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Laser Skin Resurfacing

Laser resurfacing uses ablative lasers to reduce the appearance of wrinkles and scars, even pigmentation, tighten skin and remove lesions (both benign and malignant). 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 hypopigmentation (lightening of skin). This popular procedure is known by several other names, including lasabrasion, laser peel, or laser vaporization.

Who is a good candidate for laser resurfacing?

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

How does laser skin resurfacing work?

The two types of lasers traditionally 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. The newest type of laser used for resurfacing is a fractionated CO2, which emits numerous narrow, columns of laser light, allowing for small islands of normal skin to remain intact.

CO2 Laser Resurfacing

Recovery time: allow up to two weeks.

This method has been used for years to treat different benign and malignant skin conditions. A newer generation of CO2 laser resurfacing 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. 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. 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.

Fractional Laser Resurfacing

Recovery time: allow one full week.

The use of a fractional laser with ablative settings delivers many narrow columns of laser light to the skin, which induces the formation of many zones of thermal damage referred to as microscopic thermal zones (MTZs). This technique allows undamaged skin surrounding the MTZs to serve as a reservoir for tissue to regenerate faster than traditional ablative lasers. Complications, as discussed below, appear to be less severe and less frequent with the fractional laser resurfacing.

What can be expected during and after laser skin resurfacing?

In general, all forms of laser resurfacing discussed 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 laserabrasion 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 laserabrasion 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 5 to 21 days, depending on the nature of the condition that was treated and laser used.

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 makeups are particularly suitable for this camouflage since they neutralize the red color. Oil-free makeups 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 (hyperpigmentation). This may be minimized by use of a bleaching agent after laser skin resurfacing.

What are the possible laser resurfacing complications?

  • 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.
  • Hyperpigmentation, and more rarely, hypopigmentation, may result in the laser-treated areas. In general, the hyperpigmented areas may be treated with bleaching cream to speed fading of the pigment. In addition, the patient is advised to use broad-spectrum sunscreens for weeks before and after the treatment to prevent pigmentary changes.
  • 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.
  • 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.
  • You should expect swelling after laser skin resurfacing. Oral steroids can be prescribed to manage swelling around the eyes.
  • 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.
  • Scarring after laser skin resurfacing, although very rare, may occur in laser-treated areas.
  • Cessation of smoking is highly recommended because smoking is known to have harmful effects on the healing process.

How should I take care of my skin after laser resurfacing?

It is 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 may become dry and peel.

New skin will form after the treated area has 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 re-treating 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 30.

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 a physician.

Will my insurance cover laser skin resurfacing?

Insurance does not cover laser resurfacing because it is an elective cosmetic surgery.

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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: 12/21/2012…#11015


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