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Khalil A. Khatri, MD; Victor Ross, MD; Joop M. Grevelink, MD, PhD; Cynthia M. Magro, MD; R. Rox Anderson, MD

Arch Dermatol. 1999;135:391-397.

Objective  To compare the efficacy, adverse effects, and histological findings of erbium:YAG (Er:YAG) and carbon dioxide (CO₂) laser treatment in removing facial rhytides.

Design  An intervention study of 21 subjects with facial rhytides. All participants were followed up for 6 months. The end points of the study were wrinkle improvement and duration of adverse effects.

Setting  Academic referral center.

Subjects  Nineteen female and 2 male volunteers with skin type I to III and wrinkle class I to III participated in the study.

Intervention  In all subjects, 1 side of the face was treated with a CO₂ laser and other side with an Er:YAG laser. Skin biopsies were performed in 6 subjects before treatment and immediately, 1 day, 2 days, and 6 months after treatment. Observations were recorded by subjects, investigators, and a blinded panel of experts.

Main Outcome Measures  Improvement in wrinkles and severity and duration of adverse effects.

Results  The CO₂ laser–treated side had relatively better wrinkle improvement when evaluating all subjects (P<.03). However, in subjects receiving more than 5 passes of Er:YAG laser, improvement scores were not significantly different from those for 2 to 3 passes of CO₂laser treatment. Posttreatment erythema was noted at 2 weeks in 14 subjects (67%) on the Er:YAG laser–treated side and 20 subjects (95%) on the CO₂ laser–treated side. The frequency of erythema was significantly less after Er:YAG laser treatment at 2 (P=.001) and 8 (P=.03) weeks. Hypopigmentation was seen in 1 Er:YAG-treated (5%) and 9 CO₂-treated (43%) sides (², P<.05). Histological evaluation showed residual thermal damage of up to 50 µm on the Er:YAG-treated side and up to 200 µm on the CO₂-treated side.

Conclusions  Erbium:YAG laser is safe and effective in removing facial rhytides. Subjects treated with Er:YAG laser recover more quickly from the procedure than those receiving CO₂ laser treament.

From the Department of Dermatology, Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston (Drs Khatri, Ross, Grevelink, and Anderson); Beth Israel Deaconess Medical Center, Harvard Medical School (Dr Magro); and Pathology Services Inc, Cambridge, Mass (Dr Magro). Dr Ross is now with the Department of Dermatology, US Navy Hospital, San Diego, Calif; and Dr Magro with Ameripath Cutaneous Pathology and Immunoflorence Laboratory of Cleveland and University Hospital and the Department of Dermatology, Case Western Reserve University, Cleveland, Ohio.

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