by Heather Rock Woods

Swept across the face like a paintbrush across a canvas, a new laser tool removes damaged and wrinkled skin, accomplishing full-face peels faster than other laser devices while avoiding the complications and imprecision of more traditional face-peel methods, a Stanford facial plastic surgeon reports.

The new tool is a specially designed handpiece that emits a wide-diameter laser beam. By sweeping this beam across the whole face, the device removes skin 33 percent faster than other laser handpieces, which resurface the face one section at a time as if filling in a paint-by-number pattern, said Dr. R. James Koch, an assistant professor of surgery (facial plastic and reconstructive) at Stanford University School of Medicine.

In a six-month study of 54 patients, Koch found that a carbon dioxide laser with the new hand attachment gave precise control while rapidly resurfacing the skin. The pen-like handpiece, attached to the laser source by a flexible fiber, can repair sun-damaged skin, remove small growths and diminish wrinkles, he said.

"The results are better than with the traditional chemical peels and dermabrasion [sanding] because the doctor can accurately control the depth of skin removal," Koch said.

While destroying damaged skin, the laser also tightens underlying collagen, producing a "mini-face lift" effect, Koch reports. Collagen is the fibrous protein that gives skin its elasticity.

Koch's study is the first to test the new device. His preliminary data contributed to the Food and Drug Administration's approval of the handpiece last fall, Koch said. The device, called the NovaScan carbon dioxide laser handpiece, is made by Luxar Corp., a laser company in Bothell, Wash.

Koch will present his results Sunday, April 6, at the 17th annual meeting of the American Society for Laser Medicine and Surgery, held in Phoenix, Ariz. The findings will also be published later this year in the journal Lasers in Surgery and Medicine, he said.

"Laser treatment produces dramatic results," Koch said. When new skin grows back, "people really do have a firmer, new layer. We've observed that people sometimes even get acne again, which normally occurs in young people's skin."

During the study, he used the device to perform 36 full-face skin peels and 20 localized treatments for facial growths or wrinkles. Two of the 54 patients had both local treatments and full-face peels.

Before and six months after the procedures, Koch and an assistant ranked the severity of each person's skin wrinkles on a scale of 1 to 6. Most of the patients -- about 80 percent -- improved by two levels, he said.

"The laser treatments worked best for sun-damaged skin and upper-lip wrinkles. There was, however, surprising improvement in the eyebrow frown lines and the crow's feet, or squint lines," he said.

When surveyed with questionnaires six months after the procedure, 91 percent of the patients said they were satisfied and 9 percent said they were not, Koch reports.

Face peels -- using various methods including chemical peels, dermabrasion and laser resurfacing -- are intended to reduce or eliminate wrinkles, acne damage, lesions, loose skin and chronically sun-damaged skin, which can be leathery with dark or yellowish patches and pre-cancerous growths.

Chemical peels and dermabrasion can be difficult to deliver consistently, said Koch, who has experience using each of these techniques.

To administer a chemical peel, physicians select one of several kinds of caustic chemicals. Each kind removes skin to a different, although approximate, depth. "Controlling the depth of skin peeling with chemical applications is difficult," Koch said.

Dermabrasion, or skin sanding, is like using heavy-duty sandpaper to rub away the rough upper layers on a piece of wood, he said. "Technically it's very difficult and very bloody," Koch said.

"With the laser, there's no bleeding. The control of the laser really beats the two traditional ways of peeling the skin," he said.

Carbon dioxide lasers -- so called because they use excited gaseous carbon dioxide molecules to generate the laser beam -- have been used to treat skin for about four years. Facial plastic surgeons use "superpulsed" carbon dioxide lasers, which send out short bursts of energy (heat), allowing the skin to cool momentarily between pulses, Koch said. Carbon dioxide lasers operate at a wavelength that targets the skin's main ingredient: water molecules.

None of the patients in Koch's study experienced skin burns or other complications from the new device, he said. However, he stresses that any surgeon using this technique must be skilled both with lasers and with skin anatomy. "The person needs to have enough experience to know which layer of the skin the laser has reached," he said.

Scarring is one of several problems that can result from damage to deeper skin layers, Koch noted.

In his study, patients who had the full-face laser treatment -- which took 27 minutes on average -- did experience some discomfort during the procedure. Ninety-four percent reported mild discomfort, usually a slight burning sensation in certain areas. The remaining 6 percent reported pain, but none found the pain severe enough to ask him to halt the procedure, Koch said.

Patients stayed home for an average of one week to recover from the effects of the treatment, which resemble those of a bad sunburn, he said. The patients took pain medication for several days after the procedure.

Koch is now testing a new facial bandaging that may eliminate post-operative discomfort, even without pain medication. "The whole process is much easier on the patient, and the skin heals faster with these dressings," he said.

After a face peel, patients must avoid direct exposure to sunlight for at least three months because the skin is especially sensitive and can react by producing too much pigment. "I tell doctors in some areas of the country that they may want to do this procedure only in the winter, because otherwise their patients may be tempted to go out into the sun," Koch said.

Study participants paid $250 for a full facial peel with the new device. Normally, the procedure would cost $2,500, he said. Koch has no financial interest in Luxar Corporation, which makes the NovaScan handpiece. Koch funded the study with participants' fees and his own time, while Luxar provided the handpiece. SR