To Debride or Not to Debride? That Is the Question: Rethinking Char Removal in Ablative CO 2 Laser Skin Resurfacing

BACKGROUND: The treatment standard for laser skin resurfacing (LSR) includes aggressively wiping away the char with moist gauze before and after each pass to prevent heat buildup and lateral tissue damage from existing char. No published study has addressed not debriding between passes with traditional higher fluence, high-density, multipass CO(2) LSR in humans. PURPOSE: The objective was to disprove the dogma that wiping away the laser char between treatment passes is necessary. MATERIALS AND METHODS: A total of 158 patients were treated over a 23-month period with multipass, nondebrided CO(2) laser resurfacing (6 J/cm(2), density 6). A small series of split-face studies were performed by debriding one side and not debriding the other side after each pass, and 89 full-face patients were treated without debriding any char between two or three passes. Histologic and photographic studies were performed in selected patients to determine the differences between debrided and nondebrided techniques. RESULTS: None of the nondebrided patients experienced significant complications. Operative times were shortened as was postlaser pain and erythema. CONCLUSION: Histologic analysis showed that three passes of 6 J/cm(2) with a density of 6 produces extremely similar epidermal and dermal changes regardless of debriding between passes or not. This is the first study in humans using high-energy, high-density, multipass LSR without debriding between passes. The authors have indicated no significant interest with commercial supporters.