Forced cold–air anesthesia has been reported to decrease the discomfort associated with various dermatologic laser therapies.

We sought to evaluate the effect of cold-air anesthesia on patient comfort during ablative fractionated carbon-dioxide (CO₂) laser treatment for photoaging.

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.

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).

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.

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.