The Role of Carbon Dioxide (Co2) Laser in Skin Resurfacing and Skin Cancer Prevention
Carbon dioxide (CO2) laser treatment is a significant method for addressing photoaging, mild scarring, and removing individual skin lesions. Dating back to the 1960s, CO2 lasers were primarily used for tissue cutting and destruction, employing a continuous wave mode that ablates tissue to a depth of 400-500 μM. This application spanned various clinical uses, from treating cervical intraepithelial neoplasia to upper eyelid blepharoplasty. Over time, CO2 laser technology progressed, leading to the development of high-energy pulsed CO2 lasers in the 1990s. These newer lasers ablate tissue at shallower depths, between 20 and 100 μM, while minimizing thermal damage to deeper tissue layers.
Advancements continued with the emergence of fractional CO2 laser systems in 2004. Fractional treatment involves dividing the laser beam into numerous microbeams, creating columns of ablation interspersed with normal, undamaged tissue. This approach potentially offers a better side effect profile, particularly in avoiding dyspigmentation in patients with darker skin.
Laser resurfacing, whether total or fractional, entails using energy at a specific wavelength to ablate superficial skin layers. CO2 lasers emit energy at a wavelength of 10,600 nm, primarily absorbed by intracellular water. This absorption ablates superficial skin layers, promoting subsequent re-epithelialization from residual skin appendages and adnexal structures in the dermis, such as sweat glands and hair follicles. The thermal injury below the ablation zone induces collagen contraction and remodeling in the dermis, leading to skin tightening. Compared to other lasers, CO2 lasers cause less bleeding due to greater coagulation of small blood vessels in the dermis.
CO2 lasers find application in various cutaneous conditions, including photoaging, scarring reduction, and the treatment and prevention of premalignant lesions and keratinocyte skin cancers. In cosmetic procedures, CO2 lasers excel in treating photoaging and rhytids, offering precise control over treatment parameters. They are also effective in reducing acne scarring by inducing thermal damage and stimulating collagen production.
For surgical scars, CO2 lasers produce less bleeding and crusting compared to dermabrasion. Moreover, they are advantageous for treating keratinocytic skin cancers, particularly in patients on anticoagulation medication, due to their coagulation-inducing properties. However, a drawback is the inability to confirm complete excision of malignant lesions histologically due to ablation artifacts.
The mechanism of CO2 laser’s protective effect is not completely understood; however, it is suspected that the laser treatment reduces the overall burden of photo-damaged keratinocytes and may promote a wound healing response, which gives healthy skin cells a selective advantage.
In a study conducted by a group of Dermatologists at Mass General Dermatology Laser & Cosmetic Center, 95 patients were enrolled. 43 patients received fractional ablative laser therapy, and 52 served as controls and did not receive laser treatment. The rate of subsequent facial keratinocyte carcinoma development over an average follow-up of more than 6 years was 20.9% in the fractional ablative laser-treated patients and 40.4% in controls, indicating that patients treated with fractional ablative laser had about half the risk. When controlling for age, gender, and skin type, control patients were 2.65-times more likely to develop a new facial keratinocyte carcinoma than laser-treated patients. Also, among patients who developed facial keratinocyte carcinoma, the time to development was significantly longer in patients treated with fractional ablative laser compared with untreated patients. These findings suggest that fractional ablative laser treatment may have an important role in protecting against subsequent keratinocyte carcinomas.
Based on this research, it is encouraged for patients to have CO2 laser treatments to help prevent skin cancer if they are at risk or notice abnormalities. Additionally, it’s important to take proper precautions to reduce the risk of skin cancer, including:
- Wearing sunscreen daily
- Wearing hats and protective clothing in the sun
- Performing self-skin examinations
Safety and Side Effects
CO2 lasers, in use since the early 1960s, are considered safe and effective. However, like most procedures, CO2 laser resurfacing does involve some risk. Having the treatment performed by a reputable and experienced laser-certified professional can significantly minimize your risk of complications.
Common side effects of CO2 laser resurfacing include:
- Some skin discoloration and swelling
- Skin that feels raw, similar to a mild sunburn
- Itching
- Dryness and peeling
- Sun sensitivity
Deeper, more extensive resurfacing can leave your skin looking and feeling like it might after severe sunburn. Your skin might also ooze and blister.
Potential Complications
CO2 laser resurfacing can occasionally lead to:
- Infection
- Acne flares
- Cold sore reactivation if you have a history of cold sores
- Scarring
- Milia, or very small skin bumps
- Hyperpigmentation
- Skin burns and injuries if the laser is not used correctly
Again, choosing a qualified laser professional and following their pre-care and post-care instructions can significantly reduce your risk of any side effects or complications.
In summary, Carbon dioxide lasers play a pivotal role in skin resurfacing, offering precise control, effective treatment of various conditions, and potential advantages in skin cancer management.
To learn more about how CO2 lasers can benefit your skin resurfacing and skin cancer prevention needs, reach out to our experienced physicians at Aesthetics and Medical Lasers of Colorado. You can contact us at 720-818-0533 or visit our website at aestheticsandmedicallasers.com. Conveniently situated in Longmont and Ft. Collins, we proudly serve the communities of Boulder, Lafayette, Erie, Longmont, Berthoud, Loveland, and Greeley. Our team is dedicated to providing personalized care and cutting-edge treatments to help you achieve your skincare goals.
