Carbon Dioxide Laser Resurfacing

What is carbon dioxide laser resurfacing?

Carbon dioxide laser resurfacing is used to treat a variety of skin conditions. Carbon dioxide lasers very precisely remove thin layers of skin with minimal heat damage to the surrounding structures.

Carbon dioxide lasers treat:

• Wrinkles (rhytides).
• Photodamage.
• Scars.
• Warts.
• Linear epidermal nevi (birthmarks).
• Rhinophyma (enlarged oil glands on the nose).

The lasers have been in use for many years to treat non-cancerous (benign) and cancerous (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.

The ability to rejuvenate sun-damaged, wrinkled skin has been revolutionized by this new technology. Carbon dioxide laser resurfacing joins other treatment options including tretinoin (Retin-A®) products, vitamin C lotion, alpha hydroxy acids, chemical peels, microdermabrasion, collagen or fat augmentation and botulinum toxin (Botox®) for decreasing facial lines and scars. Be sure to look for a surgeon with documented training and experience in laser surgery.

What can be expected during and after carbon dioxide laser resurfacing?

Carbon dioxide laser resurfacing is usually performed on an outpatient basis, using local anesthesia in combination with sedative medications given by mouth or through a vein.

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 one-and-a-half to two hours.

Following the laser resurfacing procedure, a non-stick dressing is applied to the treatment sites for 24 hours. You may be instructed to clean the treated areas two to five times a day with saline or a dilute vinegar solution. You can then apply Vaseline®, Eucerin®, or Aquaphor® to the area. This wound care is intended to prevent the forming of any scabs, 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 and the intensity of the laser settings. The stronger the settings, the longer the recovery time.

Once the areas have healed, you can wear oil-free makeup 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), although anyone can be affected by this condition after laser treatment. This may be minimized by the use of a bleaching agent before surgery. It also may be reduced with the continued use of this agent after healing.

You should avoid sun exposure for four weeks before laser treatment and liberally apply sunscreens pre- and post-procedure.

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What are the possible risks and side effects of carbon dioxide laser resurfacing?

• Milia, which are small white bumps or cysts, may appear in the laser-treated areas during healing. These may be removed by gentle cleansing with a washcloth or by a dermatologist in the office by nicking the surface with a blade and expressing the cyst material out of the skin.
• 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 ease 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 rare, may occur in laser-treated areas.
• Quitting smoking is highly recommended because of its documented harmful effects on the healing process.

How do I care for my skin after carbon dioxide laser resurfacing?

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. Use a sunscreen specifically formulated for use on the face with a sun protection factor (SPF) of at least 30.

Liberal moisturizer application is also recommended after healing. You can resume application of Retin-A and/or glycolic acid products approximately six weeks after the procedure, or as directed by your healthcare provider.