Selective epidermal cooling during laser dermatologic surgery provides great benefit, allowing the use of higher fluences, permitting treatment of darker skin types, and decreasing procedure discomfort. Three main approaches to epidermal cooling have included contact cooling, cryogen spray cooling (CSC), and air cooling, all of which improve the margin of safety associated with laser procedures by increasing the threshold for epidermal damage.
To be effective, the cooling medium should be placed in direct contact with the skin surface or the intervening layer between the cooling medium and skin will impair heat extraction. We have reviewed several cases of pitted scarring after laser treatment in conjunction with contact cooling, which presumably occurred because direct contact was not maintained between the cooling handpiece and skin surface.
Kelly KM, Svaasand LO, Nelson JS. Optimization of Laser Treatment Safety in Conjunction With Cryogen Spray Cooling. Arch Dermatol. 2003;139(10):1372-1373. doi:10.1001/archderm.139.10.1372