyschromia, vascular changes, and skin laxity.
The mechanism of action, efficacy, adverse effects, and administration of traditional and fractional ablative laser resurfacing for skin rejuvenation will be discussed here. The basic principles of laser therapy for cutaneous lesions are reviewed separately. (See "Principles of laser and intense pulsed light for cutaneous lesions".)
Technology for ablative laser resurfacing has continuously evolved. The procedure was first performed in the 1980s with the continuous wave carbon dioxide (CO2) laser. Use of this laser was complicated by an unfavorably high risk of adverse effects, and the subsequent development of pulsed CO2 lasers and rapidly scanning continuous wave CO2 lasers improved the safety of treatment . In the 1990s the erbium:yttrium aluminum garnet (Er:YAG) laser was introduced as an alternative device for ablative laser resurfacing. Advantages of Er:YAG lasers included more precise control over the depth of cutaneous ablation and a lower incidence of adverse effects.
For a number of years, the CO2 and Er:YAG lasers were the primary lasers used for ablative laser resurfacing for skin rejuvenation, with CO2 lasers considered the gold standard for this indication. However, in the early 2000s, the approach to laser skin rejuvenation was dramatically altered by the development of fractional lasers, which emit numerous narrow, microscopic columns of laser light. Fractional lasers treat only a defined fraction of the skin within a targeted area, leaving intervening areas of skin unaffected (figure 1). The reservoir of undamaged skin adjacent to sites of laser injury allows for rapid reepithelialization after treatment through the migration of viable cells into wounded areas.
Aside from the repair of photodamaged skin, ablative laser resurfacing is used for a variety of other indications, such as the treatment of scars, actinic keratoses, epidermal nevi, and other cutaneous lesions and disorders. Nonablative traditional and fractional lasers also have been studied for facial rejuvenation; however, these lasers generally are less efficacious than their ablative counterparts for this indication .