Skin rejuvenation can be accomplished by ablative, nonabrasive, and fractional modes of injury. In the 1990s, ablative laser resurfacing was introduced with the advent of pulsed 10,600 nm carbon dioxide and pulsed 2940 nm erbium-YAG lasers. While ablative
Table 13.1 Summary of Devices in Lasers and Light-Based Therapy
resurfacing produced excellent clinical outcomes, it lost popularity due to prolonged recovery times, persistent erythema, risks of hypopigmentation, and limitation to lighter skin types and facial areas. Even in a relatively fair skin, ablative laser resurfacing often produced an unnatural sheen to the skin, which was most evident at lines of demarcation such as that between the face and neck. For rhytids and laxity, ablative laser resurfacing produced very impressive results. However, ablative laser resurfacing did not address deep meilolabial folds, volume loss in the lips, and central facial volume loss. Moreover, while perioral rhytids showed very impressive results, these rhytids often necessitated adjuvant therapies. Botulinum toxin A to the perioral areas and superficial placed fillers such as collagens and hyalurons addressed the perioral area; medium – to deep-placed fillers such as hyaluronic acids and calcium hydroxyapatite can address the meilolabial folds, and volume enhancing and collagen stimulating fillers such as polylactic acid and calcium hydroxyapatite can address mid – facial volume loss.