Laser Skin Resurfacing
As you get older, you may begin to notice signs of skin damage that occurs naturally from aging. (1) It is normal to accumulate damage over the years from sun exposure, acne flare-ups and other lifestyle choices.
You may also get wrinkles or fine lines as you get older because the collagen that keeps skin tight begins to break down. Perhaps you have tried using prescription medications or facial preparations to get rid of blemishes or lines with little luck obtaining the desired results.
If you are looking for another option to rejuvenate the appearance of your skin, laser skin resurfacing may be the right treatment for you.
Laser skin resurfacing works by focusing a laser that emits light of a particular wavelength to a targeted area of skin. Water in the skin absorbs the light energy and gets converted into steam, resulting in controlled damage to the skin. (1)
Laser skin resurfacing removes the thin top layer of damaged skin and heats the lower layer. The injury the laser causes stimulates a healing response, promoting the growth of new collagen and the appearance of fresh and tighter looking skin. (2)
The type of laser that is used during the procedure will depend on skin colour, the type of blemish you would like treated and how quickly you would like to recover from the treatment.
There are two main types of lasers used during the procedure, namely ablative and non-ablative lasers.
- Ablative – Ablative lasers are more invasive and remove the outer layer of damaged skin, while also heating the lower layer to stimulate collagen growth. Two frequently used ablative lasers are carbon dioxide (CO2) and Erbium. CO2 lasers are good for treating scars, warts, wrinkles and deeper skin blemishes. Erbium may be best used for individuals with darker skin and can treat fine lines, wrinkles and age spots. (3) Since ablative lasers remove the top layer of skin, the healing process may take longer. (3)
- Non-ablative – Non-ablative lasers are considered to be non-wounding because they pass through the outer layer of the skin and do not remove that layer. (3) Instead, they heat the lower layer to stimulate collagen growth. This results in a shorter healing time, but also may make non-ablative lasers less effective. (3) Types of non-ablative lasers are pulsed-dye, ND: YAG and Alexandrite. These types of lasers can be used to treat skin colour changes, redness and rosacea.
Both ablative and non-ablative methods can use a fractional laser, which breaks up the laser into multiple beams so that some sections of the skin area remain untreated. Fractional lasers can help promote a shorter recovery time. (2)
There are several types of lasers that are used to treat a variety of skin conditions, and new ones seem to be introduced on a regular basis. Among the most commonly used lasers are:
- Fractionated lasers: These types of lasers use ablative laser technology. They were developed as an alternative to more intense treatments. They are excellent treatments for sun damaged skin, acne scars, wrinkles, and for improving skin texture. Fractional lasers are a popular choice because they involve considerably less downtime and recovery than traditional lasers.
- Carbon Dioxide Laser (CO2): CO2 lasers are ablative lasers frequently used to improve acne scars, wrinkles, skin tone and skin texture. The main downside of CO2 lasers is that they are invasive, meaning there is considerably more recovery time involved and you will have some lingering pinkness in the treatment area for approximately a month.
- Erbium-YAG (yttrium/aluminum garnet) or Er:YAG: Energy from Erbium-YAG lasers are absorbed by the superficial layers of the epidermis, getting rid of damaged or unwanted tissue. The pulsing actually lessens the heat on the skin, resulting in less damage. This laser is a less invasive alternative to CO2 lasers and is frequently used to treat sun-damaged skin. These lasers are not as effective for deeper wrinkles, but the recovery time is shorter.
- Q-switched Nd:YAG laser: These types of lasers are commonly used to remove tattoos. They can remove pigmentation lesions and black or blue tattoos.
- High-Power Long-PulsedNd:YAG: This system is a popular choice for vascular lesions and to remove unwanted hair.
- Long-Pulsed Nd:YAG laser: This laser is ideal for vascular lesions, broken capillaries, redness, facial flushing and telangiectasia (blue or purple spider veins on the face).
A good candidate for laser skin resurfacing is someone who wants to improve any of the following: (2, 4)
- Fine lines
- Loss of skin tone or uneven skin tone
- Fine wrinkles
- Age spots
- Sun-damaged skin
- Mild to moderate acne scars
- Liver spots
- Enlarged oil glands
Laser skin resurfacing skin care procedure. American Society of Plastic Surgeons website. Accessed October 26, 2020. https://www.plasticsurgery.org/cosmetic-procedures/laser-skin-resurfacing[/tip] You may need to discuss with your doctor your eligibility for this procedure if you have the following: (1, 2, 4)
- A history of poor scarring or keloid development (raised scars)
- A history of herpes
- Darker skin tone
- Allergies to topical anesthetics
- An autoimmune disease or weak immune system
- Radiation therapy to the face
- Active acne
- Deep wrinkles
- Taken the acne medication isotretinoin for the last year
Note that this procedure is not used as a skin tightening treatment. (4)
Before getting laser skin resurfacing, your doctor will ask you about your medical history and medications you take to determine your eligibility for the procedure. Some medications, such as isotretinoin, can interfere with healing. (1)
Your doctor will also examine your skin and explain to you how your skin tone or skin thickness may affect your results. (2)
If you are prone to cold sores, you will be advised to take medicine to prevent herpes infection. Sometimes the procedure can promote herpes flare-ups. (2)
You will need to avoid unprotected sun exposure 2 months before the procedure because darker skin can negatively affect results. You will also be required to stop smoking at least 2 weeks before the procedure. (2)
Your doctor may ask you to take a particular treatment for your skin 6 weeks before your procedure that will help give you optimal results. (4)
Laser skin resurfacing is usually performed in an outpatient office. You can expect the whole procedure to take between 30 minutes and 2 hours depending on the size of the area being treated. (2)
The procedure consists of the following steps: (2, 3)
- Your doctor will first numb your skin to prevent you from feeling pain. You may be given a sedative if treating the whole face.
- The doctor will apply the laser to the area of skin being treated. If you are awake during the procedure the pulse of the laser may feel a bit uncomfortable, similar to a rubber band snapping against your skin.
- The treated area will be covered with an airtight and watertight dressing. Expect to arrange a ride home if you are sedated.
After the procedure, it is normal to feel like the treated skin area has a mild sunburn. Your skin may be raw, swollen, itchy and stinging and may also ooze and blister for a few days. (2, 4) During this time you will be given a pain reliever and cool compresses to soothe the area. (2) It usually takes one week for the skin to heal after using the Erbium laser and up to two weeks if a CO2 laser was used. (4) After 4-7 days your skin will start to peel. (4)
For you to recover, you will need to follow the instructions given by your doctor. You will usually need to clean the treated area multiple times a day to prevent infection. Your doctor may also recommend skincare treatments and the application of sunscreen and moisturizer. (4)
You will want to keep your skin protected from the sun for one year, as the sun can produce damage to the treated skin. You will also need to stop using makeup and stop all activities that may give you a risk of infection, such as swimming or going to the gym, until the skin has healed. (2)
It is important to note that non-ablative resurfacing produces a shorter recovery time. You may still have redness, swelling and discomfort but you will be able to resume normal activities and skincare immediately after the procedure. (2)
It is normal to have redness, swelling or discomfort after the procedure. However, like any other laser treatment, laser skin resurfacing has other potential side effects.
These can include: (1, 2, 5)
- Erythema (redness) that can last from weeks to several months
- Hypo- or hyperpigmentation (skin color changes)
- Herpes flare-up
- Skin tightness
- Acne flares
Although you may still see redness in the treated area for weeks or months, you should expect to see favourable and long-term results from just one treatment once your skin heals. (4) For example, it has been reported that sun damage can improve after treatment by 50%. (5) However, you may still develop wrinkles with ageing and may need re-treatment if necessary. (4)
In contrast to ablative resurfacing, you may notice improvement over time rather than immediately with non-ablative treatment. Also, since non-ablative treatment is less invasive, it may take multiple treatments to get desirable results. (3)
Laser skin resurfacing has the benefits of being safe and more precise in the amount of skin that can be removed. (5) However, other methods can produce similar results.
Some of these alternatives include: (1, 6)
- Chemical peels: This method uses chemicals to peel away outer layers of skin to reveal smoother skin below. Chemical peels are good for the treatment of age spots, wrinkles, fine lines and acne scars.
- Dermabrasion: This mechanical method uses an abrasive wheel to remove the outer layers of the skin. Since it creates a wound, healing is stimulated and smoother skin underneath replaces damaged skin. This method is good for treating deep acne scars.
- Microdermabrasion: This mechanical method removes the thin outer layers of the skin by using a handheld device that has an abrasive surface, such as crystals, at the end. Microdermabrasion is considered safe and you can resume normal activities right after.
- Microneedling: This method depends on the body’s natural healing response to rejuvenate skin. Fine needles are used to induce small injuries to the skin. These injuries trigger a healing response that promotes collagen growth.
Since laser skin resurfacing is considered a cosmetic procedure it is not covered by insurance. The cost of the procedure depends on the doctor’s experience, the type of procedure and laser used, the time in which it takes to perform the procedure and the region in which you live. On average, the cost for an ablative resurfacing procedure is $1,963, whereas the cost for a non-ablative procedure is $1,201. (4) However, these may not include the cost of prescriptions or re-treatment visits.
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- Hirsch RJ, Dayan SH, Shah AR. Superficial skin resurfacing. Facial Plast Surg Clin North Am. 2004;12(3):311-vi. doi:10.1016/j.fsc.2004.02.006
- Mayo Clinic. Laser resurfacing. Mayo Clinic website. Updated January 24, 2020. Accessed October 26, 2020. https://www.mayoclinic.org/tests-procedures/laser-resurfacing/about/pac-20385114
- American Board of Cosmetic Surgery. Laser skin resurfacing: Top 8 things you need to know. American Board of Cosmetic Surgery website. Published August 1, 2016. Accessed October 26, 2020. https://www.americanboardcosmeticsurgery.org/skin-resurfacing/the-top-8-things-you-need-to-know-about-laser-skin-resurfacing/
- American Society of Plastic Surgeons. Laser skin resurfacing skin care procedure. American Society of Plastic Surgeons website. Accessed October 26, 2020. https://www.plasticsurgery.org/cosmetic-procedures/laser-skin-resurfacing
- Hruza GJ, Dover JS. Laser skin resurfacing. Arch Dermatol. 1996;132(4):451-455.
- American Board of Cosmetic Surgery. Skin Resurfacing Guide. American Board of Cosmetic Surgery website. Accessed October 26, 2020. https://www.americanboardcosmeticsurgery.org/procedure-learning-center/non-surgical/skin-resurfacing-guide/