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Richard E. Fitzpatrick, MD; Mitchel P. Goldman, MD; Nancy M. Satur, MD; Whitney D. Tope, MPhil, MD

Arch Dermatol. 1996;132(4):395-402.

Abstract
Background and Design
Public demand for procedures to rejuvenate photoaged skin have stimulated the use of high-energy short-pulsed carbon dioxide lasers as a precise and predictable treatment modality. The purpose of this study was to determine the degree of clinical improvement achieved in treating perioral and periorbital wrinkles with a high-energy, microseconddomain pulsed CO₂ laser. Photodamaged skin in the perioral (n=73) and periorbital (n=38) regions was treated with multiple passes of confluent single pulses of CO₂ laser energy (10 600 nm, 3-mm collimated beam, <1-millisecond pulse, 450 mJ per pulse, 2 to 5 W), with the tissue being cleansed and débrided with normal saline between passes. A nine-point clinical scoring system was devised for evaluation of the degree of wrinkling and photodamage present. Preoperative and postoperative photographs were independently scored by four "blinded" reviewers. The patients were observed postoperatively for 1 to 12 months for the course of healing, and adverse events were recorded.

Results
All three classes (mild, moderate, and severe) of photoaging of the skin responded equally well, showing an average wrinkling score reduction of 2.25 for the periorbital region and 2.34 for the perioral region, the most superficial wrinkles and photodamage being eliminated and the more severe being markedly improved. An unexpected finding was tightening of loose and folded skin. Side effects included transient erythema and postinflammatory hyperpigmentation, and one instance of an isolated hypertrophic scar.

Conclusions
Resurfacing of photoaged skin by means of a high-energy, microsecond-domain pulsed CO₂ laser with a specific clinical treatment protocol results in predictable improvement in perioral and periorbital wrinkling and photodamage with minimal risks. Heatinduced collagen shrinkage appears to contribute to these results by tightening loose skin and folds.

(Arch Dermatol. 1996;132:395-402)

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