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Laser Skin Resurfacing
Laser skin resurfacing can remove wrinkles, discolorations, age spots, and treat sun damaged skin and can stimulate your body's fibroblasts to increase collagen production. Laser resurfacing treatment is used when skin problems are moderate to severe—wrinkles especially around the eyes and mouth (crow’s feet and lipstick lines), uneven pigmentation including port-wine birthmarks, skin blemished with scars from accidents or acne, and some tattoos.
A laser is a high-energy beam of light that can selectively transfer its energy into tissue to treat the skin. It works like high-tech scalpel that allows the physician greater control and finesse. Laser devices can be classified as ablative and non-ablative. Ablative lasers literally remove damaged upper layers of skin, allowing a fresh layer to emerge. Lasers also act as thermescent fibroblast stimulators. Non-ablative treatment does not involve resurfacing but rather the uses the laser’s heat to stimulate fibroblast production, thereby, thickening the underlying collagen structure and treating a wrinkle from the inside out rather than remove it.
Different types of lasers (CO2, Erbium YAG, Cool Touch) are suited to treating specific problems.
Though still a fairly new surgical method, laser resurfacing has been shown to produce less, if any, bleeding, bruising and post-operative discomfort than is typically seen with other resurfacing techniques. It cannot, however, smooth prominent folds around the nose and mouth, jowls, eyelids, or prominent frown lines on the forehead. These require surgical procedures such as a facelift, eyelid lift, brow lift or, alternatively, collagen or other fillers and/or BOTOX® injections. Laser resurfacing is often done in conjunction with these procedures, however.
What does it cost?
The different treatments vary in cost according to the area treated, the individual physician and where he or she practices. Generally, full-face laser resurfacing treatments range from $2750 to $4200 US, while partial face treatments cost $1000 to $2600 US. In Canada, this procedure can start at $1,000 and cost up to $8,000 CDN.
In certain cases, health insurance may cover the laser surgery if it is to correct or improve congenital deformities or accidental skin injuries or the removal of pre-cancerous skin. Be sure to check your policy and contact your insurance company before the procedure is performed.
What happens during the procedure?
Laser resurfacing is usually performed in a physician’s office or in an outpatient surgical center, either operated by your physician or a hospital facility. If you are having another procedure, such as a facelift or eyelid lift at the same time, then overnight hospitalization may be required.
Laser resurfacing is normally performed under local anesthetic with mild or deep, intravenous sedation. Topical anesthetic are also used to numb the skin in more superficial procedures. Your physician may suggest general anesthesia if the procedure is going to be extensive. How long laser resurfacing can take is highly individual. Depending on the extent of the treatment, a procedure can take anywhere from a few minutes to an hour or more for more deeper treatments. Prior to undergoing a procedure, your physician will take your health history and may require a routine physical exam, including some blood tests.
The laser is passed over the area to be treated and literally evaporates the targeted areas of skin, leaving only a faint trace of "smoke" behind and revealing the lower layer of new, pink skin. By making more than 1 or 2 very deep passes, the physicians can avoid leaving a noticeable "line" where the laser did not pass, such as at the jaw line and the area in front of the ears. The more numerous and light the passes, the more blended the area is with non-treated skin, meaning there is no telltale line.
The most commonly used lasers are the carbon dioxide (CO2) laser, NLite laser and the Erbium:YAG laser. Each is selected for to treat specific skin conditions because each works slightly differently. For some darker skinned patients, The Erbium, pulse dye and NLite laser may be a safer choice although every case is individual
The Cool Touch Laser (thermescent Nd: YAG 1320 LASER) is considered a non-ablative and can purportedly be used on any skin color, any skin type, and on any part of the body without the risks of hypo- or hyperpigmentation and does not require the healing time associated with conventional lasers. First, the skin is numbed with a spray of super-cooled cryogen gas, then, a series of rapid-pulse Nd-YAG laser beams are directed at the area to be treated. Little discomfort is reported during the treatment and healing is quick. The procedure is repeated in a series of three to five visits. The resulting tightening of the skin continues for several weeks afterward. The treatment appears to be especially suitable for lines around the eyes and mouth.
The Er:YAG Laser (Erbium) is also emitted in pulses, thereby evaporating the skin’s superficial layers while avoiding the heat emitted which results in less damage.
The NLite: (class IV medical, non-ablative HeNe flashlamp pumped, pulsed-dye LASER) is a device specifically designed for non-ablative removal of wrinkles and rejuvenation by stimulating fibroblast production. Non-ablative lasers do not cause resurfacing or removal of epidermal layers but rather stimulate your fibroblasts or collagen by triggering a thermal wound response. The yellow light of NLite passes right through the skin without damaging the NLite and does not require a blast of cold gas to protect the epidermis because it does not reach the same level of heat as the Cool Touch Laser.
Are there risks or potential side effects?
Although laser skin resurfacing is a considered a safer, less invasive procedure than deep chemical peels or dermabrasion, it is not for everyone. Laser surgery is a relatively new technique, but in the hands of a qualified physician complications are infrequent and usually minor.
As with all elective procedures, there is always a possibility of complications including infection, blisters, burns, scarring, temporary or permanent Loss of sensation or pigmentation changes. Any skin resurfacing treatment carries the risk of cold sores in persons who have a history of recurring fever blisters or herpes simplex. Before you undergo laser skin resurfacing, tell your physician if you have a history of cold sores, a tendency to scar unusually. Acne breakout after resurfacing, especially in those who have suffered from acne before but can be treated with antibiotics. Milia, very small superficial cysts may appear on the treated skin but these can be removed. Finally, contact dermatitis can appear following the treatment due to the use of antibiotic ointments.
Two particular risks are adhesion and ectropion. Adhesions occur when treated areas of skin may remain in contact with each other after the procedure and can heal together, forming a small fold in the skin. This risk is decreased by making sure problems areas, such as the lower eyelid, are taut when the dressing is put on after the procedure. Ectropion is a rare but serious complication of both blepharoplasty (eye lid lift) and laser resurfacing around the eye area. As elastic tissue is lost with aging, there is a pulling down of the lower lids the lower eyelid making it appear inverted. The exposed portion of the inside of the lid can become irritated, and the outlet for the tear duct then drains tears onto the face.
If your skin is olive, black or brown and even yellow skin - take care in your choice of resurfacing measures. It is important to note that Asians and people of color tend to have a darker skin tone than Caucasians, and as a result, have a different set of complications caused by skin resurfacing treatments like permanent discoloration or blotchiness. Those of Asian, African and Latin origins are at a higher risk for hyperpigmentation of the skin (darkening of the skin). It is recommended that these individuals make sure that they see an experienced physician who has performed laser skin resurfacing on darker skins, and who is aware of how to treat such skin types. You should also ask for a "spot test" if you are uncertain as to the results.
Although age is not a limiting factor in most cases, it is important to recognize that older people heal more slowly. Acne sufferers may not be able to undergo the procedure if their acne is in an active stage due to a greater risk of infection. Be sure to ask your physician about all of the risks associated with the procedure you are considering before you make any decision.
Time and gravity cannot be stopped and laser skin resurfacing may rejuvenate the skin but it will not stop the aging process nor is it a substitute for a facelift. Lines and wrinkles will, eventually recur.
More extensive laser surgery, as with any other surgical procedure, requires you to be in good health. Sun protection is one of the most important things you can do to make sure your skin stays fresh and smooth looking. Your doctor may suggest a skin-care program as well.
What to expect post-procedure?
After the skin has been treated with the laser, it will covered with either a thin film of Bacitracin or antibiotic burn cream like, Silvadine. Sometime, a second synthetic breathable skin is applied to protect the newly surfaced tissue the first five to ten days during the healing process.
Redness and swelling and slight discomfort are all to be expected. Your physician will give you instructions on the proper care of your skin and will prescribe the necessary antibiotics and pain medications to help alleviate discomfort. Applying small ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with an ounce of frozen berries or peas. Regular icing is the key to relieving the swelling for the first 48 hours but you must avoid getting the area wet.
How soon does normal life resume?
The healing time depends on the depth to which the laser penetrated. It may take a week or more to recuperate after laser resurfacing. Your skin will feel like a bad sunburn and you may get crusting, which you should not pick off. Your skin will probably scar more from picking than before your treatment, however, crusting usually subsides in a little over a week. The skin might weep and need dressing changes and additional application of the ointments your physician will may give you. The skin will turn pink, but it may take up to six months for the skin's redness to completely fade, and up to one year for normal pigmentation to return.
You may be given a bovine mucalpolysacharide solution or wash, this is a cow-derived cartilage extract that has the anti-inflammatory properties of 1-2% hydrocortisone. It accelerates epidermal healing. You will probably be able to return to work and social activities from a week to two weeks following the procedure. You will most likely be advised to avoid strenuous activity and exercise for up to six weeks. Makeup can usually be worn a week to two weeks after the procedure and there are special products available to offset the skin’s redness. Your physician will let you know when you can use AHA's and/or Vitamin A.
The most important factor is proper healing is protecting your skin from the sun. It is extremely important that a sunscreen with UVA and UVB block be used at all times. Patience is also important as it may take 3 months for the final results to be noticeable.
Who performs it?
Laser skin resurfacing is usually administered by a plastic surgeon, a dermatologist, an otolaryngologist (ENT) or an oculo-plastics specialist.
Are you a good candidate?
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to reduce refine the texture and pigmentation of your skin without surgery, then a chemical peel may be appropriate, however:
- Those who suffer from a connective tissue disorders, such as lupus erythematosus or Sjogren's syndrome or those who have problems with their immune system are not appropriate candidates.
- Your skin type and color, ethnic background and age will be factors in determining if this type of treatment is right for you.
- You must be free of active skin infections, including most kinds of acne and any type of cold sore, including herpes simplex.
- You must not have taken Accutane® for the previous 18 months at least.
- Darker skin poses special considerations due to increased risk of undesirable skin pigmentation changes. Black skin, Asian skin, and other dark complexions may become permanently discolored or blotchy after any skin-refinishing treatment.
- Make sure you are not prone to scarring problems such as keloids or if skin does not react well to burns or excessive scarring due to minor cuts and abrasion. If you scar badly when you are burned, the results of laser resurfacing could be disastrous.
- Make sure your doctor is aware of any medical conditions or allergies you may have and any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
- Make sure you have a good understanding of the limitations of the procedure.
- An ideal candidate would be of European descent with elastic, non-oily skin.
How to prepare for this procedure?
You may be prescribed medication to take prior to the treatment to prevent a bacterial infection or fever blisters (herpes simplex) and topical medications such as tretinoin (vitamin A) and hydroquinone to prepare your skin, aid in healing and decrease the risk of undesirable pigmentation changes. You will be asked to limit your sun exposure at least a month before the procedure. Your physician will give you specific instructions to prepare for the procedure but these are some general guidelines to follow:
- You should wear loose clothing that to put on over your head.
- You should refrain from wearing makeup, wearing any perfume, and shaving on the day of treatment.
- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as Motrin® or Advil®, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed. Besides, smoking increases muscle activity and can contribute significantly to wrinkles.
Are there alternatives to this procedure?
Alternatives to laser skin resurfacing include chemical peels, dermabrasion, and injectable fillers like collagen, etc. Although laser skin resurfacing can have a rejuvenating effect on the skin only a surgical procedure like facelift, eyelid lift or brow lift can actually tighten sagging skin. Finally, vitamin A, glycolic acid and other topical treatments, known as “skin polishers”, stimulate generation of new skin from underneath and promote filling in of wrinkles and depressed acne scars. These preparations are often used to pre-treat the skin before administering a skin resurfacing treatment.
Locate a certified physician with our Doctor Locator.
To view Personal Stories about this procedure contributed by our members, Click Here.
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