Laser Skin Resurfacing FAQs

Laser stands for “light amplification by the stimulated emission of radiation.” Lasers work by producing an intense beam of bright light that travels in one direction. The laser has the unique ability to produce one specific color (wavelength) of light, which can be varied in its intensity and pulse duration. There are many lasers which have unique purposes. The newest laser systems have become remarkably precise and selective, allowing better treatment results and safety levels not previously available. There are two categories of lasers used for skin resurfacing: ablative and non-ablative whose selection depends on which is deemed the most appropriate mode of skin resurfacing treatment, considering your preferences needs.

Ablative lasers remove the top layers of the skin (epidermis) and heat the layer under the epidermis. This causes collagen (a substance that gives skin structure) regeneration. As the wound caused by the laser heals, smoother and more even skin results. There are three types of ablative lasers used for resurfacing: carbon dioxide (CO2), erbium:YAG (Er:YAG), and the long-pulsed erbium:YAG laser.

The newest generation of pulsed CO2 lasers delivers short bursts of extremely high-energy laser light. This vaporizes the undesired skin tissue one layer at a time, revealing fresh skin underneath. Often referred to as a pulsed CO2 laser, the laser’s highly focused beam enables the dermatological surgeon to gently remove the skin’s surface with a lower risk of scarring and other complications. Healing generally occurs over a two-month period.

The high-powered Er:YAG laser produces energy in a wavelength that gently penetrates the skin, is absorbed by water (a major component of tissue cells), and scatters the heat effects of the laser light. These unique properties allow physicians to remove thin layers of skin tissue with great precision while minimizing damage to surrounding skin.

The Er:YAG laser is commonly used for skin resurfacing in patients who have superficial to moderate facial wrinkles, mild surface scars, or skin discoloration. The gentle touch of the Er:YAG laser means it is uniquely effective in rejuvenating sun-damaged skin in areas such as the delicate skin around the eyes and mouth, where other lasers may cause scarring. Other body areas, such as the neck and hands, also may be considered for treatment with the Er:YAG laser. Skin rejuvenation with the Er:YAG laser may offer the advantages of reduced redness, decreased side effects, and rapid healing (about 5-7 days).

The Erbium Yag laser is selected for patients with superficial to moderate facial wrinkles, mild surface scars or discolorations. The gentleness of the Erbium Yag laser is selected in areas where the skin may be more delicate. These areas include those around the eyes, mouth, neck and hands. Furthermore, the Erbium Yag laser is selected for patients with darker skin types and for those who cannot tolerate prolonged redness after the procedure.

Non-ablative lasers have gained immense popularity in recent years because they require little to no healing time. They work by bypassing the surface of the skin and treating the layers underneath, known as the papillary dermis. This allows the skin to respond as if it were repairing a wound and skin regenerates. With this technique, the epidermis is generally not removed. Because they are less intense than ablative lasers, non-ablative procedures pose minimal downtime and recovery. Non-ablative treatments require multiple sessions, and may take several weeks after the last session for the optimal results of treatment to be seen.

The technique used for Laser Skin Resurfacing directs short, concentrated pulsating beams of light at irregular skin. Laser skin resurfacing removes skin very precisely, layer by layer. This popular procedure is also known by several other names, including lasabrasion, laser peel or laser vaporization. The two types of lasers most commonly used in laser resurfacing are carbon dioxide (CO2) and erbium. Each laser vaporizes superficial, damaged skin cells safely.

Laser resurfacing is performed in the dermatological surgeon’s office to help the following conditions:

• Erase fine lines and wrinkles of the face, especially on the upper lip, cheeks and forehead.
• Smooth and tighten eyelid skin
• Improve crow’s feet around the eyes
• Soften pucker marks and frown lines
• Remove brown spots and splotchy, uneven skin color
• Improve and flatten scars
• Treats spider veins, stretch marks, tattoos, birthmarks
• Uneven pigmentation and pre cancerous growth

If you have fine lines or wrinkles around the eyes, mouth or on the forehead, scars from acne, or non-responsive skin after a facelift, then you may be an ideal candidate for laser skin resurfacing.

If you have active acne or if you have very dark skin, you may not be a candidate for Laser Skin Resurfacing. Also, individuals who have taken accutane in the past 12-18 months or are prone to abnormal (keloid-like) scarring or those with active skin infections on the treatment area may not be appropriate candidates for this procedure. This technique is also not recommended for stretch marks.

Since results are technique-sensitive and entail an artistic component, it is important to select a board-certified physician who has demonstrated laser expertise.

• Relatively “bloodless” surgery
• Precisely controlled surgery
• An addition or alternative to other skin rejuvenating procedures
• Safe, reliable and effective out-patient, same day surgery

Slight reddening and local swelling of the skin, similar to a sunburn, may occur. These effects typically last 24 hours or less. In some instances, blistering may occur.

Both erbium and CO2 laser resurfacing are done on an outpatient basis, using local anesthesia (pain relief at the site of the procedure) 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.

A partial-face lasabrasion takes 30-45 minutes and the full-face treatment takes 1-1/2 to 2 hours.

Following laser resurfacing, a sterile dressing is applied to treatment sites. When the dressings are removed (usually after 1 to 3 days), the patient cleans the treated areas two to five times a day with cool tap water saline or a dilute vinegar solution. An ointment such as Vaseline, Eucerin or Aquaphor is then applied. The purpose of this care is to prevent any scab formation. In general, effected areas heal in 10-21 days, depending on the nature of the condition that was treated.

Once the treated areas have healed, makeup may be worn to help mask the pink to red color that is generally evident following laser skin resurfacing. Green-based make-ups are particularly suitable for this task as they neutralize the red color. Oil-free make-ups 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 completely disappear. Blonde and redheaded patients will find that the redness generally persists longer than indicated above.

Patients with darker skin tones have a greater risk of healing with darker pigmentation. To minimize this risk, use a bleaching agent before laser skin resurfacing treatment, as well as continued use of this agent after healing.

• You should expect swelling after laser skin resurfacing. Ask your doctor about what you can do to lessen this effect.
• Milia, which are small white bumps, may appear in the laser-treated areas during healing. These may be removed by gentle cleansing with a washcloth.
• Hyper pigmentation (increased pigmentation), and more rarely hypo pigmentation (decreased skin pigmentation), may result in the laser-treated areas. In general, the hyper pigmented areas may be treated with bleaching cream to speed fading of the pigment.
• Reappearance of a 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 seven to 10 days after laser resurfacing.
• Scarring after laser skin resurfacing, although very rare, may occur in laser-treated areas.

The healing process after the treatment can be as important as the procedure itself. It’s important to remember that skin treated with laser resurfacing may react in different ways.

• Prevent bacterial infections by taking an antibiotic prior to the surgery and continuing for seven to 10 days afterwards.
• Sleep on an extra pillow at night to help reduce the swelling after laser resurfacing. Ice pack application is also helpful in the first 24-48 hours.
• Most commonly, you may feel like you have mild sunburn. There will be slight swelling and redness of the skin. You may experience itching or stinging for 12 to 72 hours after the procedure. Five to seven days after laser resurfacing, your skin will become dry and peel.
• New skin will form after the treated area has been peeled. This skin will at first appear pink. It should begin to gradually lighten for up to a year after treatment. Your doctor will not consider retreating the area until the area is completely healed.
• 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. A sunscreen specifically formulated for use on the face should be chosen, with at least a sun protection factor (SPF) of 15.
• Liberal moisturizer application is recommended after healing. Patients may resume application of Retin-A and/or glycolic acid products around six weeks after laser resurfacing or as directed.
• Cessation of smoking is highly recommended because of known harmful effects on the healing process.

While the duration of a Laser Resurfacing treatment depends on the size of the treatment area, most treatments last between 30 and 90 minutes. Mild sedation and topical anesthesia are used before the laser treatment begins.

Laser skin resurfacing procedures are generally safe when performed by a board-certified physician. Infection or abnormal healing are infrequent following laser skin treatments, but they do present a small risk. Refer to Laser Resurfacing Side Effects.

Laser resurfacing is most commonly performed under local anesthesia with oral sedation medication, especially when it’s used to treat localized areas of the face. You’ll be awake but relaxed, and will feel minimal discomfort.

All surgical procedures carry some risk, but under the care of a certified physician, risk of scarring, swelling, bruising and infection is low. It is important to tell your doctor if you have a current cold sore or herpes outbreak or if you recently experienced an outbreak before your procedure: herpes infections are dangerous after laser resurfacing and require vigorous treatment. Other complications include prolonged redness, uneven surfaces and changes in skin pigmentation.

After the initial pinkness fades, patients will see a significant improvement in their skin. Final results of laser resurfacing treatments may take several months to fully see. Laser resurfacing leaves the skin looking younger, tighter and smoother. Make up can be used after about two weeks and it is important to protect your new skin with appropriate sunscreen.

When laser resurfacing is performed by a qualified, experienced physician, complications are infrequent and usually minor. However, because individuals vary greatly in their anatomy, their physical reactions and their healing abilities, the outcome is never completely predictable.

Risks associated with laser resurfacing include: burns or other injuries from the heat of the laser energy, scarring, and obvious lightening or darkening of the treated skin. Also, laser resurfacing can activate herpes virus infections (“cold sores”) and, rarely, other types of infection.

Additional corrective measures and treatment may be required if healing seems abnormal or delayed or if there is any evidence of abnormal pigmentation or scarring.

Laser resurfacing offers a number of advantages over other resurfacing methods: precision, little (if any) bleeding and less post-operative discomfort. However, laser resurfacing isn’t for everyone. In some cases, an alternative skin resurfacing treatment, such as dermabrasion or chemical peel, may still be a better choice. Call us for a consultation to determine which treatment is best for you.