The difference with the plasma resurfacer, Dr. Fincher said, is that the lower fluences preserve the epidermis until reepithelialization is complete. "It does not vaporize the epidermis, which accelerates wound healing. About 4 days later, you have reepithelialization and necrotic keratinocytes moving up and beginning to slough." By day 10, histology shows a fully reformed stratified epidermis and increased number of active fibroblasts generating collagen, he said.
These devices have received Food and Drug Administration approval for use in single-pass, low-energy repeat treatments and single-pass, high-energy treatment of facial rhytids, and for the treatment of superficial skin lesions.
Dr. Fincher has used a plasma resurfacer for about 2 years, with no incidence of scarring or hypopigmentation. He has seen some transient hyperpigmentation, however, and two patients have had prolonged (4–6 weeks) erythema.
"We tell people that, pretty reliably, they will be back to normal in 10 days," he said.
A full-face treatment can be done in about 15 minutes. Patients who are being treated for dyschromia or photodamage will probably require two or three treatments about 1 month apart. These low-energy treatments are usually performed with a topical anesthetic, although nerve blocks may be necessary for some patients. The high-energy treatments necessary for treating acne scars usually require local anesthetic or IV sedation.
"We still have a CO2 laser and use it occasionally, but this has replaced it as our workhorse resurfacing device," Dr. Fincher said.