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Lasers, of which there are many types, resurface by the discharge of energy from light that is absorbed by molecules in the tissue being treated. For example, the CO2 laser light is absorbed by water molecules. Any tissue with water (skin being the most salient example) will absorb the light from this laser and ultimately transform this energy into heat. Thus a thermal injury will occur-a burn.

The CO2 laser is the most commonly used laser for skin resurfacing. To complicate matters, though, there are different types of CO2 units. Their differences have to do with the amount of energy delivered to a given area over a period of time. The clinical effect (benefit as well as unwanted side effect) is a product of the variables of laser light delivered. The newest is the Unipulse which minimizes much of the morbidity but cosmetically rivals the other CO2 lasers. It is, at least for now, the laser we use at the Center for Plastic Surgery.

The erbium laser is the latest non-CO2 laser for resurfacing. It is mainly intended for very shallow wrinkles. Its effect on deeper skin problems is minimal. This laser allows for relatively rapid healing and has minimal morbidity.

There are other lasers used for treatment of various manifestations of skin aging. Melanotic spots, telangiectasia (small red lesions), and other skin lesions may be preferentially dealt with by a laser. There is not enough space in this manuscript for a thorough discussion of all lasers. What is important to remember is the complexity of treatment options. Skin restoration is very individualized and should be undertaken only when benefits are predictably expected and unwanted side effects are modest or non-existent. This can only be accomplished by a trained and experienced professional.

General questions…