Nonablative Skin Resurfacing

The undesired prolonged recovery and risks of ablative laser resurfacing led to the devel­opment of nonablative laser resurfacing with a myriad of lasers in the infra-red region. While safety was generally accomplished with these modes, the clinical results were, at best, modest. The premise of nonablative devices is “inside-out” resurfacing, where the epidermis remains intact and collagen remodeling occurs from selective dermal heating of water. While histologic and ultrastructural images of this technique were impressive, the modest clinicalimprovement and the variability in results led to the lack of continuation of this modality for clinical use. Simultaneously, the late 1990s witnessed the development of photorejuvenation, whereby lasers and light sources were utilized to treat facial canvas dyschromias and vascular anomalies. The terms “photofacial” and “photorejuvenation” were coined to explicate this process, which involved the selective photothermolysis of ecstatic facial telangiectasias and benign pigmented lesions such as lentigines. The nonse­lective thermal transfer also produced some dermal collagen remodeling. The clinical results were quite impressive for pigments and vessels, but not very impressive for true rhytids. Both infra-red laser nonablative laser resurfacing and visible laser and light source photorejuvenation absolutely require the use of botulinum toxin A for dynamic rhytids, and dermal fillers for static rhytids and volume replacement.