Laser resurfacing is a treatment to improve the look of the skin. It uses a laser to send out brief pulses of high-energy light. This light is absorbed by water and substances in the skin called chromophores. The light is changed into heat energy. The heat then destroys (vaporizes) thin sections of skin, layer by layer. As the wounded area heals, new skin grows to replace the damaged skin that was removed during the laser treatment. Some lasers only tighten the skin by heating it but do not destroy the skin.
The CO2 (carbon dioxide) laser is the most common type of laser used for resurfacing. Erbium lasers are also used often.
In most cases, laser resurfacing is very precise and causes little damage to the surrounding skin and tissue. It is done most often on the face, but it may be done on skin in other areas of the body, such as the hands, neck, and chest.
Newer laser methods
Newer methods of laser resurfacing cause fewer problems and have faster recovery times. These methods include:
- Fractional laser skin resurfacing. This treats microscopic columns of skin. The treated areas of the skin are surrounded by untreated areas. The result is visible improvement without much bleeding or scabbing.
- Plasma skin resurfacing. This technique uses plasma energy to destroy the lower layers of skin. It does not affect the top layer of skin. This top layer protects the lower layers of skin as they heal.
- Superficial erbium: YAG laser resurfacing. This is a mild laser treatment method. It works best for minor wrinkles and other skin problems.
- Infrared laser resurfacing. It targets deeper layers of the skin with heat to smooth and tighten the skin.
How it is done
The areas to be treated are cleaned and marked with a pen. A nerve block with a local anesthetic is usually used to numb the area before treatment. You may also get medicine to help you relax. If your whole face is going to be treated, you may need pain relievers, sedation, or stronger anesthesia. (In some cases, general anesthesia is used.) You may need to wear goggles to prevent eye damage by the laser. And wet towels will be placed around the area to absorb excess laser pulses.
The laser is passed over the skin, sending out pulses. Each pulse lasts less than a millisecond. Between passes with the laser, the skin will be wiped with water or a saltwater solution. This is done to cool the skin and remove tissue that the laser has destroyed. The number of passes needed depends on how large the area is and what type of skin is being treated. Thin skin around the eyes, for instance, needs very few passes with the laser. Thicker skin or skin with more severe lesions will need more passes.
The pulses from the laser may sting or burn slightly. You may feel a snapping feeling against your skin. In most cases, there is little or no bleeding. Severely damaged skin is more likely to bleed. When the treatment is done, the area is covered with a clean dressing or ointment.
Laser resurfacing is usually done in a doctor's office or an outpatient surgery centre.
What To Expect After Surgery
The time needed to heal and recover after laser resurfacing depends on how big and deep the treated area is. Someone who has the full face resurfaced, for example, will take longer to recover than someone who has only a small area of skin treated.
In most cases, the wounded area will be pink, tender, and swollen for at least several days. Cold packs and non-steroidal anti-inflammatory drugs (NSAIDs, such as aspirin or ibuprofen) may help reduce swelling and pain. After the skin grows back, the skin will stay red for several weeks.
Proper care of the treated area while the skin heals is very important.
- Rinse the skin several times a day with cool tap water to avoid infection. This will also help to get rid of the crusting that may form. Avoid soaps and perfumes.
- Change the ointment or dressing on the treated area to keep the area moist. This will help the skin heal.
- Avoid sun exposure. After the peeling has stopped, use sunscreen every day. New skin is more likely to be damaged by the sun.
If you are getting treatment around your mouth, you may get an antiviral drug called acyclovir to prevent infection. Tell your doctor if you have had cold sores in the past.
You will need several follow-up visits to your doctor. The doctor will keep track of how well the skin heals and regrows. He or she will also watch for and treat early signs of infection or other problems.
Why It Is Done
Laser resurfacing may be used to remove or improve the look of:
- Superficial scars from acne, surgery, or trauma that are not growing or that are getting thicker.
- Colour (pigment) changes or defects in the skin, such as liver spots, port-wine stains, or café-au-lait spots.
People with lighter skin who do not get a lot of sun exposure after the procedure tend to have the best results. People with darker skin may benefit from laser resurfacing, but their skin may not heal as well.
You may not be a good candidate for laser resurfacing if you:
- Have had skin colour changes, scarring, or thickened tissue (fibrosis) from earlier treatment.
- Have a skin, blood flow, or immune disorder that could make healing harder.
- Have a history of abnormal scarring (keloid or hypertrophic scars).
- Are using isotretinoin (a drug used to treat acne) or have used it in the last 6 to 12 months. This raises the risk of scarring.
- Have a bacterial or viral infection of the skin.
How Well It Works
There are many things that can affect the short-term and long-term results of laser resurfacing. These include your skin type, the health of your skin, how much experience your doctor has, the type of laser used, and your lifestyle after the treatment. Some types of skin problems or defects respond better to laser resurfacing than others. People with lighter skin who limit their time in the sun after treatment tend to have better results than those with darker skin and those who keep spending lots of time in the sun.
In general, laser resurfacing tends to have good results with fairly low risks.
- Wrinkles caused by aging and long-term sun exposure, such as those around the eyes and mouth, respond well to laser resurfacing. But the long-term results for these types of wrinkles aren't known. Keep in mind that new wrinkles will probably appear as your skin ages.
- Wrinkles caused by repeated movement and muscle use (such as those on the forehead or along the sides of the nose) may be improved. But they won't go away completely. They often come back months or years later because the muscles still perform the movements that caused the wrinkles.
- Mild or moderate acne scars may be somewhat improved. Laser treatment doesn't work as well on severe acne scars.
The long-term results of laser treatment may not be seen for several months.
Side effects and risks of laser resurfacing may include:
- Swelling, itching, crusting, and soreness. These are expected effects of laser resurfacing. They will go away over time.
- Redness. Normally this lasts 6 to 12 weeks, but it may last up to 6 months. Some people may turn red or flush during stress or exertion more easily than they used to. This can last for up to a year.
- Colour (pigment) changes in the skin.
- Skin irritation, including acne flare-ups in people who are prone to acne.
- Bacterial, viral, or fungal infection of the skin. Infection may affect the rest of the body also.
- Scarring (rare). Scarring may be improved with medicine.
- A condition in which the edge of the eyelid rolls outward and exposes the inside of the eyelid. (This is called ectropion.) It is a rare but serious complication of laser treatment in the eye area. Surgery is sometimes needed to correct it. It is more likely to occur in people who have a loose lower eyelid or who have had surgery (blepharoplasty) on their lower eyelids.
What To Think About
Laser resurfacing first injures or wounds the skin and then destroys the top layers. You need to prepare yourself for how your skin will look after treatment and throughout the healing process. It is also very important for you to follow your doctor's instructions on caring for your skin after the treatment. This will help you avoid infection and help your skin heal.
Be sure that your doctor knows what you hope to achieve. And make sure that you know what results you can expect. Even with realistic expectations, you may not see results for several weeks or months after the treatment. And you may need more than one treatment to get the results you want.
After laser resurfacing, you will need to wear sunscreen every day and avoid the sun as much as you can. New skin is more likely to be damaged and change colour from sunlight.
Options for resurfacing
Laser resurfacing, chemical peel, and dermabrasion are the most common techniques to improve the texture and look of the skin. These techniques use different methods, but they have basically the same effect on the skin. They destroy and remove the upper layers of skin to allow the skin to regrow.
No one technique is better than the others. When done by an experienced surgeon, laser resurfacing may be slightly more precise than chemical peels or dermabrasion. But the choice of technique is based on the site you want to treat, your skin type and condition, the doctor's experience, your preferences, and other things. Some people may get the best results by using more than one technique.
Other Works Consulted
- Tanzi EL, Alster TS (2012). Ablative lasers, chemical peels, and dermabrasion. In LA Goldman et al., eds., Fitzpatrick's Dermatology in General Medicine, 8th ed., vol. 2, pp. 3021-3031. New York: McGraw-Hill.
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