NEW YORK (Reuters Health) – Carbon dioxide (CO2) laser resurfacing is a safe and effective long-term treatment for facial wrinkles and solar aging, physicians report in the July/August issue of the Archives of Facial Plastic Surgery. Hypopigmentation – the single complication they observed in patients more than two years after treatment – can be minimized by using sunscreen before and after the procedure.

Drs. P. Daniel Ward and Shan R. Baker, both at the University of Michigan in Ann Arbor, analyzed recent photographs of 47 patients who had undergone entire facial laser resurfacing an average of 2.3 years earlier.

Patients’ mean improvement in facial rhytid score was 45%. The rate of complications was 55%, which included milia or acne in 14 cases (30%), hyperpigmentation in eight (17%), and hypopigmentation in six (13%). There was also one case each of viral infection and ectropion.

Most complications resolved within 12 months. One case of hyperpigmentation lasted past 12 months but resolved during the second year. Hypopigmentation, however, persisted in all 6 affected patients. This complication was associated with a greater response to the resurfacing treatment (mean improvement in rhytid score 74% vs 42%, p = 0.004).

"The risk of developing hypopigmentation can be minimized by cautioning the patients to use sunscreen before and after the procedure and by treating all skin within cosmetic units to decrease the incidence of observable lines of demarcation," the authors advise.

In an editorial, Dr. Paul J. Carniol at Overlook Hospital in Summit, New Jersey, notes that newer methods have been developed in attempts to shorten recovery periods and lower the complication rates associated with carbon dioxide resurfacing. He points out, however, that the newer techniques, such as erbium and YSGG resurfacing lasers, nonablative lasers, fractionated lasers, and plasma resurfacing, may not produce the same results. "Carbon dioxide laser resurfacing remains the gold standard," Dr. Carniol says.

Arch Facial Plast Surg 2008;10:238-245.