What is laser skin resurfacing?
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 skin resurfacing?
You may be an ideal candidate for laser skin resurfacing if you have:
- Scars from acne
- Uneven skin pigmentation
- Non-responsive skin after a facelift
- Fine lines or wrinkles around or under the eyes, forehead, or mouth
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. This method 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, 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 treatment in the toolbox 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 (trade name Botox®). Patients should look for 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 a full evaluation of 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. This induces the formation of many zones of thermal damage referred to as microscopic thermal zones (MTZs). The technique allows undamaged skin surrounding the MTZs to serve as a reservoir for tissue to regenerate faster than traditional ablative lasers. Complications, as seen 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. Here is what to expect during and after resurfacing:
- Areas of the face 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 nonstick dressing is applied to the treatment sites for 24 hours. The patient then cleans the treated areas 2 to 5 times a day with saline or a diluted vinegar solution (see instructions below). 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 type of 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 2 to 3 months but may take as long as 6 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 possible laser resurfacing complications?
- Milia, which are small, white bumps, may appear in the laser-treated areas during healing (up to a month after treatment). 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.
- 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 prepare for laser skin resurfacing?
- Avoid tanning or heavy sun exposure and use a broad-spectrum sunscreen daily for 4 weeks prior to treatment.
- Avoid deep facial peel procedures for 4 weeks prior to the treatment (for example, aggressive chemical peels, laser resurfacing, dermabrasion).
- Do not use medications that cause photosensitivity (such as doxycycline, minocycline) for at least 72 hours prior to treatment.
- If you have a history of herpes (oral cold sores, genital) or shingles in the treatment area, let your doctor know and start your antiviral medication (valacyclovir, acyclovir) as directed (usually 2 days prior to treatment and continue for 3 days after treatment).
How should I take care of my skin after laser resurfacing?
- Immediately after treatment, the skin will be red and feel sensitive and sunburned. Five to 7 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 up.
- Redness typically lasts 1 to 2 weeks and mild pinkness may be prolonged.
- Immediately after treatment there may be pinpoint bleeding. There may also be some facial swelling, particularly around the eye area.
- Cleanse the treatment area as instructed by your doctor.
- Patients are encouraged to sleep on an extra pillow at night to help reduce the swelling for the first 4 days after the procedure.
- You may apply a cool compress or a wrapped ice pack for 15 minutes every 1 to 2 hours as needed, during the first 24 to 48 hours.
- Avoid activities that can cause flushing for 2 weeks after treatment.
- Avoid aggressive facial treatments for 4 weeks and any topical products that may cause irritation for 6 weeks following treatment.
- If blistering, crusting, or scabbing develops, call your doctor. Do not pick or attempt to remove scabs as this may cause infection or scarring.
- Apply a thin layer of petroleum jelly (or any occlusive moisturizer) or antibiotic ointment (such as bacitracin) to the area twice a day until the skin heals.
- 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 a sun protection factor (SPF) of at least 30.
- Liberal moisturizer application is also recommended after healing. Patients may resume application of tretinoin or glycolic acid products around 6 weeks after laser resurfacing or as directed by a doctor.
Will my insurance cover laser skin resurfacing?
Insurance does not cover laser resurfacing because it is an elective cosmetic surgery.
Vinegar wash instructions
- Make a vinegar solution with 1 teaspoon of white vinegar in 2 cups of water. Soak gauze in the vinegar solution and gently apply dripping wet to the treated areas allowing the gauze to remain in place for approximately 10 to 15 minutes. Using gentle pressure, wipe the treated area using the gauze.
- Keep in mind that serous (clear) drainage and/ or tiny areas of bleeding in the treated areas may be present on the day of surgery and 1 day after.
- Avoid aggressively rubbing the treated area.
- American Society for Dermatological Surgery: Laser Resurfacing
- American Society of Plastic Surgeons: What is laser skin resurfacing?
- American Society of Aesthetic Plastic Surgery: Skin Resurfacing
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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: 5/10/2016…#11015