Resurfacing of photodamaged skin on the neck with an UltraPulse® carbon dioxide laser

Background and Objective: Successful treatment of facial wrinkles with carbon dioxide or erbium laser resurfacing brings about a more youthful appearance of the skin on the face. A variable degree of contrast with the untreated skin on the neck prompts many patients to request treatment for photodamaged skin on the neck. The objective is to investigate the feasibility of resurfacing photodamaged skin on the neck with the UltraPulse(R) carbon dioxide laser. Study Design/Materials and Methods: The study was carried out in two phases. During the first phase, a small area on the upper neck was tested with three different parameters. The best parameter was then used to treat the neck area in a single pass in 10 cases in the second phase. Patients were then evaluated at 3-6 months. Results: The three parameters tested were 200 mJ at CPG settings of pattern 3, size 9, density 6,300 mJ at CPG 3-9-5, and 300 mJ at CPG 3-9-6. The latter seemed to achieve the best results, and there were no complications at any test sites. This setting was used to treat the whole anterior and anterolateral part of the neck with a single pass, wiping away the resultant epidermal debris. Moderate improvement in color and texture, but no improvement in wrinkling, were observed at 3-6 months. However, a mild degree of patchy hypopigmented scarring in the lower neck was encountered in three cases, as well as one other case of patchy hypopigmentation without textural changes. Conclusion: Despite some obvious improvements, the risk of scarring and hypopigmentation with the tested parameters out-weighs the potential benefits. The lower part of the neck responded very differently from the upper part. Alternative strategies to achieve better results are discussed.