The short-pulsed
Er:YAG laser system is an excellent ablative tool for cutaneous resurfacing. This system is most efficacious for patients with milder cutaneous involvement, including mild photoinduced facial rhytides, mildly atrophic
scars, and textural changes caused by
fibrosis and dermatochalasis. The
Er:YAG laser cannot achieve the same dramatic clinical and histologic improvements produced with the
CO2 laser but does offer some distinct advantages that make it a valuable addition to the
laser surgeon's armamentarium. The
Er:YAG laser, because of its higher affinity for water-containing tissues, effects a much finer level of tissue ablation. Although
erbium laser resurfacing results in decreased postoperative morbidity with a shorter recovery period, it cannot effect the same degree of improvement in photodamaged skin as can the
CO2 laser. Excellent results, however, can be achieved with this
laser, up to 50% or more overall clinical improvement, in patients with milder photodamage and
scarring (Glogau classes I and II). In darker-skinned patients, the
Er:YAG laser is often the preferred treatment modality. Continued research in the field has already led to the development of longer-pulsed
Er:YAG lasers, which offer a compromise between the
CO2 laser and the short-pulsed
Er:YAG lasers in terms of clinical benefits while maintaining the safety profile of the traditional short-pulsed system. In addition, many surgeons now use a combination approach with the CO2 and
Er:YAG lasers in an effort to maximize
collagen contraction in certain areas and limit postoperative morbidity. As more research is conducted within the field of cutaneous resurfacing, newer systems will be developed in the continuing effort to create the ideal
laser system--one which ameliorates the signs of photoaging without risk of major side effects or significant postoperative recovery.