COMMENTARY

Predicting Efficacy of Fractional Carbon Dioxide Laser

Treatment for Resurfacing
DAVID M. OZOG, MD, FAAD

David Ozog, MD, FAAD, has indicated no significant interest with commercial supporters.

A blative and nonablative fractional lasers have

become mainstays for cosmetic surgeons,
with multiple studies confirming efficacy for a vari-
ety of conditions.1 Side effects, although less fre-
quent than their fully ablative counterparts, are
reported, including prolonged erythema, ectropion,
and scarring.2
The article by Naouri and colleagues3 is an impor-
tant advancement in our knowledge of in vivo der-
mal modeling after fractional ablative laser
treatment. Maximizing clinical response and mini-
mizing adverse events are the ultimate goal of every
laser surgeon. We have all had patients who pre-
operatively presented as excellent candidates for
ablative treatment only to have suboptimal response
to multiple sessions. Conversely, other patients have
an outstanding response to identical parameters and
end up as an example of success on our lecture slides.
This type of rigorous scientific work adds to our
understanding of the factors that may differentiate
these two types of patient responses.
The objective nature of this work challenges us
to reassess our assumptions regarding clinical results.
The finding that midfacial areas such as forehead,
lip, and chin had a statistically significantly greater
increase in dermal collagen than cheeks and neck
is surprising. In practice, patient satisfaction is
typically higher in the thinner skin of the cheeks,
particularly in the periocular area. This may be a
function of the thicker skin in this central area, re-
quiring a larger increase in collagen to confer a
similar clinical response.
The future for fractional ablative lasers will probably
include real-time adjustment of fluence and pulse
duration from ultrasound feedback of ablation depth
as a ratio to tissue depth. This may be coupled
with feedback on tissue temperature and other
measurements to optimize results. Perhaps an
interface will also have information such as patient
age, retinoid use, and other variables to adjust
parameters accordingly.
References
1. Tierney EP, Kouba DJ, Hanke CW. Review of fractional photo-
thermolysis: treatment indications and efficacy. Dermatol Surg
2009;35:1445–61.
2. Metlitsa AI, Alster TS. Fractionated laser skin resurfacing treat-
ment complications: a review. Dermatol Surg 2010;36:299–306.
3. Naouri M, Atlan M, Perrodeau E, et al. High-resolution ultrasound
imaging to demonstrate and predict efficacy of carbon dioxide
fractional resurfacing laser treatment. Dermatol Surg
2011;37:596–603.
Address correspondence and reprint requests to: David M.
Ozog, MD, FAAD, Director of Cosmetic Dermatology,
Division of Mohs and Dermatological Surgery, Henry Ford
Hospital, 3031 W. Grand Boulevard, Suite 800, Detroit,
Michigan 48202, or e-mail: DOZOG1@hfhs.org

Director of Cosmetic Dermatology, Division of Mohs and Dermatological Surgery, Henry Ford Hospital, Detroit,
Michigan

& 2011 by the American Society for Dermatologic Surgery, Inc.  Published by Wiley Periodicals, Inc. 
ISSN: 1076-0512  Dermatol Surg 2011;37:604  DOI: 10.1111/j.1524-4725.2011.01944.x

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