I am sure many of you have heard of CO2 lasers for treating wrinkles of the face. The traditional CO2 laser causes thermal (heat) damage to the entire area of skin treated. This is a controlled damage and the depth of thermal injury is controlled by the machine and the operator. In effect, a very superficial burn results and after healing newer, more refined skin is the result. When I was doing my burn rotation during residency, I had two patients who sustained flash burns to their face, resulting in superficial burn to the face. After healing, their skin looked much smoother than before. Of course, I do not recommend this method of treatment!
The downside to traditional CO2 laser resurfacing is the longer recovery period (the burn may take 7-10 days to completely heal), slightly higher risk of infection and more importantly, the color of the lasered skin is usually lighter than the non-treated area. In some patients with darker skin, there is also a higher risk of hypo or hyper pigmentation of the skin and or prolonged redness of the skin, which may take months to resolve. However, if the patient has deep, static, facial lines and significant sun damage to the skin, the traditional CO2 laser may be the best option for this patient.
For others who have fine wrinkles, mild hyper pigmentation and or mild acne/acne scars, my choice is the Mixto Laser. The Mixto laser is a CO2 laser and, if the settings are changed, it can act as a traditional CO2 laser. However, in most cases, the laser is used as a Fraxel type laser. This means the laser causes thermal damage to some parts of the skin but leaves small areas of skin intact. This results in even more superficial heat damage than the traditional CO2 laser. The advantage of this method of laser resurfacing is less down-time (typically 4-5 days of swelling and crusting on the skin), and less chance of infection, hypo or hyper pigmentation. Also, the Mixto laser procedure can be performed in the office with topical numbing cream on the skin, whereas the traditional CO2 laser requires either intravenous sedation or general anesthesia. On the other hand, since the level of damage is less, the result is not as dramatic as the traditional CO2 laser. This means patient selection and patient expectation is important.
I recommend this type of laser to patients who have fine wrinkles on the face, mild to moderate sun damage and spotty brown spots on the face. It is also helpful for patients who have scattered actinic keratosis on the face (these are rough spots on the face due to sun damage). The Mixto laser can also be used on the neck, chest, and hands. The indication for treatment is the same in these areas.
The Mixto laser is not a magic bullet. It will cause some shrinkage of the skin, but do not expect a face lift!
The good news is, in almost all patients only one treatment is needed to see improvement, compared to other lasers which may require 3-5 sessions. The patient, of course, can get more than one treatment if required and a maintenance program every 1-3 years may be used, depending on the patient skin type and life style.
Like every thing else, the Mixto laser is only the beginning. The patient must avoid sun (or use sun block with UVA and UVB protection) religiously, avoid tanning beds, smoking, etc. in order to maximize the benefit and longetivity of the treatment.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon with over 10 years of experience in both cosmetic and reconstructive surgery. His office is located in Orange County, California. To schedule a consultation, please call (714) 834-0101.
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