Laser 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.

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.

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.

• 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.

• 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.

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.