Michael F. McGuire, M.D., F.A.C.S.

One of the few procedures to actually decline in frequency in several recent surveys of aesthetic surgeons has been CO2 laser resurfacing. Since it is generally agreed that laser resurfacing provides the most precisely controlled and potentially effective method of resurfacing the face, this decline is understandable only in relation to the arduous, lengthy, and appalling period of healing, and the subsequent months of resolution of the dark red erythema that is challenging to camouflage. These problems are certainly less with a "lighter," more superficial resurfacing, using lower energy and/or density settings, but the effectiveness of any type of resurfacing is directly related to the depth of the resurfacing, and the laser is best utilized for patients where a significant effect is indicated.

For deeper resurfacing patients, where 3 - 4 passes are made at settings of 300 millijoules, density 5 - 6, and 50 watts, the typical healing period is approximately 10 - 14 days, and the subsequent erythema typically takes 4 - 6 months to resolve to the point where camouflage make-up is not mandatory. Especially if the healing period requires claustrophobic masks, painful applications of vinegar, and/or witchcraft applications of everything from lard to hemorrhoidal preparations, this is too much for most patients to tolerate, no matter how dramatic the final outcome. It is also too much for most physicians to tolerate, and many stopped using the laser for resurfacing altogether. The subsequent endless months of fading are also a tremendous challenge for even the most patient patients and their doctors, even if the eventual result is dramatic, and produces a skin appearance and improvement that cannot be matched with any other procedure or method.

Rather than declining in my practice, however, CO2 laser resurfacing has been steadily increasing in my practice over the last 5 years since I started using the Oxy-Mist program. This program involves the use of Amino-Plex® delivered with a fine mist of oxygen immediately after the resurfacing is completed, and then daily for four days. A protective balm is applied after the treatment, and the patient then cleanses the treated area 6 - 8 times a day with a Rinseable Azulene Cleanser and re-applies the balm. There is no other care required, no masks, less pain, and the treatments are soothing and very pleasant. Most significantly, all 74 patients have been healed to the point where they could apply camouflage make-up within 7days, even when deep, aggressive resurfacing was performed (3 - 4 passes, using 300 millijoules, density 5 - 6, and 50 watts for the first two passes).

The subsequent erythema in Fitzpatrick 2 - 3 skin types has been dramatically less following the Oxy-Mist program, and many patients have chosen not to wear make-up, since the color of the skin is a pink similar in appearance to a mild sunburn, which is easy to explain socially. This has been especially valuable in the many men whom I have treated with laser resurfacing over the past four years. I would have not treated them previously at all. Those patients who do wear camouflage make-up usually only need to do so for 4 weeks (not months). Fitzpatrick type 1 patients naturally have had more significant erythema that lasted longer, and usually have required make-up for 4 - 6 weeks for camouflage.

This clinical experience confirmed the findings of a clinical study done four years ago when I was first became aware of the Oxy-Mist program. Comparing healing and erythema between patients is impossible to do with any scientific accuracy because of all the variables that exist in wound healing and inflammation between individuals. The clinical study compared the rate of healing and the intensity and resolution of the subsequent erythema in the same patient. A significant CO2 laser resurfacing ( 300 millijoules, density 5, 50 watts, 2 passes in all areas, and up to 4 passes in selected areas of deep rhytids or acne scarring) was performed on half of the volunteer patient's face at one session, and post laser treatment was randomized to either the Oxy-Mist program or one of the other methods used (an occlusive mask, or petroleum jelly). The second side was then resurfaced two weeks later using the same laser settings, and treated with the opposite post-laser treatment method. The time for healing to be complete, the intensity of the subsequent erythema, and the time for resolution of the erythema were then compared between the two sides in each patient. In each case, the Oxy-Mist side healed in 5 - 7 days to the point where camouflage make-up could be applied, whereas on the opposite side, the healing required 9 - 14 days to reach the same point. Pain was less on the Oxy-Mist side, weeping was less, and swelling was much less severe. Subsequent erythema was less on the Oxy-Mist side, and resolved significantly within two weeks after healing was complete. On the opposite side, the erythema took a month or more after healing was complete to reach the same point in all patients.

While the quality of the improvement was not the focus of the study, and is much more difficult to evaluate and compare in an objective way, the patients indicated that they noticed that the texture was better on the side treated with Oxy-Mist - softer, smoother, more refined. In some cases this difference was also visible, with the skin appearing tighter, smoother, and more attractive.

The Oxy-Mist treatments can be given in the office or at the patient's home, and newer devices allow the patients or family to administer the treatments themselves. The treatments are soothing, and the patients enjoy them. Each treatment takes about fifteen minutes to complete after washing the face with the special azulene cleanser that is part of the program.

While certainly still a challenge, the healing period is much shorter, less painful, and less miserable in general with the Oxy-Mist program. Using this method has dramatically increased the number of patients willing to undergo CO2 resurfacing, because of the ability to return to work and social activities sooner, decreased pain and misery, and a shorter time to have to wear camouflage cosmetics. Many of the patients haven't worn camouflage cosmetics at all, since the erythema is similar in appearance to "I got too much sun this weekend," and is a healthy look, especially with the dramatic improvement in the quality and texture of the skin.

Significant laser resurfacing does not need to be the agony it formerly was, both for the patient and the physician. With the Oxy-Mist treatment, the benefits of CO2 resurfacing are finally worth the effort involved.