Comparison of two high-energy, pulsed carbon dioxide lasers in the treatment of periorbital rhytides

BACKGROUND. Carbon dioxide (CO2) laser technology has expanded over the past 20 years from the production of precise excisional and cutting instruments to the recent development of high-energy, pulsed systems that allow for controlled tissue vaporization. These newest lasers permit removal of thin layers of skin with minimal damage to normal adjacent skin structures. The precise and reproducible nature of tissue destruction has led to a resurgence of interest in cutaneous resurfacing. OBJECTIVE. To compare the clinical effectiveness, side effect profile, and postoperative course of two different high-energy, pulsed CO2 lasers (ultrapulse and surgipulse) in the treatment of periorbital rhytides. METHODS. Ten patients with moderate to severe periorbital rhytides received laser treatment using the surgipulse CO2 laser on one side and the ultrapulse CO2 laser on the opposite periorbital region. Equivalent laser parameters and treatment conditions were used with both systems. Sequential clinical analyses were performed independently by two blinded assessors. In addition, optical profilometry measurements of silicone rubber skirt surface casts were obtained before and after laser irradiation to determine skin texture changes. RESULTS. There was a 63% average clinical improvement of periorbital rhytides following surgipulse laser treatment and a mean improvement of 82% after ultrapulse laser irradiation. Skin surface texture in all laser-treated rhytides approximated those found in normal skin. An increased number of laser passes were required using the surgipulse system to effect the same clinical endpoints as the ultrapulse system. CONCLUSION. While both the surgipulse and ultrapulse high-energy CO2 laser systems can effectively improve periorbital rhytides, the ultrapulse system provides a slightly enhanced clinical response with fewer passes, presumably due to improved tissue vaporization.