Laser resurfacing is a technique used wherein molecular bonds of a material are dissolved by a laser.  It is used for the treatment of wrinkles, , sun spots, sun damage, scars (see acne scar treatment), stretch marks, actinic keratosis  or pre cancers, and telangiectasias or “spider veins”

It can be combined with liposuction when this is done to remove excess fat from the chin and jaw area. The skin may be wrinkled after fat is removed and laser resurfacing can help tighten and smooth over the new contours.  Some laser modalities like the new Fractional Co2 Laser and the traditional co2 laser can be used as cutting devices that can actually assist the physicians with their surgery.

Laser resurfacing is traditionally has been done with an Erbium:YAG 2940nm wavelength or traditional CO2 10,600nm wavelength laser. Complete resurfacing was first done with  the traditional CO2 laser.

With advanced technology available, currently most laser resurfacing is done with a fractional co2 laser.  The term fractional pertains to the method in which the laser light is transferred. Tiny pinpoints of laser light are used to deliver the laser to the surface of the skin in only a fraction of the area.  Several hundred or thousands of pinpoints may be used per square inch, leaving healthy skin in between the ablated areas. This is intended to allow more rapid healing and less risk.  The laser resurfaces the top layer of skin while also utilizing heat to contract and contribute to new collagen formation.

The newest types of laser resurfacing are Radio Frequency (Syneron Matrix RF), Erbium (Er:YAG) Fractional Co2 lasers (like Sciton Profractional, SmartXide Dot, and the Fraxel Re:pair) lasers. These were developed to remove skin more precisely, layer by layer, using very short pulsed light energy or continuous light beams that are delivered in a scanning pattern to remove thin layers of skin with minimal heat damage to the surrounding structures.

Skin resurfacing can also be performed with a plasma based device instead of a laser.  At least one manufacturer of such a plasma device claims “It’s the only treatment proven to generate new skin – at the fundamental levels – for as long as a year after treatment”. However these claims do not have supporting evidence published in a peer reviewed medical journal, and have not been verified by any independently funded studies. Superiority to laser-based devices remains an open question.

Fractional photothermolysis is another form of laser treatment with several devices currently on the market including Matrix RF, Fraxel Re:store Laser, Pixel, Lux1540, and Affirm.  Some doctors claim FP provides similar results to carbon dioxide laser resurfacing without risk of scarring or significant downtime.  Though this may be true to some extent, the number of treatments needed and the level of improvement available still do not compare to the traditional co2 laser.  However, fractional co2 lasers and FP can provide similar results with the primary difference being the number of treatments needed.  FP will typically require 3-4:1 over the new Fractional Co2 technology.

As of January 2008, there are a number of papers referenced on Pub Med which mostly support those claims. Complications observed in a study of 961 treatments included acneiform eruptions (1.87%) and herpes simplex virus outbreaks (1.77%). Side effects and complications observed in this study were of a temporary nature PMID 18190541. There have been, however, anecdotal negative accounts of bad scarring and hyperpigmentation without any findings of infection [1].

When compared to a chemical peel, dermabrasion or other forms of laser treatment, a laser allows the surgeon to customize the surgery not only for each patient but also to each area of the face.  They can more easily target problem areas like around the mouth or crows feet.

CO2 laser resurfacing has been shown to have an increased risk of hypo-pigmentation and scarring when compared to the erbium lasers.  This is due to the high degree of coagulation and thus heat production that occurs as a nature of the Co2 wavelength.  Both Erbium and Co2 fractional systems have a better safety profile than lasers of the past.

Both Erbium and CO2 are used to treat deep rhytides, sun damage and age spots. Through the heating of the deep dermis, fibroblasts are stimulated to form new collagen and elastin helping to bring increased turgor and thickness to the skin.  You will continue to see improvement with a fractional co2 laser for up to six months which means that you have to wait some time to see the final results.