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 2 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 1 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 1 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.

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).

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