Ultrastructure of collagen theramlly denatured by microsecond domain pulsed carbon dioxide laser

Background: Clinical improvement in photodamaged skin after carbon dioxide (CO₂) laser resurfacing is thought to result in part from thermal collagen shrinkage. The presence of such collagen has not been unequivocally demonstrated. To identify and characterize the morphological features of collagen after CO₂ laser exposure, we irradiated ex vivo human facial skin and bovine calcaneus tendon with microsecond domain pulsed CO₂ laser energy and examined specimens for histopathological and ultrastructural changes in collagen. Observations: In dermis and tendon, 3 zones of collagen structure were apparent on electron microscopy. The first, most superficial zone demonstrated loss of collagen structure. The second zone consisted of admixed normal collagen fibers and thickened collagen fibers. Zone 3 consisted of normal-appearing collagen fibers. Conclusions: Ultrastructural examination of irradiated collagen revealed distinct morphological zones of denatured collagen fibers. Partially denatured fibers had an increased diameter consistent with lineal shrinkage. Zonal distinction was undetectable by light microscopy. Ultrastructurally, the zones of denatured collagen located above the normal fibers correlated with the zone of altered material seen on light microscopy. These findings suggested that collagen fiber shrinkage does occur after pulsed CO₂ laser irradiation and that this phenomenon contributed, at least in part, to the immediate tissue contraction observed clinically.