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Carbon Dioxide Laser Resurfacing

(Also Called 'Laser Resurfacing')

How does it work?

Carbon dioxide lasers have been in use for many years to treat different benign and malignant skin conditions. A new generation of carbon dioxide lasers uses very short pulsed light energy (ultrapulsed) 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. These lasers have been successfully used to treat wrinkles (rhytides) 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 carbon dioxide laser resurfacing is rapidly progressing and evolving. The ability to rejuvenate sun-damaged, wrinkled skin has been revolutionized by this new technology. Carbon dioxide laser resurfacing is yet another tool in our treatment options, which include Retin-A® products, vitamin C lotion, alpha hydroxy acids, chemical peels, dermabrasion, collagen or fat augmentation, and botulinum toxin for decreasing facial lines and scars. Patients are encouraged to seek out surgeons with documented training and experience in laser surgery.

What can be expected during and after the procedure?

In general, carbon dioxide laser resurfacing is performed on an outpatient basis, using local anesthesia in combination with orally- or intravenously-administered sedative medications. The areas to be treated are numbed with a local anesthetic. General anesthesia may be used when the entire face is treated. Wrinkles around the eyes, mouth, or forehead may be treated individually, or a full-face laser resurfacing may be performed. A partial-face laser resurfacing takes 30 to 45 minutes, and the full-face treatment takes 1½ to 2 hours.

Following the laser resurfacing procedure, a Telfa® 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, which can increase the chance of scarring and prolong the healing time. 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, oil-free makeup may be worn to camouflage the pink-to-red color that is generally seen after laser resurfacing. Green-based makeup is particularly suitable for the redness in the skin. The redness in the laser-treated sites generally fades in two to three months, but may take as long as six months to disappear; it generally persists longer in blondes and redheads.

Patients with darker skin tones have a greater risk of healing with darker pigmentation (hyperpigmentation). This may be minimized by preoperative use of a bleaching agent as well as continued use of this agent after healing. Patients should be advised to avoid sun exposure for four weeks before their laser treatment and to liberally apply sunscreens pre- and post-procedure.

What are the possible side effects?

  • 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.
  • Acne flares may occur after laser resurfacing. This may resolve on its own, or can be treated with conventional acne therapies.
  • Hyperpigmentation, and more rarely, hypopigmentation, may result in the laser-treated areas. In general, the hyperpigmented areas may be treated with bleaching cream to facilitate fading of the pigment. Hypopigmentation is more difficult to treat.
  • Reactivation of a herpes simplex cold sore may occur, especially after laser resurfacing around the mouth. This can be prevented by giving an antiviral medicine prior to the surgery and continuing it for seven to 10 days post-procedure.
  • Bacterial infections can be prevented by taking an antibiotic prior to the surgery and continuing for seven to 10 days post-procedure.
  • Postoperative swelling is to be expected and is lessened by administration of intramuscular steroids.
  • Patients are encouraged to sleep on an extra pillow at night to help reduce the swelling. Ice pack application is also helpful in the first 24 to 48 hours.
  • Scarring, although very rare, may occur in laser-treated areas.
  • Cessation of smoking is highly recommended because of its documented harmful effects on the healing process.

How is the skin cared for afterwards?

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

Liberal moisturizer application is also recommended after healing. Patients may resume application of Retin-A and/or glycolic acid products approximately six weeks after the procedure, or as directed by their physician.

References

Alexiades-Armenakas M, Dover J, Arndt K. The spectrum of laser skin resurfacing: Nonablative, fractional, and ablative laser resurfacing. Journal of the American Academy of Dermatology 2008; 58(5):719-737.

Perkins S, Henry D. Management of aging skin. In: Flint, PW. Cummings Otolaryngology: Head & Neck Surgery. 5th ed. St. Louis, MO: Mosby; 2010:Chap 27.

Tanzi EL, Alster TS. Skin resurfacing: ablative lasers, chemical peels, and dermabrasion. In: Wolff K, Goldsmith LA, Katz SI et al, editors. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York, NY: McGraw Hill Medical; 2008:Chap 252.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/22/2011...#8314


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