INTRODUCTION
Noninvasive laser procedures have gained increasing popularity in the dermatology field in the United States. Lasers of different wavelengths exist to treat cutaneous disorders and improve aesthetic outcomes for cosmetic purposes. Over the years, advancements in lasers have allowed for more effective results in a shorter amount of time. Traditionally, 1 laser treatment was performed per visit with ample time allowed between visits to minimize adverse events. Expected adverse events can include erythema, swelling, blistering, and post-inflammatory pigmentation (PIH), especially in darker skin types, etc.1 Typically, the skin needs 1 to 3 months to heal from each treatment depending on laser type.
As devices have evolved and improved, laser procedures are now often overlapped or combined in practice to achieve faster and, often, better outcomes. This is particularly the case when the devices have a synergistic effect on the skin. Synergistic effects of combined treatment have led to greater improvement in pigment distribution, fine wrinkles, sallowness, and skin tone.2 Waiting to have several sessions may not be realistic for every patient. Patients seeking laser procedures may have jobs, families, and other social factors that make multiple session treatments challenging. Therefore, it is becoming more common for physicians to combine laser treatments into a single session to accommodate for patient convenience.
Most evidence that supports combined use of laser treatments evaluate for aesthetic outcomes. There are few studies that examine for safety. One prospective study evaluated the safety of combining CO2 and erbium:YAG lasers in a single session for perioral skin resurfacing. It showed that combining lasers reduced the duration of crusting, swelling, and itching post-treatment compared to CO2 laser alone.3 Another case report described a combination of CO2 laser, pulsed dye laser (PDL), and triamcinolone acetonide injection in a single session for keloid treatment. This combination decreased the size of the keloids dramatically, with minimal side effects.4 Of the studies that looked at aesthetic outcomes alone, a combination of PDL and non-ablative fractional erbium:glass/thulium laser showed significant improvement in outcomes for the treatment of burn scars.5 In addition, fractional CO2 treatments alternating with sessions of PDL have shown significant improvement
As devices have evolved and improved, laser procedures are now often overlapped or combined in practice to achieve faster and, often, better outcomes. This is particularly the case when the devices have a synergistic effect on the skin. Synergistic effects of combined treatment have led to greater improvement in pigment distribution, fine wrinkles, sallowness, and skin tone.2 Waiting to have several sessions may not be realistic for every patient. Patients seeking laser procedures may have jobs, families, and other social factors that make multiple session treatments challenging. Therefore, it is becoming more common for physicians to combine laser treatments into a single session to accommodate for patient convenience.
Most evidence that supports combined use of laser treatments evaluate for aesthetic outcomes. There are few studies that examine for safety. One prospective study evaluated the safety of combining CO2 and erbium:YAG lasers in a single session for perioral skin resurfacing. It showed that combining lasers reduced the duration of crusting, swelling, and itching post-treatment compared to CO2 laser alone.3 Another case report described a combination of CO2 laser, pulsed dye laser (PDL), and triamcinolone acetonide injection in a single session for keloid treatment. This combination decreased the size of the keloids dramatically, with minimal side effects.4 Of the studies that looked at aesthetic outcomes alone, a combination of PDL and non-ablative fractional erbium:glass/thulium laser showed significant improvement in outcomes for the treatment of burn scars.5 In addition, fractional CO2 treatments alternating with sessions of PDL have shown significant improvement
