Answer:
In a study of 259 patients, Alster et al assessed the efficacy of high-energy pulsed CO2 lasers in treating facial wrinkles. Responses to treatment were assessed at 1, 4, 8, 12, and 24 weeks postoperatively. On average, the investigators found a 90% improvement with periorbital wrinkles most responsive to the therapy (93%). Wrinkles which were more severe and caused by excessive muscle movement such as forehead wrinkles had the least improvement (86%). Persistent erythema and hyperpigmentation are the most common complications but these usually resolve after several months. Other potential complications include acne, milia, dermatitis, infection, and hypertrophic scarring. Most complications are related to postoperative care. Weinstein et al recommend the use of Flexzan, a semiocclusive biosynthetic dressing made from polyurethane foam in the immediate postop period. This is applied after the face is dried and usually changed at 24 hours to remove wound exudate. The face should be gently, but thoroughly cleansed with preservative-free tap water and perfume-free cold cream. The face is carefully dried with a cool hair drier or low-energy laser to enable the dressing to stick better. This dressing is left for 7 to 10 days. The patient then showers, washes the hair, and returns to the office with wet dressings which are removed with baby or bath oil. Usually the skin is completely healed. A few small areas may be incompletely healed and will need reapplication of small sections of Flexzan. Antiviral medication is started 24 hours before the procedure while antibiotics are started the morning of the surgery. These are usually continued until reepithelialization is complete. After reepithelialization, the skin should be treated with oil-free, perfume-free cleansers and moisturizers. A tinted titanium dioxide UVA blocking sunscreen should also be used to minimize hyperpigmentation.