The carbon dioxide laser may be used in a focused mode for cutting or a defocussed mode for vaporizing the skin. In the cutting mode it is used in delicate surgical techniques such as eyelid correction. The advantage is that as the laser cuts it seals off the blood vessels and nerve endings which decreases the time for healing and the amount of post operative pain.
In the vaporizing mode the carbon dioxide (CO) laser is used to remove abnormal tissue such as warts and scars and more recently to resurface the skin to stimulate rejuvenation.
The wavelength of the CO, laser heats the cells of the unwanted skin or abnormal tissue to the point
where it is vaporized away in a plume of tissue particles and steam. If the heat is excessive there is
a risk of scarring or Pigment changes to the adjacent normal skin tissue.
When the CO, laser was first introduced as a surgical tool the light was delivered continuously to the skin. This was only interrupted when the surgeon released the foot pedal to close the shutter and prevent the escape of the laser light beam. The control over the dissipation of heat was
poor and the risk of damage was high. It took a highly skilled surgeon to judge what power
and time duration of laser lightwould remove abnormal tissue without damaging the surrounding
tissue. For this reason the use of the CO, laser as a surgical tool was relatively uncommon for a number of years and when it was used it was reserved for the removal or alteration of abnormal tissue,
such as warts.
Developments in C02 laser technology have focused on controlling the heat produced by the laser light so that only targeted tissue is affected. The UltraPulse and TruTouch C02 lasers have accomplished this by computerized delivery of extremely short repetitive pulses. The time in between each pulse allows the skin to cool so that the heat does not remain in the tissue long enough to cause more damage than is intended. Other lasers, such as the SiIk, Touch CO, laser, have achieved the necessary control over heat dissipation by moving the continuous wave of laser light around very rapidly so it does not dwell in any one area for very long. This is also controlled by computer.
Both types of technology seem to be effective in controlling heat transfer. The deciding factor in the outcome of CO, laser surgery and especially resurfacing is the skill of the surgeon. Despite testimonials to the contrary, computerized controlled delivery of the laser light cannot do all the work. The laser is the brush and the surgeon is the artist. If a surgeon simply moves the laser light over the surface of the skin obliterating everything in its path then the healing process will be slow and the results less than satisfactory.
