The treatment of facial photoaging has spurned many an innovation in dermatology and plastic surgery over the past twenty years. Among these are topical treatments; chemical peels; mechanical treatments such as dermabrasion; and most aggressively, surgical lifts and ablative laser treatments. For such laser treatments, the 10,600-nm CO2 laser has been the gold standard since the early 1990s. The lengthy period of time during which the CO2 laser has been the predominant choice certainly speaks to its clinical efficacy.

However, this efficacy does not come without cost. Providing full-thickness epidermal ablation down to depths of 150 μm with multiple passes, the CO2 laser also provides significant morbidity and downtime in the postoperative period, often lasting three weeks or more. More important, CO2 laser treatment results in persistent erythema in a majority of patients, lasting much longer than the immediate recovery period – in some patients, this can be six months or more. Other side effects include delayed-onset posttreatment hypopigmentation and scarring, which can be especially devastating for both patient and treating physician, given the aesthetic nature of the procedure itself.

While the ablative laser remains a very useful tool in capable hands, patient and physician dissatisfaction with the previously mentioned issues caused a trend among most aesthetic physicians in the early 2000s toward nonablative skin rejuvenation. Like the high-energy, short-pulse CO2 laser, these devices employed the concept of selective photothermolysis, as described by Anderson and Parrish in 1983.