The effect of cold-air anesthesia during fractionated carbon-dioxide laser treatment: Prospective study and review of the literature

Background: Forced cold-air anesthesia has been reported to decrease the discomfort associated with various dermatologic laser therapies. Objective: We sought to evaluate the effect of cold-air anesthesia on patient comfort during ablative fractionated carbon-dioxide (CO2) laser treatment for photoaging. Methods: We conducted a prospective split-face study to evaluate the effect of cold-air anesthesia on patient comfort during ablative fractionated CO2 laser treatment for photoaging. Both patients and physicians rated the perceived discomfort of the treatment on each half of the face on a pain scale of 0 to 10. In addition, patients were asked to evaluate the side effects of the procedure (erythema, edema, crusting, scaling) on each half of the face. At 6 months posttreatment, blinded physician photograph evaluation was performed of 5 clinical indicators of photoaging. Results: For the side of the face treated with topical anesthesia alone, the mean patient-reported pain score was 7.47. On the side treated with cold-air anesthesia and topical anesthesia, the mean pain score was 4.27 (P < .01). For the side treated with topical anesthesia alone, the mean physician-reported pain score was 7.8, relative to the side treated with cold-air anesthesia and topical anesthesia, for which the mean physician-reported pain score was 3.73 (P < .01). Limitations: Although significant differences were found in pain tolerance with fractionated CO2 laser with the use and absence of forced-air cooling, additional large-scale studies are needed to confirm the device's use in patient tolerability and side-effect profile. Conclusion: The use of forced cold-air device in conjunction with topical anesthesia provides a well-accepted modality for patient comfort during ablative fractionated CO2 resurfacing. (J Am Acad Dermatol 2012;67:436-45.)