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Efficacy and Patient Satisfaction of a Prospective Side-by-Side Study

Christian Raulin, MD, PhD; Hortensia Grema, MD

Arch Dermatol. 2004;140:1333-1336.

Background  Ablative skin resurfacing with carbon dioxide (CO₂) and erbium:YAG lasers is still considered the gold standard for treating rhytides, photodamage, and acne scars. However, the prolonged downtime and undesired concomitant effects that are involved have sent dermatologists looking for less invasive nonablative laser techniques to rejuvenate skin.

Objective  To combine cold-air cooling with single-pass CO₂ laser skin resurfacing to generate as much benefit as possible while minimizing the spectrum of adverse effects.

Study Design  The efficacy of single-pass CO₂ laser skin resurfacing on perioral and periorbital wrinkles was examined prospectively during a 6-month follow-up period. In a side-by-side comparison, the influence of simultaneous cold-air cooling on concomitant effects, pain tolerance, therapeutic success, and patient satisfaction was also studied. Eight patients with perioral and/or periorbital wrinkles underwent the procedure. During laser treatment, only the right half of each face was cooled using a cold-air system.

Results  Six months after treatment, a mild improvement of the wrinkles was observed in all cases. The use of cold-air cooling did not have any impact on the long-term results, although in a direct comparison between sides, it was observed that cooling reduced the recovery period from 3.9 ± 1.5 (mean ± SD) days to 3.5 ± 1.4 days (P = .09) and helped postoperative erythema fade more quickly, from an average of 21.3 ± 17.9 days to 11.7 ± 3.9 days (P = .17). The reduction of pain was significant, which led to a much higher level of patient acceptance: on a numerical analog scale of 1 to 10, the rate decreased from an average of 6.8 ± 1.8 (mean ± SD) to 3.6 ± 1.7 (P = .006).

Conclusions  Given the clear decline in demand for invasive laser technologies, single-pass CO₂ laser skin resurfacing in conjunction with cold-air cooling is a worthwhile alternative both to conventional resurfacing and to conventional subsurfacing. The use of cold-air cooling not only minimizes intraoperative and postoperative adverse effects, it also contributes strongly to patient satisfaction.

Author Affiliations: Laserklinik Karlsruhe, Karlsruhe, Germany.

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