Cosmetic Laser Resurfacing

It is an honor to be able to present an issue in Seminars in Plastic Surgery with a focus on laser resurfacing. Once thought to be in decline after its popularity in the mid to late 1990s, using a laser to resurface the skin has evolved greatly with advances in technology. With the new millennium, laser-resurfacing demand has increased due in great part to new machines that allow laser surgeons to offer less downtime and better safety. Currently, a wide variety of technologies allow for ablative and nonablative laser resurfacing that is often fractionated to speed up the healing process. It is my hope that this issue will allow the reader to better understand the latest technology and important issues facing a modern laser surgeon.

We start with a comprehensive review of available laser resurfacing machines. A physician who decides to purchase a new laser is met with a confusing number of options. Preissig and Hamilton have done an excellent job of combing the worldwide offerings by laser manufacturers and organizing the available technologies into manageable categories. Furthermore, they have explained the differences of these devices so the reader may better understand what these technologies offer.

Unfortunately, laser resurfacing can be painful. One aspect of treatment that can make the difference between a happy and unhappy patient is the comfort level of the procedure. The bewildering array of laser choices discussed by Preissig and Hamilton is matched by the numerous topical anesthetics, cooling devices, and systemic anesthetics. Fortunately, Sergio Gaitan has authored a detailed review of the available modalities to alleviate procedural discomfort.

Whereas the first two articles are fairly comprehensive reviews over the numerous laser and anesthetic choices, the next article is much more focused. I asked Dr. William M. Ramsdell to provide an in-depth description of the most recent advance: fractionated CO₂ resurfacing. He did not disappoint. This article offers specifics on critical aspects of the procedure such as patient selection, preprocedure care, and postprocedure care. My favorite part of the article, however, is the treatment section. So rarely is a cosmetic procedure described in such detail. Most journal articles are full of vague generalizations. Not here!

Across the country, physicians have learned important and sometimes subtle techniques to enhance their laser resurfacing practice. Everybody loves useful information and Sonia Shah and Dr. Murad Alam have submitted an article with a series of laser pearls. As such, it is a fascinating read that teaches the little things often overlooked in more general articles.

Lastly, having a complication is never a desired outcome, but early detection and appropriate intervention is critical. Dr. William M. Ramsdell has kindly submitted a second article in this journal entitled, Fractional CO₂ Laser Resurfacing Complications. Often laser articles focus on the positive aspects of laser surgery and as a result, there is a dearth of educational investment in complication management. Ironically, mastering the art of detecting and treating complications helps to separate a novice from a master laser surgeon. Though last in terms of journal layout, this is one of the most important offerings in this edition.

I sincerely hope that you enjoy this special edition of Seminars in Plastic Surgery with a focus on laser resurfacing. The efforts of our authors were second to none; please join me in thanking them for their efforts.