The study is "well-performed," James M. Stuzin, MD, a plastic surgeon in private practice in Miami, Fla., writes in an accompanying essay. However, his treatment-of-choice for regional resurfacing around the mouth is another technology -- long-pulsed erbium laser. Healing occurs within five to seven days and redness disappears in four to six weeks, he says.
"The long-pulsed erbium laser is not quite as deep or efficacious as the CO2 laser;" writes Stuzin, who also is a clinical assistant professor of plastic surgery at the University of Miami School of Medicine. "However, we feel that the rapid healing and minimal [pigment lightening] associated with this treatment outweigh the slightly increased tendency toward residual [wrinkles] after treatment. ... We simply return them to the operating room and retreat only the wrinkles that remain and not resurface the entire area a second time.
"Although we agree with [Kitzmiller's findings], our strong feeling remains that when performing regional resurfacing, less is often more," he says.
"Excellent study," says Seth A. Yellin, MD, chief of facial plastic surgery at Emory Health Care and director of the Emory Facial Center in Atlanta. "As the authors point out, with a properly skilled surgeon, either technique works well. I personally think CO2 lasers are the workhorse of resurfacing. ... The CO2 laser generates some heat, which tightens the skin ... you want that in an aging face."
Collagen injections are an important adjunct to any resurfacing procedure, Yellin says. "All of these procedures at best give a 50% improvement in wrinkles at six months, and that's not good enough. For better results, I inject Dermalogen, which is human collagen. Around the lips, it lasts about four months. It may be used in addition to or in [place] of laser ... often as a combination six months after laser, if they still have one or two deep lines."
Erbium lasers are an efficient tool for "planing" skin, but have their limitations, Yellin tells WebMD. "The erbium energy generates so much less heat [than CO2 lasers] and it literally vaporizes skin with much less heat damage to surrounding tissue. However, when you're looking at not only treating wrinkles but want skin tightening, erbium is not your tool."