Laser resurfacing is a relatively new treatment for reducing facial wrinkles and skin irregularities, such as blemishes or acne scars. The laser technique directs short, concentrated pulsating beams of light at irregular skin. Laser skin resurfacing removes skin very precisely, layer by layer, resulting in fewer problems with hypo pigmentation (lightening of skin). This popular procedure is known by several other names, including lasabrasion, laser peel, or laser vaporization.

Laser skin resurfacing can remove years of aging from the face in a matter of minutes. Chemical peels are often used for Sun damage and fine wrinkles, however the laser can address much deeper wrinkles, acne scars and other complexion problems. Ideal laser patients are fair skinned without extreme skin sagging, but with wrinkles and Sun or age spots. Laser resurfacing can be done on patients with loose skin, although these patients may benefit from face-lift or other cosmetic procedures.

CO2 lasers are used for resurfacing and for minimally invasive treatments such as spider veins, facial skin pigmentation, Sun damage, and skin tightening. The CO2 laser is especially effective in treatment of wrinkles of the lower eyelid skin and for treating wrinkles around the mouth.

In laser resurfacing, a Carbon dioxide (CO2) laser is used to remove areas of damaged or wrinkled skin, layer by layer. Laser resurfacing may be performed on the whole face or in specific regions. The benefits of laser resurfacing include:

• reduces acne scars
• reduces wrinkles
• reduces aged and Sun damaged skin
• reduces the risk of skin cancer
• reduces or eliminate brown spots and discoloration
• improves skin tone
• regenerates new collagen

Candidacy

If you have fine lines or wrinkles around or under the eyes, the forehead, the mouth, or scars from acne, or non-responsive skin after a facelift, then you may be an ideal candidate for laser skin resurfacing. If you have active acne or if you have very dark skin, you are not a candidate for this procedure.

You will be a good candidate for laser skin resurfacing if you have any one or more of the following conditions:

• wrinkles including ‘laughter lines’, ‘frown lines’, skin changes around mouth that cause ‘lipstick bleed’
• Sun-damaged facial skin
• lines around eyes- ‘crow’s feet’
• brown spots or blotchy skin coloring
• skin growths that have potential to become cancerous
• scars of acne or chicken pox
• superficial facial scars from a past injury

You will not be a good candidate if you have:

• collagen vascular diseases (lupus, scleroderma, keloid)
• immunologic abnormalities (such as vitiligo)
• used isotretinoin in last 1 year
• history of abnormal wound healing
• skin disorders
• poor physical, mental or emotional health

Different kinds of lasers used for skin resurfacing

1. Pulsed Carbon dioxide laser.
2. Erbium YAG laser.
3. Non ablative lasers.
4. Broadband high intensity light, Nd: YAG and flash lamp dye laser.
5. Radiofrequency and pulsed light.
6. Fraxel laser.

How does laser skin resurfacing work?

The two types of lasers most commonly used in laser resurfacing are Carbon dioxide (CO2) and erbium. Each laser vaporizes superficial, damaged skin cells. Both types of lasers reduce the risk for the patient because they limit the amount of heat absorbed by the skin.

CO2 laser resurfacing

The CO2 laser is the gold standard for skin tightening and wrinkle reduction, however it has the longest recovery time of up to 2 weeks. The face is very red for the first week and fades to pink for the next week. At 10 to 12 days, you can wear makeup to cover the pinkness. Generally, by the third or forth week, the majority of the pinkness is gone and the positive effects of the laser resurfacing can be appreciated. Some patients may stay a very light pink for several months, but this can be covered by make up. Research has shown that the improvement of wrinkles will continue to be seen as the skin continues to heal over the course of 18 months.

How the laser works

The CO2 laser is a concentrated beam of light that creates a precision burn on the outer layers of the skin. A single pass with the laser will remove a very thin layer of skin, about the thickness of a human hair. Patients with minimal Sun damage or wrinkles may only need a single pass. Patients with advanced Sun damage, wrinkles or deep acne scars will need multiple passes. Every patient is different so there is no exact formula for the number of passes.

The actual laser procedure takes about 45 to 60 minutes and usually requires IV sedation. Immediately after the laser surgery, the face will be covered with paper tape or a laser healing cream and cold packs.

Recovery

This method has been used for years to treat different benign and malignant skin conditions. A new generation of CO2 laser resurfacing uses very short pulsed light energy (ultra pulsed) or continuous light beams that are delivered in a scanning pattern to very precisely remove thin layers of skin with minimal heat damage to the surrounding structures. CO2 laser resurfacing has been successfully used to treat wrinkles and scars as well as other benign skin growths such as warts, linear epidermal nevi (birthmarks), rhinophyma (enlarged oil glands on the nose), and other skin conditions.

The field of CO2 laser resurfacing is rapidly changing and improving. The ability to rejuvenate Sun-damaged, wrinkled skin has been revolutionized by this new technology. CO2 laser resurfacing is yet another tool in the treatment package that includes such options as Retin A products, vitamin C lotion, alpha hydroxy acids, chemical peels, dermabrasion, collagen, hyaluronic acid or fat augmentation, and Botulinum toxin. Patients should seek out surgeons with documented training and experience in laser skin resurfacing.

Erbium laser resurfacing

Recovery time: Allow one full week.

Erbium laser resurfacing is designed to remove superficial and moderately deep lines and wrinkles on the face and should require only local anesthetic. This laser can also be used on your hands, neck, or chest. One of the benefits of erbium laser resurfacing is minimal injury of surrounding tissue. This laser causes minimal side effects, such as swelling, bruising and redness, so your recovery time should be more rapid.

If you have a darker skin tone, erbium laser resurfacing may work better for you. Your doctor will determine which laser is best for you after he or she fully evaluates your medical history, current physical condition, and desired results.

Frequently asked questions?

What can be expected during and after laser skin resurfacing?

In general, both erbium and CO2 laser resurfacing are performed on an outpatient basis, using local anesthesia in combination with orally- or intravenously-administered sedative medications. Wrinkles around the eyes, mouth, or forehead may be treated individually, or a full-face laser abrasion may be performed. The areas to be treated are numbed with a local anesthetic. General anesthesia may be used when the entire face is treated. A partial-face laser abrasion takes 30 to 45 minutes, and the full-face treatment takes 1-1/2 to 2 hours.

Following laser resurfacing, a telfa nonstick dressing is applied to the treatment sites for 24 hours. The patient then cleans the treated areas two to five times a day with saline or a dilute vinegar solution. An ointment such as Vaseline, Eucerin, or Aquaphor is then applied. This wound care is intended to prevent any scab formation. In general, the areas heal in 10 to 21 days, depending on the nature of the condition that was treated.

Once the areas have healed, makeup may be worn to camouflage the pink to red color that is generally seen after laser skin resurfacing. Green-based makeup’s are particularly suitable for this camouflage since they neutralize the red color. Oil-free makeup’s are recommended after laser resurfacing. The redness in the laser-treated sites generally fades in two to three months but may take as long as six months to disappear. The redness generally persists longer in blondes and redheads.

Patients with darker skin tones have a greater risk of healing with darker pigmentation (hyper pigmentation). This may be minimized by use of a bleaching agent after laser skin resurfacing as well.

Complications

1. Milia, which are small white bumps, may appear in the laser-treated areas during healing. These may be removed by gentle cleansing with a washcloth.
2. Hyper pigmentation, and more rarely hypo pigmentation, may result in the laser-treated areas. In general, the hyper pigmented areas may be treated with bleaching cream to speed fading of the pigment.
3. Reactivation of a herpes simplex cold sore may occur, especially after laser skin resurfacing around the mouth. You can prevent this by asking your doctor for an antiviral medication, which you can begin taking before your surgery and continue taking 7 to 10 days after laser resurfacing.
4. You can also prevent bacterial infections by taking an antibiotic prior to the surgery and continuing to take it for 7 to 10 days afterwards.
5. You should expect swelling after laser skin resurfacing. Oral steroids can be prescribed to manage swelling around the eyes.
6. Patients are encouraged to sleep on an extra pillow at night to help reduce the swelling after laser resurfacing. Ice pack application is also helpful in the first 24 to 48 hours.
7. Scarring after laser skin resurfacing, although very rare, may occur in laser-treated areas.
8. Cessation of smoking is highly recommended because smoking is known to have harmful effects on the healing process.

After treatment care

It's important to remember that skin treated with laser resurfacing may react in different ways. Most commonly, you may feel like you have mild sunburn. There will be slight swelling and redness of the skin. You may experience itching or stinging for 12 to 72 hours after the procedure. Five to seven days after laser resurfacing, your skin will become dry and peel.

New skin will form after the treated area has been peeled. This skin will at first appear pink. It should begin to gradually lighten for up to a year after treatment. Your doctor will not consider retreating the area until the area is completely healed.

Daily sunscreen application is necessary after healing to protect the newly laser-resurfaced skin. A "broad-spectrum" sunscreen, which screens both ultraviolet B and ultraviolet A rays, is recommended after laser skin resurfacing. A sunscreen specifically formulated for use on the face should be chosen, with at least a Sun protection factor (SPF) of 15.

Liberal moisturizer application is also recommended after healing. Patients may resume application of Retin A and/or glycolic acid products around six weeks after laser resurfacing or as directed by their physician.