The Clinical Applications of the Ultra Pulsed CO2 Laser
The precision of the continuous wave CO2 Laser as a surgical knife was well established by the mid 80’s. The search was on for the safe application of the CO2 Laser as an ablative tool for use in facial rejuvenation.
A plethora of papers were published from 1991 to 1996 on the topic.
The landmark paper was from Stuzin and Baker et al from Miami: “The Histological Effects of the High-Energy Pulsed CO2 Laser on Photoaged Facial Skin” (Plastic Reconstruction Surgery 99:2036, - 1997).
Experts in the care of photoaged skin, they set out to convince themselves of the efficacy of the Ultra-Pulsed CO2 Laser by treating small areas of facial skin and simultaneous biopsy of an adjacent area and a further biopsy of the treated area at the time of a Facelift about 2 weeks to 6 months after the CO2 Laser treatment.
The histopathological outcomes were outstanding, with significant epidermal and dermal improvement.
All specimens showed normal epithelical regeneration and the elimination of epidermal atopia and atrophy.
Melanocytic hypertrophy and hyperplasia were corrected, substantial neo-collagen formation in the superficial and mid dermis, a proliferation of elastin fibres and a diminution of glycosaminoglycans.
The Clinical Outcome (aka “the Proof of the Pudding”)
The above histopathological events are well demonstrated in a patient shown before treatment, 15 months after treatment (Full Face Resurfacing and Upper Blepharoplasty) and 7 years after the treatment.
Non-Surgical Facial Rejuvenation – Carbon Dioxide Laser Resurfacing
Long term sun exposure, both from work and leisure, is a hazard of life in Australia. Solar (sun) damage affects both the epidermis (the very thin superficial layer) and the dermis (the thicker, deeper layer) of skin.
Solar damage to the epidermis results in scaly, dry skin, with red and brown blotches all over.
The base of the epidermis is called the basement membrane and is made up of mainly basal cells which are the template cells for formation of new skin cells. Though these cells are replaced every 30 days, the template cells, once damaged, can only produce new cells with the existing damage in them.
30 days, the template cells, once damaged, can only produce new cells with the existing damage in them.
Solar damage to the dermis results in thinning of this layer, including the collagen and elastin in the dermis, which give form and tone to the skin. Solar damage to facial skin is compounded by aging changes, causing facial skin to be droopy, thin and lined.
The reversal of solar damage and aging of facial skin
This requires repair or replacement of the basal cells of the epidermal basement membrane to rejuvenate the epidermis, and production of new collagen and elastin in the dermis to restore the tone of the dermis.
- Repair (healing) is the easier of the two and lasers and intense pulsed light (which has a similar action to Laser) have the ability to convert light into heat, which has a healing effect on the damaged template cells.
- Replacement (regeneration) of the epidermis and new collagen formation in the dermis is obviously the better outcome and the carbon dioxide laser is the laser of choice for this.
The Carbon Dioxide (CO2) Laser – how does it work its magic?
“Scarless Surgery” has been the holy grail in the use of lasers. For many years, while various lasers had been developed, there were many problems caused by the heat generated, resulting in burn injuries.
The carbon dioxide laser causes its desirable effects by “PhotoThermolysis” (photo = light /
thermo = heat / lysis = destruction), ie, the CO2 produces light, which becomes heat, which then destroys the target cells (the basal cell of the epidermis), which is then replaced from the cells stored in the dermis (please see attached note at the end).
The CO2 laser also stimulates the dermis to produce new collagen and elastin, thus improving both the epidermis and dermis – the effects are dramatic when seen.
Technical Note For Those Who Need To Know!
1. The epidermis is a very thin layer draped over the dermis and gains traction and adhesion to the dermis with spike-like projections into the dermis, and it is these basal cells that migrate to the surface after epidermal damage caused by the CO2 laser.
2. The carbon dioxide laser produces its effect by damaging spots of epidermis and leaving normal epidermis between these damaged or burnt spots. Usually heat spreads like ripples in a pool and the spots of heat coalesce and cause burn injury.
The beauty of the modern carbon dioxide laser is the ultrashort dwell time (laser – skin contact time), and the rapid thermal relaxation time (very short heat diffusion time), which prevent the ripple effect to prevent burn injuries.
3. A further improvement is the development of software, permitting fractional CO2 laser treatment. In fractional treatment, less skin is damaged and the healing is faster. The treatment is therefore appropriate for younger people with less damaged skin.
4. The Carbon Dioxide Laser was invented in 1964 by Dr Kumar Patel at the Bell Laboratory in New Jersey, USA. This was the first laser produced from a single gas source. The CO2 laser, with its long wavelength of 10,600 nm had great affinity for water, which gave it the ability to destroy cells by “PhotoThermolysis”, ie light converting to heat, which then destroyed the cell.
It took a while before there were medical indications for the CO2 laser and initially, it was used as a “knife”, with the added ability of coagulating small blood vessels at the same time as cutting tissue.
This is a high precision knife and works best with delicate tissue such as in the periorbital area.
Dr Isaac Kaplan, a Plastic Surgeon, deserves a lot of credit for the early surgical applications of the CO2 laser. However, the great advances came with the development of pulsed CO2 lasers. Heat diffusion was a major problem when the CO2 laser was used in its original Continuous Waveform, with resultant difficulty in control of heat and leading to unpredictable results.
The Pulsed CO2 Laser enabled the delivery of energy in a period of time faster than the Thermal Relaxation Time of the tissue, thus preventing heat diffusion and gave a very controlled and predictable outcome.
The initial truly pulsed laser (instead of the earlier “chopped” continuous wave) was the SuperPulsed Waveform which was faster and more powerful than continuous waveforms. Further improvement came in the form of the UltraPulsed CO2 laser by Coherent (now Lumenis) which increased power but with more precision and hence minimizing thermal injury.
Carbon Dioxide in the Treatment of Skin Cancer
Certain types of cancers can be treated very well with a CO2 Laser. As well as removing the cancer, the laser also has the added advantage of making the skin look younger.
Why Choose Us?
As an internationally trained Specialist Plastic Surgeon, Dr. Chandran Arianayagam is well-positioned to perform your mummy makeover. He has performed all of the included procedures from his clinic in Coffs Harbour since January, 1995 and has operated and observed in Australia, India, Malaysia, the United Kingdom and the United States.
With a list of qualifications including a Bachelor of Surgery and a Bachelor of Medicine, Dr. Chandran Arianayagam is also a Fellow of the Royal College of Surgeons of Edinburgh and has been granted Specialist status in Plastic Surgery in the Commonwealth of Australia. He is also a Corresponding Member of the American Society of Plastic Surgeons and the American Society for Aesthetic Plastic Surgery.
Dr. Arianayagam is an expert who places great importance on the complete comfort of all his patients. This includes at least two consultations prior to treatment, and a team at PCLS Coffs Harbour who offer outstanding levels of in-patient and post-operative care. Every procedure, from the initial steps through to a full recovery is given high-levels of follow up care.
Once you have made the decision to go ahead with the surgery and have chosen Dr. Arianayagam as your surgeon, you will also be offered the opportunity to speak to one of our patients who has the same procedure.
Frequently Asked Questions
A Carbon Dioxide or CO2 Laser is a “fractionated” laser, which means a single wavelength of light frequency is used, providing greater precision than is possible with a surgical scalpel. Lasers are able to remove certain cancers with minimal scarring, which is obviously welcome particularly in sensitive areas like the lips, nose and face.
The CO2 laser has a very high cure rate for the following cancers:
- Superficial Basal Cell Carcinomas (BCCs)
- Squamous Cell Carcinomas (SCC) in situ
- Bowen’s Disease
- Leukoplakia (sun damage to the mucosa of the lips)
- Pre-cancerous lesions
All of these conditions tend to be limited to the upper layer of the skin, known as the epidermis, and are very responsive to laser treatment.
Laser treatment is not appropriate for invasive (deeper) BCCs, SCCs and all Melanomas.
All surgical procedures are accompanied with risks such as post-operative bleeding, allergic reactions, infection, and in mild cases, deep vein thrombosis, and haemotoma. To understand the risks associated with the exact procedures relevant to your mummy makeover, book a consultation with our team who will give you all the relevant information.
- Rockvale Cardiac Centre, 18 Rockvale Road, Armidale, NSW
- Duke Street Medical Centre, 9 Duke Street, Grafton, NSW
- Barton Lane Medical Practice, 121 Johnson Street, Tamworth, NSW
- 3 Highfields Circuit, Port Macquarie, NSW 2444
There are several locations available, all of which offer a high-level of patient care and a skilled and knowledgeable team. The PCLS Coffs Harbour staff are with you from beginning to end for your procedure and recovery process.
The PCLS team will coordinate a care plan, and stay in touch throughout your recovery process via the following PCLS locations: