The American Journal of Cosmetic Surgery

Even though laser technology has been available for over 30 years, it has been only within the past 10–15 years that its applications have been exploited extensively for cosmetic surgical procedures. The expansion of laser technologies and applications is in part due to an improved knowledge of laser-tissue interaction, which has resulted in the development of many new and improved laser systems. With the large number of laser systems currently available, every cosmetic surgeon should have a working knowledge of the basic concepts of lasers, laser-tissue interactions, and the capabilities and limitations of each system, in order to maximize the potential benefits of laser systems in patient care.

A technique for CO₂ upper lid blepharoplasty is presented. Disadvantages and complications are discussed. Conclusions include the comparative advantages of decreased intraoperative hemorrhage and postoperative ecchymoses, shortened operative time and improved patient satisfaction.

A modified eyelid retractor designed to put the skin and aponeurosis of upper eyelid levator on stretch while protecting the cornea and globe during eyelid surgery is presented. There are several advantages to the use of this retractor as compared to other, previously used instruments.

The CO₂ laser, used for lower eyelid blepharoplasty, presented here according to David's technique, approaches the lower eyelid fat via the transconjunctival route. This technique avoids the possible sequelae associated with conventional surgical blepharoplasty, such as scarring and lower lid retraction. Postoperative recovery time is extremely rapid and associated with very little or no discomfort. CO₂ laser surgery helps to prevent the risk of hemorrhage and infection, and keeps edema, when it occurs, to a minimum. The cosmetic results are excellent.

Currently, various modalities such as phenol and TCA peels and dermabrasion are available for regeneration of the aged skin. A prior study by our group has demonstrated the clinical effectiveness of CO₂ laser resurfacing in treating actinically damaged skin of the entire face with concomitant histologic improvement characterized by elimination of the solar elastosis and replacement by new collagen bundles. In the present study, we have taken this approach one step further and are presenting results of a series of 130 patients treated with combined CO₂ laser resurfacing and trichloracetic acid (TCA) chemical peeling. The laser is used primarily for wrinkles, keratotic lesions, and pigmentary changes; and TCA is used to blend affected and unaffected skin. Fewer complications were noted with CO₂ laser resurfacing/TCA peels than with phenol peels or dermabrasion. This combined technique can be a useful modality in the cosmetic as well as therapeutic treatment of the aged skin, as marked clinical and histologic improvement has been demonstrated.

This report describes our experience over a 36-month period with 110 lower facelift surgeries using the CO₂ laser as the primary or only cutting and undermining instrument. Carbon dioxide laser surgery was safe and effective in these 110 cases. Using the laser provided excellent hemostasis, absence of postoperative pain, and minimal postoperative bruising and swelling. There were no complications specific to the laser. There were no operating room fires and no laser accidents to the skin, eyes, or other tissues of the patients or operative personnel. Postoperatively there were no hematomas, no infections, no unusual scarring, no flap necrosis, and no dehiscence of incision lines.

Because an ideal method for removing tattoos still eludes us, a plethora of alternatives described in the literature is available. Selecting the right treatment modality requires familiarity with both the advantages and the disadvantages of each technique being considered. This paper attempts to summarize the attributes and pitfalls of commonly used methods of tattoo removal to assist the surgeon in choosing the most suitable method.

The KTP is a versatile laser system when used for cosmetic surgery.

When combined with a hexascanner or small spot size handpiece, it is equivalent to a continuous-wave yellow dye laser or copper vapor laser in the treatment of vascular lesions. The KTP laser wavelength (532 nm) is near the peak of a hemoglobin absorption curve as is the wavelength of the continuous-wave yellow dye or copper vapor laser.

The KTP laser is also excellent for use in the treatment of Lentigines. The solar lentigines of the hand, arm, and leg are particularly treatable. The hexascanner delivery system makes the KTP laser particularly time-efficient when used to treat the multiple lesions that usually occur with this condition.

The KTP laser can also be combined with special quartz contact probes and used for incisional cosmetic surgery such as blepharoplasty, rhytidectomy, forehead lifting, and new “endolaser” small-incision cosmetic surgery. The contact probes focus and defocus the laser quickly allowing the precision use of the laser deep under a flap with a spot size of 0.1 mm. The coagulative abilities of the laser allow an almost bloodless dissection. The Laserlift™ produces less swelling and bruising for the patient and allows the surgeon to complete complicated surgery with excellent visualization in a bloodless field.

In the past, the treatment of “ice pick” and pox-type scarring has been a perplexing problem. Successful methods of treatment have included excision, punch excision, and punch replacement. These are usually first-stage procedures, however, and often require secondary treatment. This paper describes a method of treating these types of scars with the CO₂ laser which can give excellent results and, in some cases, be an end-stage procedure.

Human activity in microgravity environments place flight crews at risk to injury that may require surgical triage and care. Current protocols developed to handle surgical care in microgravity are derived from earth-based wound care techniques. Fluid and debris containment, spacecraft environmental contamination, and expediency of wound care in microgravity remain as significant obstacles. For space based surgery, lasers may allow procedures for rapid stabilization of emergency or traumatic injuries, surgical fluid control, hemostasis, and reduce contamination of the aircraft environment. The purpose of this paper is to outline the basic concept of laser surgery in an aviation and microgravity environment using carbon dioxide, neodymium–yttrium—aluminum–garnet (Nd:YAG), KTP, and excimer laser incisions within high altitude, military, aviation, and microgravity environments.

“The plans for extending the human presence beyond the limits of Earth into space are: in the 1990s, to establish a permanent presence on the Space Station; in the first decade of the 21st century, to establish an outpost on the lunar surface, and to follow that in the second decade with an expedition to the surface of Mars.”

“The demands and potential hazards of space flight require that crew members maintain health and peak proficiency at all times.”

“Medical support for space station operations will require new philosophies and new technologies.”

“The major considerations in developing such a system … for use in a spacecraft are to provide a sterile environment as well as to prevent contamination of the cabin with blood and other debris while performing the surgery.”

For years, dermatologists have treated vascular and cutaneous lesions with lasers, but only recently have cosmetic surgeons begun to realize the potential applications and advantages of lasers over convential “cold steel.” In the past lasers were inordinately expensive, complicated to maintain, and cumbersome to use. As a result of these problems and a relative lack of experience many physicians believed that lasers were “gimmicks” or “marketing tools.” Today, however, they are less costly, more compact, and easier to maintain. Handheld fiberoptics and contact tips simplify their mode of application and emulate the sensory feedback of a surgical scalpel. This article will attempt to foster a better understanding of lasers by reviewing the currently available systems, their individual functions, and their unique application.

Laser surgery in an outpatient setting requires preparation, investigation, and education. To establish a successful office laser surgery unit, the physician should purchase a safe, functional laser and adjuvant equipment, acquire the necessary skills, set up proper documentation, distribute appropriate patient information brochures, and ensure proper education of staff, patients, and the public.