Laser Skin Resurfacing

What is laser skin resurfacing?

Laser resurfacing uses lasers to reduce the appearance of wrinkles and scars, to even out skin coloring (pigmentation), to tighten skin and to remove lesions, both benign (non-cancerous) 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 by vaporizing it. Lasers remove the outer layer of your skin – the epidermis – and heats the underlying layer, called the dermis. The lasers stimulate the growth of new collagen fibers resulting in new skin that is smoother and firmer. 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 or chickenpox.
• Uneven skin pigmentation.
• Skin scars or birthmarks.
• Age spots, liver spots.
• Sun-damaged skin.
• Non-responsive skin after a facelift.
• Fine lines or wrinkles around or under the eyes, forehead or mouth
• Enlarged oil glands on your nose.

You may not be a good candidate for laser skin resurfacing if you have:

• Active acne.
• Very dark skin.
• Deep wrinkles.
• Excessive or sagging skin.

How does laser skin resurfacing work?

There are two forms of laser resurfacing. First there’s carbon dioxide (CO2) and erbium lasers. These lasers create a uniform injury to your skin in the treatment area. The other form of laser resurfacing is called fractionated CO2 laser treatment. Fractionated CO2 laser resurfacing involves using the laser to drill numerous narrow columns of holes deep into the layers of your skin, but with the surrounding skin remaining untreated and intact.

CO2 laser resurfacing

CO2 laser resurfacing 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.

Recovery time with CO2 laser resurfacing is up to two weeks.

Erbium laser resurfacing

Erbium laser resurfacing is designed to remove superficial and moderately deep lines and wrinkles on your 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 fewer side effects than CO2 lasers, 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 be a good choice for you.

Recovery time with erbium laser resurfacing is one full week.

Fractional laser resurfacing

Because fractional CO2 laser resurfacing delivers many narrow columns of laser light to your skin, much of your skin is not injured. Your skin tightens as the collagen between the treated laser holes contracts. The benefit of this type of laser is that less skin is injured. The risk is that because the laser light penetrates more deeply than other lasers, there’s a greater risk of complicated healing and scarring.

Recovery time with fractional laser resurfacing is one full week.

Your doctor will determine which type of laser resurfacing treatment is best for you after a full evaluation of your medical history, current physical condition and desired results.

What can be expected during and after laser skin resurfacing?

In general, all forms of laser resurfacing 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.
• Your face or area to be treated with be thoroughly cleaned.
• Following laser resurfacing, a nonstick dressing is applied to the treatment sites for 24 hours. You will then cleans the treated areas two to five times a day with saline or a diluted vinegar solution (see instructions below). An ointment such as Vaseline® or moisturizing creams such as Eucerin®, or Aquaphor® are then applied. The purpose of using ointments or creams is to prevent any scab formation. In general, the areas heal in five 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 good choices for camouflage since they neutralize your red skin color as your skin heals. 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 up to a year to disappear. The redness generally persists longer in people with blonde or red hair.
• If you have a darker skin tone, you have a greater risk of healing with darker pigmentation (hyperpigmentation). A bleaching agent after laser skin resurfacing may be used to lighten your skin color. Your doctor will consult with you.

How should I prepare for laser skin resurfacing?

• Avoid tanning or heavy sun exposure and use a broad-spectrum sunscreen daily for four weeks before to treatment.
• Avoid deep facial peel procedures for four weeks before treatment (for example, strong chemical peels, laser resurfacing, dermabrasion).
• Don’t 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 two days before treatment and continue for three days after treatment).
• To prepare your skin for laser resurfacing, you may be asked to apply a topical retinoid on your skin for about four weeks before your procedure.

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, you should 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 your mouth. You can prevent this by asking your doctor for an antiviral medication, which you can begin taking before your surgery and continue taking for seven to 10 days after laser resurfacing.
• You can also prevent bacterial infections by taking an antibiotic before the surgery and continuing to take it for seven to 10 days afterwards.
• You should expect swelling after laser skin resurfacing. Oral steroids can be prescribed to manage swelling around your eyes.
• Scarring after laser skin resurfacing, although very rare, may occur in laser-treated areas.

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

• Immediately after treatment, your skin will be red and feel sensitive and sunburned. Redness, swelling, itching or stinging may last for a few days. Depending on the treatment, skin may even appear raw, ooze a yellow liquid and even blister. Don’t scratch or pick at skin that crusts as this can cause scarring or lead to an infection.
• Five to 7 days after laser resurfacing, your skin will become dry and peel. Your new skin will at first appear pink. It should begin to gradually lighten up over the next two to three months
• Cleanse the treatment area two to five times a day as instructed by your doctor.
• Sleep on an extra pillow at night to help reduce the swelling for the first four days after the procedure.
• Apply a cool compress or a wrapped ice pack for 15 minutes every one to two hours as needed, during the first 24 to 48 hours.
• 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.
• Avoid aggressive facial treatments, such as tretinoin or glycolic acid for four weeks and any topical products that may cause irritation for six weeks following treatment.
• Avoid activities that can cause flushing for two weeks after treatment.
• Don’t smoke. Smoking slows the healing process.

After healing:

• Apply a daily broad-spectrum (screens both ultraviolet B and ultraviolet A rays) sunscreen after healing to protect your newly laser-resurfaced skin. A sunscreen specifically formulated for use on the face should be chosen, with a sun protection factor (SPF) of at least 30.
• Apply daily moisturizer as recommended by your doctor.

Vinegar wash instructions

• Make a vinegar solution with one teaspoon of white vinegar in two 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 one day after.
• Avoid aggressively rubbing the treated area.

What outcome can I expect after laser skin resurfacing?

You should see an immediate difference in your treated skin. Depending on the laser treatment, your skin may stay pink or red for a few months. Your skin may continue to improve up to a year and the improvement may last for several years. Normal aging will eventually lead to new wrinkles, which can be treated with laser resurfacing again.

You should avoid the sun as much as possible and apply sunscreen every day.

Will my insurance cover laser skin resurfacing?

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