Laser Resurfacing

Lasers are currently the most effective exfoliation tools for eliminating wrinkles. Their unique advantage over other resurfacing methods is their ability to tighten the skin. A successful procedure can make patients look 10 – 20 years younger, and the results can last for up to 10 years.

The procedure is most beneficial for the following areas:

  • It is best around the mouth and eyes. Recent evidence suggests CO2 lasers may be even better than dermabrasion for the upper lip.
  • It is slightly less beneficial for the area around the nose.

When used alone, current laser therapy does not eliminate crow’s feet, broken blood vessels, or dark circles under the eyes. Evidence on the effects of lasers on acne scars is incomplete.

Standard laser dermabrasion is too harsh for thinner skin layers, such as on the neck. Newer and gentler laser techniques, however, stimulate collagen without removing skin layers, and may prove useful for necklines.

The Laser Resurfacing Procedure. In general the procedure works in the following way:

  • Laser pulses penetrate the skin quickly, vaporizing water and surface skin without damaging the deeper layers, allowing new top skin to grow.
  • The laser delivers enough heat to shorten collagen fibers, restoring some elasticity to the skin.

Choice of Lasers. The lasers used depend on the skin type and severity of the condition. Some of the more common laser types are:

  • The carbon dioxide (CO2) laser. This is the most powerful laser treatment and is used for deep wrinkles and skin imperfections. The laser damages the skin by destroying water molecules inside and outside of the cells. In response, the skin produces more collagen, which fills in wrinkles. Research finds that the carbon dioxide laser reduces wrinkles safely and effectively over the long-term. People who have had silicone injections should not have CO2 procedures, because they can burn and scar the skin over the implanted area.’
  • Fractional Co2 Laser.  The Fractional CO2 laser is the newest and currently the most effective laser for the treatment of fine lines, wrinkles, acne scars, and pigmentation issues.  It resurfaces the skin much like the ablative CO2 laser but with much less recovery time or risk of side effects.  The fractional co2 technology provides patients with excellent results after only one to three treatments.
  • Fraxel Laser.  Fraxel laser was developed by Reliant technologies and provides an ablative fractional laser that is good for moderate acne scarring, pigmentation, port wine stains, and fine lines and wrinkles.
  • The erbium: YAG (Er:YAG). This laser is gentler than the CO2 laser, and is effective for mild wrinkles and for providing a smooth skin texture. It has a shorter recovery time. Some experts have even found the YAG laser to be as effective for removing deep wrinkles as the CO2 laser when used to sufficient depth. A variable pulse YAG laser can shift between pulses that destroy skin tissue to those that heat the skin. This process effectively resurfaces the skin with fewer side effects than CO2 laser therapy.
  • Pulsed dye laser (PDL). A pulsed dye laser uses yellow light, which is easily absorbed by hemoglobin, the molecule that gives blood its red color. Pulsed dye laser treatments are used to treat skin blemishes, such as port-wine stains, that are due to blood vessel abnormalities.
  • Radiofrequency Resurfacing. A promising technique uses low radiowave energy to resurface the skin. Preliminary research indicates that this procedure may eventually be as effective as laser surgery in reducing severe wrinkles around the eyes and mouth, with minimal pain and a shorter recovery time. A small clinical trial found that a noninvasive radiofrequency technique called NARF safely and effectively improved drooping lower eyelids.
  • Intense Pulsed Light.(IPL) Intense pulsed light (IPL) uses filters to deliver different wavelengths of light. Doctors use it to treat a number of photoaging skin problems, and it appears to have long-term effects. Typically, four to six treatments are performed over a 4-month period. Each treatment takes 15 – 20 minutes. Unlike laser light, which uses one color wavelength (such as green or red), intense pulsed light starts with a full spectrum of light. It then allows the doctor to selectively block off specific wavelengths, depending on how shallow or deep the procedure goes. IPL machines are less expensive and safer than lasers.
  • Plasma Skin Resurfacing, Portrait Plasma, was introduced in February 2005.The technology uses plasma energy (heat and light energy) to rejuvenate the skin from the deeper layers outwards. While new skin regenerates, the outer layers of the skin act as a natural bandage. When the outer layers peel off in the week after treatment, the new skin emerges. The process prevents or minimizes the raw appearance that follows laser treatments. This system uses radio waves to “excite” nitrogen gas, resulting in the release of energy. According to the manufacturer, skin regeneration using the Portrait Plasma system is rapid, and satisfaction with the procedure appears high. Long-term follow-up studies are not yet available for this new method. In 2006, the Food and Drug Administration also approved Plasma Skin Resurfacing for the treatment of wrinkles on other areas of the body.
  • Photodynamic therapy(PDT), appears to reduce the signs of aging even better than laser therapy alone. Photodynamic therapy uses a medication (such as 5-aminolevulinic acid) that is activated by laser light. In one study, this treatment dramatically increased levels of a protein involved in the growth of new skin cells, as well as substances involved in the production of collagen. Photodynamic treatment also increased the thickness of the skin’s outer layer (the epidermis).

A gentle laser procedure called non-ablative laser resurfacing (NLite) or photorejuvenation is now approved for the treatment of all facial wrinkles. The procedure uses light energy to gently stimulate new collagen, and possibly elastin production, without removing the skin tissue itself. Its effects are less pronounced than those of other laser procedures. However, because it does not injure the external layers of skin, it can be used on delicate skin areas, such as the neck and around the eyes. It also causes very little irritation afterward.

Some surgeons are using combination techniques with more than one laser technology in one session, to achieve different effects. For example, one combination technique uses CO2, YAG, pulsed-dye laser, and one other laser technology to both improve wrinkles and clear under-eye dark circles and acne scarring. Pretreatment with botulinum (Botox) injections before laser resurfacing significantly improved the treatment of crow’s feet in one study.(Do not do Botox Post Laser)

Post-Procedure Recovery.

The procedure itself is relatively painless, but the redness and irritation that occur during the healing process can be severe. Non-ablative laser resurfacing does not have the same severe after-effects as other laser treatments. For 8 – 9 days, the face looks skinned and swollen, and requires continuous moisturizing. Some doctors suggest that people with very sensitive skin who cannot tolerate the necessary medications and lubricants avoid laser resurfacing. Redness and sensitivity can persist for 1 – 4 months. The patient must stay out of the sun as much as possible during this time, and should always avoid sunbathing and damaging their skin again. Early research suggests that silicone dressings may reduce post-procedure pain and crusting.

Complications.

Scarring and infections can occur in about 1% of procedures. The risk of complications depends on the surgeon’s experience. People with a history of herpes simplex may experience flare-ups of fever, facial pain, and flu-like symptoms for 5 or 6 days after the procedure. In addition, people with darker skin may wish to avoid the procedure, because it can cause unpredictable and dramatic lightening of the skin.