Laser resurfacing

Overview

Laser resurfacing is a procedure that uses an energy-based device to improve the look and feel of skin. It's usually used to reduce fine lines, age spots and uneven skin color in the face. But it can't fix sagging skin.

Laser resurfacing can be done with various devices:

• Ablative laser. This method uses a beam of energy to destroy the outer layer of skin and heat the underlying skin. This stimulates the growth of collagen — a protein that improves skin firmness and texture. As the wound heals and skin regrows, the treated area is smoother and tighter. Types of ablative lasers include carbon dioxide (CO2) lasers, erbium lasers and combination systems.
• Nonablative laser or light source. This method also stimulates collagen growth. It's less aggressive than an ablative laser and results in a shorter recovery time. But the results are subtle. Two types of nonablative therapy are erbium (Er:YAG) and intense pulsed light (IPL).

Both ablative and nonablative methods can be done with a fractional laser, which creates microscopic columns of treated tissue. Fractional lasers shorten recovery time and reduce the risk of side effects. You'll likely need more than one treatment session. Use of fractional devices has become the widely preferred method.

Why it's done

Laser resurfacing is used to treat:

• Fine wrinkles.
• Age spots.
• Uneven skin color or texture.
• Sun-damaged skin.
• Mild to moderate acne scars.

Risks

Laser resurfacing can cause side effects, though they're milder and less likely with nonablative approaches than with ablative methods.

• Inflamed, swollen, itchy and painful skin. Treated skin may swell, itch or have a burning sensation. Your skin may look inflamed for several months following ablative laser treatment.
• Acne. Applying thick creams and bandages to your face after treatment can worsen acne or cause tiny white bumps to form for a short time. These bumps also are called milia.
• Infection. Laser resurfacing can lead to a bacterial, viral or fungal infection. The most common infection is a flare-up of the herpes virus — the virus that causes cold sores.
• Changes in skin color. Laser resurfacing can cause treated skin to become darker or lighter than it was before treatment. This is called post-inflammatory hyperpigmentation when the skin darkens and postinflammatory hypopigmentation when the skin loses color. People with brown or Black skin have a higher risk of long-term skin color changes. If this is a concern, seek out an expert with experience in selecting lasers and settings for a range of skin colors. Also ask about other facial rejuvenation techniques that are less likely to cause this side effect. Radiofrequency microneedling is one such option.
• Scarring. If you have ablative laser resurfacing, you are at a slightly higher risk of scarring.

Laser resurfacing isn't for everyone. You may be cautioned against laser resurfacing if you:

• Have taken the medicine isotretinoin in the past year.
• Have a connective tissue disease or an autoimmune disease or a weak immune system.
• Have a history of keloid scars.
• Have had radiation therapy to the face.
• Have had laser resurfacing before.
• Are prone to cold sores or have had a recent outbreak of cold sores or herpes virus infection.
• Have brown skin or are very tan.
• Are pregnant or breastfeeding.
• Have a history of an outward-turning eyelid. This condition is called ectropion.

How you prepare

Before your laser resurfacing, a member of your healthcare team:

• Asks about your medical history. Be prepared to answer questions about current and past medical conditions and any medicines you are taking or have recently taken. You also might be asked about previous cosmetic procedures you've had and how you react to sun exposure. For example, do you burn easily? Rarely?
• Does a physical exam. A care team member inspects your skin and the area to be treated. This helps show what changes can be made and how the features of your skin might affect the results of treatment. The exam also helps find out your risk of side effects.
• Talks with you about your expectations. Be prepared to talk about why you want a facial rejuvenation treatment, what kind of recovery time you expect and what you hope the results will be. Together, you and your healthcare team decide whether laser resurfacing is right for you and, if so, which approach to use.

Before laser resurfacing, you might also need to:

• Take medicine to prevent side effects. You may be given a prescription for an antiviral medicine before and after treatment to prevent a viral infection.
• Avoid sun exposure without protection. Too much sun up to two months before the procedure can cause a permanent change in skin color in treated areas. Ask a member of your healthcare team about sun protection and how much sun is too much.
• Stop smoking. If you smoke, stop. Or try not to smoke at least two weeks before and after your treatment. This improves your chance of avoiding side effects and helps your body heal.
• Arrange for a ride home. If you're going to be sedated during laser resurfacing, you'll need help getting home after the procedure.

What you can expect

During the procedure

Laser resurfacing is often done in a clinic. This is sometimes referred to as an outpatient procedure because it's not done in a hospital. Your care team numbs the skin with medicine. For treatment to the whole face, your care team might give you a medicine to help you feel calm or less anxious. This is called sedation.

During ablative laser resurfacing, an intense beam of light energy is directed at your skin. This laser beam destroys the outer layer of skin, also called the epidermis. At the same time, the laser heats the underlying skin, called the dermis. This stimulates collagen production over time, resulting in smoother skin.

Ablative laser resurfacing typically takes between 30 minutes and two hours, depending on the technique used and the size of the area treated. When done without a fractional laser, this approach usually needs only one treatment. If you're undergoing nonablative laser treatment or fractional Er:YAG laser resurfacing, you'll likely need 2 to 4 treatments scheduled over weeks or months to get the results you're looking for.

After the procedure

After ablative laser resurfacing, the treated skin will likely be swollen and itchy. The skin may change color. Your healthcare team applies a thick ointment to the treated skin and may cover it with an airtight and watertight dressing. You may take a pain reliever and use ice packs. New skin usually covers the area in 7 to 10 days. Full recovery takes at least a month.

During this time, don't use products that may irritate your face, such as cosmetics. And avoid situations that increase your risk of infection, such as public whirlpools. Always use sun protection following laser resurfacing.

The recovery time after nonablative laser resurfacing is very short. Your skin might be swollen or change color for a few hours. Use ice packs as needed. Typically, you can resume your usual activities and skin routine right away.

Results

Once the treatment area begins to heal, you'll notice that your skin looks and feels better than it did before the treatment. The effect may last for years.

Results after nonablative laser resurfacing tend to be gradual and progressive. You're more likely to see improved skin texture and color rather than smoothing of wrinkles.

With fractional nonablative and fractional ablative procedures, you'll need 2 to 4 treatments to get noticeable results. These sessions are usually scheduled over weeks or months.

As you age, you'll continue to get lines from squinting and smiling. New sun damage also can reverse your results. After laser resurfacing, always use sun protection. Every day, use a moisturizer and a sunscreen with an SPF of at least 30. Tinted sunscreens with iron oxide and titanium dioxide are useful for people with brown or Black skin. These products help protect against melasma and postinflammatory hyperpigmentation.