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April 1999

Why Does Carbon Dioxide Resurfacing Work?A Review

Author Affiliations

From the Department of Dermatology, Naval Medical Center San Diego, San Diego, Calif (Drs Ross and McKinlay); and Wellman Laboratories of Photomedicine, Massachusetts General Hospital, Boston (Dr Anderson).

Arch Dermatol. 1999;135(4):444-454. doi:10.1001/archderm.135.4.444

Despite the unquestionable efficacy of carbon dioxide laser skin resurfacing, mechanisms for cosmetic enhancement remain poorly characterized. Histological studies have provided some insight into the cascade of events from initial laser impact to final skin rejuvenation. However, there are few comprehensive studies of gross and microscopic wound healing. Additionally, the literature is fragmented; excellent individual articles appear in journals from widely disparate disciplines. For example, some reports relevant to laser skin resurfacing are "sequestered" in the engineering literature. This article is intended to update the physician on laser skin resurfacing based on the broadest review of the current literature. It proceeds from a discussion of initial laser-tissue interactions, such as collagen denaturation, to examination of long-term biological sequlae. At some cost to scientific rigor, mathematical models describing laser-tissue interactions are not presented.

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