Aaron Stone M.D.

Laser skin resurfacing or abrasion uses a carbon dioxide (CO2) or Erbium laser to remove areas of damaged or wrinkled skin, layer by layer by vaporizing them. When a new outer surface of skin is regenerated from deeper layers it has less wrinkles or scars than originally present. The procedure is most commonly used to minimize the appearance of wrinkle like fine lines, especially around the mouth (vertical lip lines) or eyes (crow’s feet wrinkles) and to remove blotchy skin pigmentation from sun damage. It does not fill in wrinkles but vaporizes down surrounding tissue, i.e. it levels mountains rather than building up valleys.  Laser resurfacing may be performed on the whole face or in specific regions for a younger looking you.

The old ablative lasers have largely been replaced fractional lasers and radiofrequency treatments. Although these methods have virtually no down time they require multiple treatment sessions to achieve results close to those of the old ablative lasers single treatment results.

Before and after ablative CO2 laser treatment of sun damaged facial skin with concentrated islands of skin pigmentation and multiple fine skin surface wrinkles. This type of light skin pigmentation is the ideal candidate for CO2 laser resurfacing. A similar result is potentially achievable with chemical peeling as well.

Read Dr. Stone’s blog about laser skin treatmentsHome Laser and Cosmetic Devices

Laser skin resurfacing can enhance your appearance and your self confidence. Realistic expectations are important to be happy with any surgery. As each patient is an individual, different results can be expected in each patient.

Alternatives
There are many alternatives available for classical ablative laser resurfacing. They include old methodologies like dermabrasion and chemical peels and newer ones like radiofrequency (Thermi, Inmode…) and fractional laser. The best one for you depends on your skin type, what the actual problem is, your surgeon’s experience, your available recovery time, what result you are looking for and how much you want to spend.

Risks
At the junction of the treated and untreated areas, there may be a difference in color, pigmentation, and texture of the skin. This is minimized by your surgeon treating aesthetic units of the face and feathering the edges of treatment.

There may be alteration or unevenness of pigmentation, especially if oral contraceptives, valium or dilantin are being used. Pregnancy within 6 months of the procedure can also affect the resulting pigmentation.  Pigmentation changes and skin rashes can be prevented or minimized by the use of prescribed pre and post treatment creams.

Scarring is rare but may result from the procedure.  Its incidence is influenced by an individual’s genetic makeup and diminished by closely following postoperative instructions.  Use of Accutane at any time prior to or after laser treatment can compromise skin healing and increase the risk of scarring.  During the healing phase the regenerating skin surface is very fragile and minor trauma such as scratching can cause permanent scars.

As with any surgical procedure there is a risk of infection although this is rare.  It is usually responds to a short course of antibiotic therapy.  An out break of fever blisters can be induced by the laser.  This is prevented or minimized by taking the prescribed medications before and after laser treatments.

Eye exposure to the laser can cause permanent eye damage.  Therefore wet gauze placed over the closed eyes, protective goggles or corneal protectors must be used during the entire laser treatment.

Healing is more rapid with pre-laser treatment of the skin and the risk of hyperpigmentation is less with post laser treatment of the skin.

Benefits
The benefits are a smoother younger looking face with more even pigmentation. Depending on what you started with you could look 10 or 20 years younger.

Recovery
Cold/ice compresses are applied to the treated areas for the first 24 hours. Increasing swelling and redness takes place in treated areas for up to 3 days. During this period the eyes may be swollen closed and eyeglasses or contact lenses should not be worn. The head is kept elevated, no lying flat or head down position and vigorous physical activity is not allowed for 3 days. Following this crusts form on the weeping skin surface and usually separate within 5 to 10 days. To prevent scarring & infection DO NOT PICK AT OR SCRATCH CRUSTS. Normal activities & work may be resumed within 3 to 5 days. The treated areas are completely healed by about 3 weeks

If treated in a closed fashion with a dressing the face will be covered with a special face mask for 5 to 7 days.

Initial use of other topical ointments or makeup can cause contact dermatitis as the denuded & early new skin are very sensitive. Treated areas are very sensitive to sunlight & should be covered with 30 SPF or greater sunscreen at all times after any crusts have separated and no denuded skin remains.  If the eyelids have been treated sunglasses with UVA & UVB 100% filters should be worn.

During the second week after treatment a skin moisturizing & protecting cream is applied.  Usually a sunscreen & skin bleaching cream is applied beginning the third week after treatment.

Normal make-up can be applied when all areas are healed by about 3 weeks.

The skin will have a reddish pink appearance that persists from 6 weeks to as long as 6 months or more. This can be treated with a different flashlamp laser treatment if desired about 6 months after the CO2 laser treatment and/or a topical cream.

Dr. Aaron Stone

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