With the passage of time, skin ages and accumulates photodamage. This results in loss of elasticity, changes in pigmentation, and the development of scarring from trauma, acne, and other insults. Laser skin resurfacing has become a gold standard option for the rejuvenation of facial skin’s texture, tone, and elasticity. For many years, carbon dioxide (CO2) lasers (wavelength 10,600 nm) were the only lasers available for laser skin rejuvenation; nowadays, there are many more options, including the solid-state erbium-doped yttrium aluminum garnet Er:YAG (2,940 nm), diode (810 and 940 nm), and erbium:glass lasers (1,540 and 1,550 nm).
Er:YAG lasers were first FDA approved in 1996 for cutaneous resurfacing, and a comparative trial with CO2 lasers demonstrated that Er:YAG had equal efficacy with a trend towards more rapid recovery. Initially, short-pulse Er:YAG lasers were approved, with pulse lengths of 250-350 μs; however, variable and longer-pulse Er:YAG lasers with pulse widths of 500 μs to 10 ms were subsequently approved in 1999. The long-pulse and variable-pulse lasers introduced in 1999 were designed to provide enhanced coagulation, reducing bleeding compared to short-pulse Er:YAG treatments.
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