Ablative Laser Resurfacing: The History, Treatment Information and Results

Since the early 1990s, ablative lasers have become the high tech equivalent to deep dermabrasion or chemical peels for skin resurfacing; the removal of the outer layer of the skin to promote new fresh skin growth. There are two main types of ablative laser – carbon dioxide lasers, and erbium:YAG laser systems. Ablative laser skin resurfacing is a process where the upper layers of aged or damaged skin are vaporized by applying a controlled laser beam.

These skin resurfacing lasers briefly direct an intense burst of laser energy onto the skin. This energy heats water within the surface layers of the skin, causing both the water and the tissue to turn to vapor. Every time the laser passes over the skin, some of the outermost layers are removed in a precise and controlled way to the appropriate depth. The skin then heals over a period of time as new layers of collagen are produced. This can significantly reduce the appearance of lines, wrinkles, and pigment changes on the face, neck, and body.

Comprehensive consultations are available by Dr. Robinson. Please call (503)-635-8930 for details.

Laser Skin Resurfacing Background Information

The use of light as a medical treatment has grown considerably over the past few years. There are now many kinds of devices, which deliver various different types of light for an ever-increasing number of potential uses.

The use of light from lasers for medical procedures was developed in the 1960s when they were first used as cutting tools in operations by some surgeons. Laser technology has developed over the last few decades to treat patients with a variety of different skin problems including the effects of sun damage, the removal of body hair and recently the treatment of psoriasis and acne.

Since the early 1990s, ablative lasers have become the high tech equivalent of  deep dermabrasion or deep chemical peels for skin resurfacing (removal of the outer layer of the skin).Figures from the American Society for Aesthetic Plastic Surgery (A.S.A.P.S.) indicate that laser skin resurfacing was the sixth most common cosmetic treatment in the U.S.A. in 2009 with over 512,000 treatments. (Note: the number of treatments quoted by ASAPS included 27.2% carried out with an ablative laser and 72.8% with a non-ablative laser). See Laser/IPL Skin Rejuvenation for details of non-ablative techniques.

What are lasers and how do they work?

A laser is a high-energy beam of light that can be directed into certain areas or tissues within the skin. These beams of light are produced in one wavelength or color at a time, and can vary in terms of their strength and the type of tissue that they can target.

Ablative Lasers

The “ablative” or skin resurfacing lasers briefly direct an intense burst of laser energy onto the surface of the skin. This energy heats water within the surface layers of the skin, causing both the water and the tissue of the skin to turn to vapor. Every time the laser passes over the skin, some of the outermost layers of the skin are removed in a precise and controlled way to the appropriate depth (see diagram below).

The skin then heals over a period of time, as new layers of collagen are produced. The skin can literally resurface itself, causing an improvement in the appearance of sun damaged or acne scarred skin. After the treatment, the skin will look much healthier than it did previously.

This intensive treatment can significantly reduce the appearance of lines, wrinkles, and pigment (or skin color) changes on the face, neck, and other parts of the body. They can be used in sensitive areas, such as lines around the lips, eyes and even eyelids, or over the whole of the face. Acne and other types of scars and certain stretch marks can also be improved.

What happens during a Laser Skin Resurfacing treatment?

Depending on the area of skin to be treated and the type of laser system used, different treatment procedures may be recommended for you by your practitioner. Your first discussion with a practitioner should clearly set out your expectations of the laser treatment and whether your medical practitioner believes that he or she can achieve this for you.

A medical history should be taken at this time to make sure that there are no reasons why you shouldn’t have the treatment. You would normally be asked to read detailed information and sign a consent form which means that you have understood the potential benefits and risks associated with the procedure recommended for you.

Photographs may also be taken by the practitioner for a “before and after” comparison at a later date.

Treatment Procedure for Ablative Laser Skin Resurfacing

• Recommendations a week before the treatment may include stop taking any aspirin or non-steroidal anti-inflammatory drugs (NSAIDS) to reduce bleeding following treatment.
• We may recommend some form of pre-treatment to the skin 2 weeks before the procedure; these can include retinoic acid, or alpha-hydroxy acid based creams, which help to condition the skin and improve healing after the laser treatment.
• The full procedure usually involves the use of local anesthetic on the area to be treated and for larger treatment areas this may be combined with some form of sedation to make you drowsy during the procedure and to lessen any discomfort.
• Before laser resurfacing, the skin surface is treated with an antiseptic and gently cleansed. Surrounding hair is protected with wet gauze, and eye shields should be worn.
• If the eye area itself is to be treated, then intraocular stainless-steel eye shields are used to ensure that your eyes are fully protected from the laser.
• If you are not sedated, be prepared for a loud cracking noise when the laser is being operated as the beams are emitted onto the surface of the skin. Do not be alarmed: this is quite normal!

How long will it take to recover from Laser Skin Resurfacing?

Most people find that they can return to work after 7-10 days.

What are the risks or side effects from Laser Skin Resurfacing treatment?

• Immediately after laser skin resurfacing, you will have a raw, uncomfortable and weeping surface burn in the area treated. This will take 3 – 8 days to heal, depending on the extent and depth of the procedure and your healing capacity.
• Side effects or risks after the procedure can include infection, itching, swelling and pain at the treatment site.

  Skin erythema (redness) will last from several weeks to 6 months following the procedure. In rare cases, this redness can continue for longer.

• Milia (small raised cysts which look like white spots) usually occur during the first 6 – 8 weeks after treatment, and may remain from a few days to many weeks after the treatment.
• Hyper-pigmentation (increased pigmentation or color in the skin) can occur in the area treated, particularly in those with darker skin types.
• Hypo-pigmentation (decreased skin color) can also occur. This is less common and appears to be related to the depth of treatment, but can occasionally be permanent.
• Rarely, scarring of the skin can occur, which in some cases can be permanent.

What should you do after a Laser Skin Resurfacing treatment?

It is very important that you follow the advice of your practitioner carefully after any laser treatment to help the procedure to be successful and to reduce the risk of complications.

Post treatment advice may include:

• use recommended painkillers and sleeping tablets as required;
• follow the recommendation of your practitioner regarding your skin. The most important thing is that the wound is kept moist and clean during the healing process;
• sleep on your back with your head propped up by a few pillows;
• return to your practitioner a couple of days after treatment for an assessment;
• avoid strenuous exercise for a couple of weeks;
• avoid scratching or picking at the skin to reduce the chances of scarring;
• start using a sunscreen about 2 – 4 weeks after the laser treatment and avoiding any direct exposure to the sun for around 6 weeks;
• contact your practitioner immediately if you notice any signs of infection, scarring or pigment changes.

What is the average cost of Laser Skin Resurfacing?

Prices for a private laser skin resurfacing procedure can range from around $800 for a small area to around $3,800 for full face laser skin resurfacing.

Summary of advice for Laser Skin Resurfacing

Traditional ablative laser skin resurfacing has been shown to be very effective in improving deeper lines and wrinkles associated with sun damaged skin.
The downside is the recovery time, cost and potential complications.

As a consequence of this, the development of lasers has focused on so called non – ablative laser and IPL light sources that do not remove the surface of the skin, but still cause visible improvement of lines and wrinkles.

These alternatives do not, as yet, produce such dramatic and long lasting results as ablative lasers, but they are safer and involve virtually no recovery time.

Please see our laser/IPL/LHE skin rejuvenation section for more details.

You will often find that your practitioner recommends the use of botulinum toxin (Botox® or Dysport) at the same time as a laser treatment. This is to reduce creasing of the skin around the eyes or forehead during the healing process.

Obviously, this is only necessary for those who have had treatment in these specific areas. Botox® helps the skin to heal and also reduces the chances of reappearance of crow’s feet or forehead wrinkles after the procedure.

No matter what equipment or techniques is used, laser resurfacing rarely removes or markedly reduces deep wrinkles or facial sag. Another alternative for deep wrinkles, whether related to movement or not, are fillers such as Restylane or JuveDerm. Facelift remains the procedure of choice to correct marked facial sag.

Before and after photographs of Laser Skin Resurfacing

Results vary depending upon both the patient and the skill of the surgeon.

Results with Sciton Erbium & ProFractional Laser. Images provided courtesy of Dr. Lee Robinson.

All before and after photographs are real patients, your results may differ.