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May 1987

Carbon Dioxide Lasers: A Broader Perspective

Arch Dermatol. 1987;123(5):566-567. doi:10.1001/archderm.1987.01660290030008

To the Editor.—  Since I am responsible for initiating the use of selectively absorbed laser pulses for specific photocoagulation of dermal vessels1 and have been primarily involved in the development of pulsed dye lasers for port-wine stain (PWS) therapy, I read the opposing adjacent articles by van Gemert et al2 and Ratz and Bailin3 with great interest. The cons and pros, respectively, of using carbon dioxide (CO2) lasers for treatment of PWS were presented with appropriate coherence and focus. Unfortunately, each article seemed to suffer from a monochromaticity of opinion. With due respect for both the science and art of cosmetic laser surgery, I hope to paint a broader perspective.The central debate is whether a treatment modality causing nonselective thermal destruction of the epidermis and upper dermis should continue to be used when an efficacious treatment is available that produces highly selective destruction of dermal vessels, while sparing the epidermis. Van Gemert et al2 picked the CO2 laser as the clearest example of a nonselective treatment, but there is equally little histologie selectivity with conventional argon-ion laser treatments. Thus, the majority of currently

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