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Noah Kawika Weisberg, MD; Timothy Kuo; Berhooz Torkian; Lou Reinisch, PhD; Darrel L. Ellis, MD

Arch Dermatol. 1998;134:1223-1228.

Objective  To develop methods to compare carbon dioxide (CO₂) resurfacing lasers, fluence, and debridement effects on tissue shrinkage and histological thermal denaturation.

Design  In vitro human or in vivo porcine skin samples received up to 5 passes with scanner or short-pulsed CO₂ resurfacing lasers. Fluences ranging from 2.19 to 17.58 J/cm² (scanner) and 1.11 to 5.56 J/cm² (short pulsed) were used to determine each laser's threshold energy for clinical effect. Variable amounts of débridement were also studied.

Main Outcome Measures  Tissue shrinkage was evaluated by using digital photography to measure linear distance change of the treated tissue. Tissue histological studies were evaluated using quantitative computer image analysis.

Results  Fluence-independent in vitro tissue shrinkage was seen with the scanned and short-pulsed lasers above threshold fluence levels of 5.9 and 2.5 J/cm², respectively. Histologically, fluence-independent thermal depths of damage of 77 µm (scanner) and 25 µm (pulsed) were observed. Aggressive debridement of the tissue increased the shrinkage per pass of the laser, and decreased the fluence required for the threshold effect. In vivo experiments confirmed the in vitro results, although the in vivo threshold fluence level was slightly higher and the shrinkage obtained was slightly lower per pass.

Conclusions  Our methods allow comparison of different resurfacing lasers' acute effects. We found equivalent laser tissue effects using lower fluences than those currently accepted clinically. This suggests that the morbidity associated with CO₂ laser resurfacing may be minimized by lowering levels of tissue input energy and controlling for tissue debridement.

From the Department of Otolaryngology (Dr Reinisch), Vanderbilt University Medical Center (Dr Weisberg and Messrs Kuo and Torkian), Nashville, Tenn; and the Department of Medicine, Division of Dermatology, Vanderbilt University and Nashville Veterans Affairs Medical Centers, Nashville (Dr Ellis).

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