Fractional CO 2 laser treatment of the skin

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The fractional CO 2 -Laserbehandlung is a further development of the method of irradiation of the skin with the radiation from carbon dioxide lasers (CO 2 laser). It is used both in aesthetic medicine and in operative dermatology .

history

The invasive laser treatment of wrinkles , acne scars and other large-scale skin changes in the area of ​​the face (so-called laser resurfacing) has been carried out with the Er: Yag laser (wavelength 2,940 nm) and especially the CO 2 laser (wavelength 10,640 nm) since 1995 .

Through the extensive application of laser light over the entire treated skin area, on the one hand the epidermis is largely removed with these lasers (invasive laser treatment), on the other hand, especially with the CO 2 laser, the collagen fiber structure should be stabilized in the long term by thermal effects in deeper skin layers.

Proper treatment with these lasers generally leads to good results. However, the effective use of these devices is limited by the fact that the painful treatment can only be carried out under general anesthesia and the healing phase of the skin can take several weeks to months, during which the patient must expect swelling and reddening of the face. In addition, scarring and permanent pigment shifts were possible. For these reasons, these treatments have not yet been able to gain acceptance for broad use on patients.

How the laser light works

The wavelength of the CO 2 laser has a high absorption rate for water. Such a high absorption of the CO 2 radiation in the skin cells with a high water content leads to their explosive evaporation (vaporization) and thus to the removal of the treated skin layers. The skin renewal takes place via re-epithelialization by keratinocytes, which originate from the skin appendages (hair follicles).

On the other hand, due to its pronounced thermal effect , the CO 2 laser also leads to inflammation processes in the deeper skin layer (dermis) and thus to a stimulation of fibroblasts, which stimulates the formation of new collagen and elastin. The heat development also leads to shrinking of the collagen fiber bundles, which have been stretched by skin aging. These effects make the CO 2 laser particularly suitable when it comes to smoothing wrinkled skin or shrinking scars.

However, the side effects of this classic CO 2 laser treatment, which has not been further modified , can be considerable, as already mentioned, and result in the patient being able to pursue his social obligations only to a limited extent for several weeks after treatment.

Treatment with the fractionated CO 2 laser is therefore a significant further development of this classic method . The principle of action is that the laser light is not applied over a large area as before, but is distributed (fractionated) over many small tissue areas. The laser beams penetrate into the depths in a columnar manner, creating numerous pinprick-like micro-wounds, all of which are surrounded by healthy skin that has not been damaged by the laser light. Depending on the device setting and manufacturer, e.g. B. 100 fine laser beams penetrate the skin on an area (spot) of 1 square centimeter. Also depending on the setting, 20 to 40% of the skin area is treated with it. The rest of the skin remains intact. For this reason, the skin can heal much faster than the previously usual types of treatment.

The search for gentler methods led to the development of non-invasive lasers (erbium glass, 1550 nm and Nd: Yag laser, 1320 nm) and flash lamps, which apply thermal energy to the skin but leave the epidermis intact. Since, as a rule, however, despite histologically verifiable structural improvements in the deep skin layer (dermis), there were no clearly visible improvements in the appearance of the skin, these devices have not found any further widespread use.

Possible applications

Requirements, implementation and duration of the treatment

Treatment with a fractionated CO 2 laser should only be carried out with suitable skin types 1 to 2, and only to a limited extent with skin type 3. Direct sunlight before and for at least 6 weeks after treatment should be avoided.

The treatment takes place after the application of a locally anesthetic cream. The actual laser treatment takes a few minutes to an hour, depending on the size of the area to be treated and the experience of the doctor. Per laser shot z. B. a skin area of ​​1 cm² can be treated with 100 MTZ (Microscopic Treatment Zones). A slight burning sensation can be felt during and after the treatment. The treated skin is then slightly swollen and slightly edematous. This condition can last for a few days. Cosmetic covering with light make-up is then possible.

Because a final treatment result develops over several months when using the fractionated CO 2 laser, a follow-up treatment usually only makes sense after 6 months.

Possible complications

  • Brown discoloration of the skin on exposure to the sun or with a corresponding skin type
  • Loss of pigment if the skin is removed too extensively
  • prolonged redness and swelling of the skin
  • Crusting and scarring

literature