Skin resurfacing with carbon dioxide (CO2) lasers is a commonly used method for skin rejuvenation. With these lasers, there is substantial skin improvement with lessening of rhytids and skin discoloration, and noticeable skin tightening. However, there is also significant morbidity associated with their use. To decrease the healing and erythema times, other types of lasers have been developed. The author discusses the practice of combining the CO2 and Erbium:YAG lasers for limiting thermal injury. For deeper rhytids in the periorbital, perioral, and forehead regions, multiple passes with the CO2 laser are often the preferred treatment. For moderate rhytids, the CO2 laser can be used for the first pass followed by one to multiple passes with the Erbium:YAG laser. Erbium:YAG lasers when used alone are beneficial for removing fine wrinkles and discolorations. Combining these lasers results in both rhytid improvement and decreased morbidity.
