(Archive Facial Plastic Surgery 1999;1:112-116)  Arthur L. Millman, MD; Geva E. Mannor, MD, MPH  Objective: To compare clinical and histological results of 2 different protocols for cosmetic laser skin resurfacing. Design Masked comparison of 2 cohort groups. Patients Forty-eight carefully selected patients who met specific inclusion and exclusion criteria for cosmetic laser skin resurfacing. Age, sex, and skin type were matched in both groups.

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Interventions Twenty-five patients had undergone cosmetic skin resurfacing with 2 impacts of a carbon dioxide laser. Another 23 patients underwent a different protocol involving 2 initial impacts of an erbium:YAG laser to ablate the epidermis followed by a single impact with a carbon dioxide laser. Skin punch biopsy specimens were obtained 1 to 2 weeks after the procedure in both groups of patients.

Main Outcome Measures Time to reepithelialization, duration of erythema, and patient acceptance were compared among 2 patient groups via Student t test. Patients were examined daily until reepithelialization, then weekly for 6 weeks, and then monthly for 6 months.

Results Mean skin reepithelialization time was 7 days (range, 4-9 days) in the combined laser group vs 12 days (range, 9-15 days) in the carbon dioxide laser–only group (P=.04). Mean duration of erythema was 2.5 weeks (range, 1.5-3 weeks) in the combined laser group vs 7 weeks (range, 5-13 weeks) in the carbon dioxide laser–only group (P=.02). All 23 patients (100%) in the combined group but only 15 (60%) of 25 in the carbon dioxide laser–only group were willing to repeat their cosmetic laser surgery (P=.04). There were greater and deeper coagulative changes in the dermis of patients in the carbon dioxide laser–only group compared with those of patients in the combined laser group.

Conclusions The combined laser protocol showed less significant clinical and histological morbidity than the carbon dioxide laser–only protocol. Patients preferred the combined protocol. Combining these 2 lasers is a safe and patient-friendly alternative to using only the carbon dioxide laser.