FRACTIONATED LASERS AND CO2 LASERS IN PASADENA / LOS ANGELES COSMETIC SURGERY

This photo is unrelated to the post. This is Wesley Harline, MD, who was one of the greatest cosmetic surgeons in the world and one of Dr. Yoho's mentors. He passed away August 2009.

Prior to about the year 1993, we only had acid peels as resurfacing techniques. These peels consisted of the several different acid treatment options. Phenol was the deepest. It has the ability to almost completely remove all the wrinkles on almost anyone’s face. The lightest peels were fruit acids such as glycolic acid. In between, was an agent called trichloracetic acid (TCA), which could remove some wrinkles, but had some potential for problems also. Then around 1992 or 1993, the CO2 lasers became practical for skin resurfacing and a very precise and safe removal of the top layers of the skin was now possible. These lasers, the Coherent UltraPulse® among them, created a very controlled depth of penetration: the top surfaces of skin could be gently removed. Just as in the acid peels from before, the skin regenerated from structures in the deep layers of the skin, which were not damaged, such as sweat glands and hair follicles.Initial healing took a week or so and left the patient with relatively fragile skin for a period of up to several months, sometimes with redness or pigmentary changes just as was seen with the acid peels.

Now, please note that acid peels are still used and are inexpensive. They are effective and although recovery times perhaps are longer for the degree of results obtained, they are still reasonable alternatives.

In any case, in 2008, we had the development of the fractionated CO2 laser, of which which are several models including the one we have, the SmartXide DOT®. This CO2 laser drills thousands of little holes leaving spaces in between with intact skin, so healing time is very rapid from the surrounding skin bridges. This laser allowed us to peel all the different body parts, which was virtually impossible using the older CO2 laser models or even using the lighter acid peels. These methods were either ineffective or caused skin color changes or scarring. The fractionated CO2 laser however is so controlled that we can peel skin that is relatively dark and produce an even result with much less chance of pigmentary changes. It is not the strongest laser, so wrinkle improvement is modest, but for color changes, such as uneven darkening and lightening, it is a wonderful device that is particularly advantageous on the neck and chest, where our other modalities were risky.

This SmartXide DOT and its cousins require, for most people, only anesthesia cream. After about an hour, the area is numb enough to be treated with the laser. There is some discomfort involved, but it should be modest. If requested, we use relaxation medicines at no additional charge. If so a driver should transport our patients home.

See photos for some ideas about what can be accomplished with our fractionated CO2 laser in our Pasadena cosmetic surgery office or Visalia/Fresno office, where we bring the laser as well.