Dec. 23, 2024
Beauty & Personal Care
Numerous laser platforms exist that rejuvenate the skin by resurfacing its upper layers. In varying degrees, these lasers improve the appearance of lentigines and rhytides, eliminate photoaging, soften scarring due to acne and other causes, and treat dyspigmentation. Five major classes of dermatologic lasers are currently in common use: ablative and nonablative lasers in both fractionated and unfractionated forms as well as radiofrequency technologies. The gentler nonablative lasers allow for quicker healing, whereas harsher ablative lasers tend to be more effective. Fractionating either laser distributes the effect, increasing the number of treatments but minimizing downtime and complications. In this review article, the authors seek to inform surgeons about the current laser platforms available, clarify the differences between them, and thereby facilitate the identification of the most appropriate laser for their practice.
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Keywords: laser, skin, resurfacing, photorejuvenation, ablation, fractional
Laser resurfacing technologies represent an exciting development in the cosmetic surgeon's repertoire to improve the tone, texture, and pigmentation of the skin. Although laser resurfacing is not a substitute for a facelift or blepharoplasty, the appropriate laser not only tightens the skin somewhat but also improves the appearance of lentigines, rhytides, skin texture, and a wide variety of scars.
There are ablative and nonablative lasers as well as fractionated and nonfractionated lasers. Nonfractionated lasers act on the entire projected surface area of the treated skin, whereas fractionated lasers target an equally distributed portion of the projected area. An easy way to understand the difference is in looking at the pixels that compose a TV image. Nonfractionated devices treat every single pixel whereas fractionated devices treat only a percentage of the pixels in the treatment area.
Ablative lasers vaporize tissue and therefore are more aggressive compared with the gentler nonablative lasers that leave the skin intact. Although ablative lasers result in far more down time and a more difficult recovery process, they remain the lasers that produce the most dramatic outcomes. For more severe facial wrinkles, dyspigmentation, and textural skin challenges, the ablative laser is often the treatment of choice.
For patients seeking more moderate improvement&#;without the possible side effects of ablative lasers&#;nonablative lasers are often ideal. These lasers leave the epidermis intact while producing rejuvenating skin effects. Depending on the technology, nonablative laser treatments may minimize the appearances of finer wrinkles, ameliorate the texture and tone of the skin, and treat dyspigmentation. By comparison, the treatments are gentler and require little to no downtime, but produce a more moderate response.
Ultimately, a patient's needs dictate the selection of the ideal laser. In this review, we seek to demystify the differences between the many available lasers and thereby facilitate the identification of the most appropriate laser for the patient.
Ablative skin resurfacing removes the epidermal layer, producing the most dramatic laser-treated results for skin resurfacing. The lasers quickly superheat water molecules in the skin tissue. When the water turns into gas, the skin cells are vaporized in a precise skin-peeling effect. This effect promotes collagen formation and retraction of the dermis and epidermis to tighten the skin. These lasers were the original treatment developed for significantly improving photodamage and acne scarring and have remained the most effective treatment. The original devices had serious side-effect profiles including scarring and difficult wound healing; however, the most recent generation of ablative lasers&#;particularly the fractionated ablative lasers&#;have been able to reduce the trauma of the treatment and decrease downtime while still allowing for effective resurfacing. These lasers are much safer than earlier models, but they still retain a higher risk of potentially severe damage in the form of scarring, discoloration, and infections of the skin (Table 1).1
Laser skin resurfacing began with the application of the carbon dioxide (CO2) laser to facial rejuvenation, initiating a new era in the field of photorejuvenation.2 These first lasers allowed the physician more precision than was previously available with older dermabrasion and chemical peeling techniques. These first CO2 lasers operated using a continuous wave (CW). While providing skin enhancement, the rates of side effects were high, including undesirable scarring. To increase control of how much and what type of tissue would be removed, short-pulse CO2 lasers were developed. However, this technique was still ablative and retained a long 2-week recovery period.
The CO2 laser emits light at the 10,600&#;nm wavelength. This wavelength is strongly absorbed by tissue water. When pulsed at less than 1 ms, the laser vaporizes tissue up to 20 to 30 µm per pulse. This limits the residual thermal damage (i.e., surrounding tissue heating effect) to a 100- to 150-µm layer of tissue. Small beams of 100 to 200 μm achieve rapid tissue vaporization, whereas beams larger than 2&#;mm induce nonvaporization and increase the risk of deep thermal damage. Concern over this possibility led to the development of high-pulsed or scanned CO2 lasers to control the depth of ablation.
It is hypothesized that CO2 lasers cause immediate contraction of the ablated areas by denaturing existing old collagen.3 This stimulates new collagen, and collagen content continues to increase well after the procedure. As a result, the CO2 laser systems work best at alleviating fine wrinkles, especially around the eyes or mouth.2 Deeper wrinkles and creases are less completely removed. In addition to wrinkles, CO2 lasers are also effective at alleviating acne scars4 and atrophic scars.
Two main types of CO2 lasers are in use today. The first is a high-power pulsed CO2 laser, which operates at 1 millisecond or less (Ultrapulse). The physician can use the pulses manually at a 3-mm diameter, or they can activate the computer pattern generator. The second type uses scanning of a CW CO2 laser (AcuPulse). Most of these scanning lasers are fractionated, a technology discussed in depth later. This second category uses computererized controls to ensure that no individual area receives treatment more than once. The scanning CO2 lasers as well as other pulsed CO2 lasers produce equivalent results, side effects, and histologic differences.5 The equivalent results were confirmed when different scanning and pulsed CO2 laser systems were used on different parts of the same patient's face.
The major long lasting side effect of nonfractionated CO2 lasers is permanent skin hypopigmentation, although permanent hyperpigmentation can rarely occur.6 Temporary hyperpigmentation is more common but transient depending on dose. The amount of hypopigmentation is related to the amount of injury supplied by the laser.7 On the other hand, injury also correlates with the amount of wrinkle reduction,8 the main goal of photorejuvenation therapy for many patients.
Using a modern CO2 laser, such as the Coherent UltraPulse, physicians can expect an improvement of facial wrinkles by 45%.6 All patients suffer from oozing, bleeding, crusting, and downtime postprocedure. Side effects, such as acne, hyper-, and hypopigmentation and infection are reported by 55% of patients, with the remainder being mostly asymptomatic.6 Only a few cases of hypopigmentation can be expected as long-term side effects after a year.
The erbium-doped yttrium aluminum garnet (Er:YAG) laser was the next laser system to be developed. It emits light at the -nm wavelength in the infrared range. This frequency is much closer to the peak absorption range of water and thus has an absorption coefficient 16 times greater than the CO2 laser. This greater absorption decreases the penetration depth into the epidermis by a factor of ten. This is an advantage, as more precise ablation of skin is possible with even less damage to surrounding tissue.
Compared with CO2 lasers, the Er:YAG laser has similar efficacy. However, the CO2 laser is considered by some to be slightly superior although this is controversial.9 This advantage is suspected to be due to better tissue tightening with the CO2 lasers.3 The Er:YAG laser has less severe side effects, with less postoperative edema and fewer days of crusting on the skin.10
After the above two laser technologies were in use, doctors hoped to synergize the effects of the two systems. Studies have shown that using an Er:YAG laser after using a CO2 treatment results in decreased side effects without a change in wrinkle improvement.11 A combined, dual wavelength CO2/Er:YAG laser also shows similar wrinkle improvement to CO2 laser therapy alone.12
Nonablative nonfractionated lasers entered the market in the late s primarily for use in skin resurfacing. This class of lasers produces a gentler effect on the skin, inducing controlled tissue injury in the dermis and stimulating dermal remodeling and collagen production. The results of nonablative lasers are mild compared with their ablative counterparts, but patients seeking gradual improvement in their complexion often select this laser class because of the minimal recovery and side-effect profile. The potential damaging risks associated with nonablative lasers are significantly lower compared to ablative lasers.13 The major benefit for these lasers is their significant reduction in downtime after a treatment compared with CO2/erbium lasers. Patients experience as little as a few hours of erythema with no scaling or peeling of the skin. Four to six treatments are necessary for very moderate effects.14 Some studies also indicate that the wrinkle improvement is limited and these lasers are now more often used for acne improvement.15 Within the nonablative, nonfractionated class, lasers of ranging wavelengths offer different targeted treatment focused on textural improvements, acne treatment, and overall skin rejuvenation.16 Patients with darker skin tones are also candidates for nonablative lasers as they do not induce the abnormal pigmentation that often arises with ablative laser use on darker skin (Table 2).16
The -nm pulsed energy laser resurfaces the skin to improve the appearance of wrinkles, acne and related scarring, skin tone, and texture.17 Like other nonablative lasers, the -nm pulsed energy laser thermally targets the fibroblasts that reside in the dermal layer to stimulate production of collagen. The -nm pulsed energy laser is a member of the mid-infrared laser class, which is effective at treating fine facial wrinkles.17 These lasers are not beneficial for treating pigment discolorations or vascular abnormalities, although they are designed to safely treat all skin types and shades.
This laser employs the large-area pattern generator (LAPG), an additional technology designed to evenly distribute the laser's path in a nonsequential fashion. In doing so, no region of skin becomes overheated, which could potentially lead to unwanted side effects. Moreover, the technology ensures that the targeted skin is treated completely and efficiently.
The long-pulsed -nm Nd:YAG laser was the first nonablative laser to reach the commercial market. The -nm Nd:YAG laser functions by avoiding damage to the epidermis and instead targeting the dermal layers to stimulate new collagen growth. The water in the skin absorbs the -nm wavelength in particular, creating an even distribution of energy without damaging melanin or hemoglobin. As such, this laser is effective on all skin types I to VI without producing changes in pigment. This laser accelerates the productive capacity and vitality of fibroblasts in this layer as seen in its promotion of the two major secretory factors they produce: basic fibroblast growth factor (bFGF) and inhibiting transforming growth factor β1 (TGF-β1).18 The laser actively reverses visible and histopathologic signs of skin aging as it stimulates collagen types I, III, and VII, and tropoelastin production.19 The laser has been noted as safe and effective in the treatment of acne and related scarring by shrinking sebaceous glands and minimizing sebum production which prevents future acne lesions.20 The literature reports mixed reviews of patient satisfaction with treatments for acne and scarring resolution.21,22 Asian patients in particular have reported efficacy of this laser in reduction of wrinkles and acne scarring.23
The -nm diode laser is effective for the treatment of facial acne as well as for improving the appearance of scarring.24 The nonablative laser has been shown to dramatically and safely improve inflammatory facial acne by partially damaging sebaceous glands to reduce sebum secretions.25 The -nm diode laser has demonstrated greater scar response after treatment than the nonablative -nm Nd:YAG laser; this quality has been particularly helpful for patients with acne scarring.26 The laser is believed to achieve these results by targeting sebaceous glands in the upper dermis while sparing the epidermis, reducing downtime.27 The laser focuses on the water in the skin, which is likely why the upper dermis is heated and therapeutically damaged.28 Interestingly, the -nm laser appears to induce a systemic effect on the skin, as treatment on only one side of the face in one study resolved acne lesions on both sides of the face.29 Unfortunately, in our experience, subsurfacing laser technology has had limited improvement of facial wrinkling. Downtime is minimal and is restricted to temporary erythema, edema, and hyperpigmentation after treatments.30 This laser achieves mild to moderate improvement of acne scarring in Asian patients without producing permanent pigmentary change even in darker skin types IV and V.31,32
The nonablative fractionated lasers combine the best of the gentle and safe aspects of both fractionated and nonablative technologies, which entered the market in . This class of lasers is aimed toward improving texture, mild to moderate wrinkles, and acne scarring as well as treating hyperpigmentation due to sun damage and aging. The neck, chest, and extremity regions are also safely and effectively responsive to these lasers. The lasers' fractional pattern assists with efficacy of the treatment as well as the safety and downtime profile.20 Treatment requires a moderate amount of downtime with correspondingly moderate results. These lasers are also effective in darker-skinned individuals with less risk of discoloration as they induce limited tissue damage and melanocyte stimulation.17 Treatment can be painful, and topic anesthetics are helpful for decreasing patient discomfort (Table 3).
This -nm nonablative fractional laser was designed to resurface the skin, reducing the appearance of superficial rhytides. It requires &#;3 to 5 treatments to see results with a minimal downtime of 3 to 5 days. The laser is safe on Fitzpatrick skin types I to VI, making it very versatile for a broad spectrum of patients. Fraxel pioneered the concept of fractionated lasers, coining the term microscopic treatment zones (MTZs)&#;or columns of thermal heating one-tenth the size of a hair follicle. These MTZs are dispersed throughout the treatment region, allowing some deep penetrating treatment while maintaining a rapid recovery rate as the epidermis is not compromised.
The -nm pulsed laser improves the appearances of rhytides by microrejuvenation, which is brought about by the induction of microcolumns of even heating.33 The StarLux system employs an additional cooling system to improve patient comfort while allowing for a higher power treatment, increasing efficiency. The Affirm laser distinguishes itself via its combined apex pulse (CAP) technology, which evenly distributes energy across a 300-μm depth, focusing the laser on the desired dermal skin layers. This laser also utilizes a cooling system for patient comfort.
The - and -nm erbium fiber lasers and the -nm thulium fiber laser are fractional lasers with ablative and nonablative capabilities that allow them to treat both epidermal and dermal skin imperfections. This laser class safely and effectively treats epidermal pigmentation, photoaging, melasma, rhytides, atrophic, surgical, and acne-related scarring and additional textural imperfections.34,35,36,37,38 As with other lasers, the laser targets water in the dermis, gently heating it to cause controlled thermal tissue damage. The fractionated component of the laser allows for a spatially precise, regular pattern of columns of tissue injury to be created across the treated region, retaining the healing function of the epidermis even while targeting both skin layers. Through the fractionated treatment pattern that targets both the dermis and epidermis, these lasers provide the significant skin resurfacing capabilities of an ablative laser while retaining the downtime profile of a nonablative laser. However, because the laser can only target a fraction of the patient's skin at a time, more treatments are typically required at 2 to 4&#;week intervals for the best outcomes.39
The most recent generation of ablative lasers are the fractional ablative lasers. Their use started around . These lasers have been able to reduce the trauma of the treatment and decrease downtime while retaining resurfacing power. These lasers are significantly safer than their nonfractionated counterparts, but they still retain a high risk of potential damage in the form of scarring, discoloration, and skin infection.1
The main use of these lasers is for mild skin tightening to battle laxity and rhytides. However, these lasers can also treat photodamage, atrophic acne scars, hypopigmented scars, and dyspigmentation.40 Overall, patients can expect moderate down time and moderate risk of complications.
Fractional technology was first developed in use with CO2 lasers. Side effects are rarer than with nonfractional lasers, and only a few cases of scarring following fractional CO2 therapy have been reported.41 The therapy may be just as effective, with one study showing 72% of volunteers having some improvement (with an average improvement of 40%), as well as 80% of volunteers reporting satisfactory reduction in visible wrinkles.42
The Lumenis UltraPulse Encore, released in , is an advanced fractional CO2 laser system with three modes of delivering the laser's energy. The first, Active FX uses a 1.3-mm spot size that ablates the superficial tissue and is useful for treating fine lines, actinic keratosis, and similar diseases. The second, Deep FX focuses the lasers energy into a 0.12-mm spot size and allows for deep ablation that is useful for treating deep rhytides. This mode can ablate up to 2&#;mm into the tissue. The Total FX mode uses both the Active FX and Deep FX modes simultaneously and is useful for treating scars and rhytides.
The Fraxel re:pair fractional CO2 laser system works much like the Encore's Deep FX mode. The pulse duration on this laser can range from 0.15 to 3 ms. By using a short pulse duration, the laser system can deliver more energy quicker and ablate deeper. By combining its small 0.14-mm spot sizes and a short 0.15-ms duration, this laser ablates to depths of 1.6 mm. Other lasers in the Ablative CO2 laser category do not have deep ablation like the Deep FX mode of the Encore and the Fraxel re:pair (see Table 4).
Fractional technology can be applied to Er:YAG lasers much in the same way that it was developed for CO2 lasers. Similar to the comparison between nonfractionated CO2 and Er:YAG lasers, the fractionated versions of these two laser types have similar postoperative and comparable cosmetic improvement.40
Radiofrequency (RF) systems are unique in that they are thermal heating systems, working more like microwaves rather than lasers. Current radiofrequency resurfacing systems are nonablative. They have the advantage of having a higher penetration depth, while aiming for collagen shrinkage and skin tightening. Another advantage is their relatively low operating temperature, as only the deeper tissue is heated. The RF largely passes through the skin surface, sparing it from heating (Table 5).
Much like the laser systems, the RF systems achieve results by denaturing existing collagen and stimulating production of newer and shorter collagen, leading to lasting tissue tightening.43 However, it has the added property of being able to heat the subcutaneous fat as well, leading to undesired visible fat reduction in some cases.18
This modality is presented here because this electrical energy is often combined with other modalities to achieve a synergistic effect. For example, radiofrequency has been combined with diode systems (Polaris WR) to achieve both clinical results by an impartial viewer and with patient satisfaction.44 Of the 20 patients in this trial, none had any pigment changes or scaring; however, most suffered pain and all had erythema, while 80% had edema for 24 hours. Another study combined the three main nonablative modalities (IR, RF, and IPL), showing a 26% improvement on average and a 71% patient satisfaction.45
After review of these laser resurfacing technologies, clear trends arise. Most of the ablative technologies offer greater results, at the cost of longer recovery times and potentially more severe side effects. On the other hand, nonablative technologies usually offer more moderate results with fewer side effects and an easier recovery. Fractionated technologies seem to combine some of the best aspects of each category, with shorter recovery times, but results approaching those of fully ablative technologies with a series of treatments. Overall, this wide selection of technologies allows the physician options to provide the appropriate care for their patients.
No financial support was received during the completion of this article.
Jason Preissig and Kristy Hamilton contributed equally to this work.
Many people start their skincare journey with cosmetic products. They&#;re easy to use, have tolerable or no side effects, and make us feel good overall. However, they take time to work and address only mild skin issues. Additionally, some become ineffective when the skin changes faster than you can treat it.
People serious about their skin health often come to a point when they start considering an in-office procedure. One of the most sought-after is CO2 laser skin resurfacing and for a number of good reasons. This article discusses the benefits of CO2 laser treatment. It also explains how CO2 laser resurfacing works and what to expect from the process.
CO2 Laser Skin Resurfacing&#;What Is It, and How Does It Work?
Carbon dioxide lasers, or CO2 lasers, can precisely remove thin layers of skin with minimal damage to surrounding structures. This makes them highly effective for treating sun damage, wrinkles, scars, warts, birthmarks, and other skin conditions. Understanding how the treatment works requires knowledge about lasers and their effects on the skin. Simply put, lasers are powerful, narrow-spectrum light beams. The CO2 laser is an invisible, far-infrared light with a wavelength of 10,600 nanometers, selectively absorbed by water molecules in the skin.
The epidermis&#;the topmost layer of the skin&#;is sensitive to CO2 laser beams. When these lasers hit the skin, the energy heats and vaporizes epidermal water molecules and, with them, the epidermal cells. In skilled hands, CO2 lasers can remove the epidermis while causing minimal damage to underlying tissues. The CO2 laser is categorized as an ablative laser because it removes the skin&#;s superficial layers.
The following events occur after CO2 laser treatment:
Removing the epidermis takes away its imperfections. They include wrinkles, rough areas, pigmentation problems, and superficial scars.
The intense laser heat burns away damaged collagen strands and contracts loose collagenous tissue.
Stripping off the skin&#;s top surface alerts the immune system and stimulates inflammatory processes. These events lead to the release of substances that induce the body&#;s natural repair mechanisms. During the healing process, the epidermal cells grow back and the skin produces more collagen. The deeper skin layers also undergo repair and renewal.
So at the end of your recovery, you&#;ll notice the following changes:
The superficial blemishes are gone, while the deep ones are significantly reduced.
The treated area becomes smoother as the new epidermis replaces the old one.
The skin is tighter and firmer due to the contraction and enhanced formation of collagen.
Overall, you get younger-looking, more even-toned skin that you can&#;t have from years of applying cosmetic products alone.
What Is the Difference Between Fractional and Non-Fractional CO2 Laser Treatment?
Fractional CO2 laser treatment exposes your skin to small, thin columns of laser light instead of wide beams. One pass of the equipment creates multiple micro-sized injuries rather than one continuous area of damaged skin tissue. Fractional lasers reduce heat injury to the skin and its side effects. They also produce multiple mini-repair sites, so recovery is usually faster.
What Skin Problems Can CO2 Laser Resurfacing Treat?
CO2 laser therapy is highly recommended for severely sun-damaged skin, the symptoms of which include the following:
Fine and coarse wrinkles
Dyspigmentation and other forms of skin discoloration
Spider veins
Loss of elasticity
It is also highly effective in improving the following skin conditions:
Post-surgical, chicken pox and acne scars
Stretch marks
Pigmentation issues like melasma and brown spots
Rhinophyma or severe pore enlargement of the nose from conditions like rosacea
CO2 laser resurfacing is an alternative treatment option for benign skin growths like actinic keratosis, warts, and moles, as well as superficial non-melanoma skin cancers. Consider this procedure if you have a skin problem unresponsive to other therapies or when facial plastic surgery is contraindicated.
What Are the Biggest Benefits of CO2 Laser Resurfacing?
Knowing how CO2 laser treatment works makes it easier to appreciate its upsides, the most important of which are the following:
1. Superior Cosmetic Results
CO2 laser resurfacing treatment is considered the gold standard for rejuvenating photoaged skin. Its cosmetic outcomes are superior to non-ablative procedures like Vbeam and intense pulsed light. Experts attribute this to its greater ability to induce the skin&#;s healing response and tighten loose collagen strands.
Fractional CO2 laser resurfacing yields comparable results to the non-fractional technique, but it has the advantage of having an easier recovery period.
2. Great for Multiple Skin Lesions
Clustered skin lesions like wrinkles and acne scars are tough to treat by incisions because they have a greater risk of complications. By comparison, lasers are precise surgical tools. A highly experienced laser dermatologist can easily avoid normal skin tissue and remove multiple lesions safely.
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3. Highly Effective Against Severe Skin Issues
A gentler skin treatment like a night cream or microdermabrasion won&#;t have any effect on deeper wrinkles and scars. They do not penetrate the skin deeply enough or stimulate a response in the inner skin layers. Meanwhile, CO2 laser treatment not only peels away visible lesions but also kickstarts repair mechanisms, effectively improving skin texture and tone.
4. Longer-Lasting Cosmetic Effects
One of the best things about CO2 laser treatments is that they get rid of skin lesions for good, but you must address the underlying cause. Religious skin care and sun protection keep the skin lesions from coming back after this procedure.
5. Fewer Sessions
CO2 laser treatments produce dramatic changes. Most patients need only one session to see results unless the lesions are widespread or they respond poorly. Consider this procedure, especially fractional laser treatment, if you have a busy schedule.
Additionally, if you have a complex skin condition, you can safely combine CO2 laser resurfacing with other procedures. For best results, entrust your skin treatments only to a highly experienced, board-certified dermatologist.
What Can You Expect During Your CO2 Laser Treatment Journey?
During your initial consultation, your skin care specialist will give you a complete medical evaluation to see if this procedure is right for you. If they think you&#;re a suitable CO2 laser treatment candidate, they&#;ll schedule you for an appointment. Your specialist will also give recommendations to prepare for your session.
Before Your Session
Good preparation is crucial in preventing complications after the procedure. Your laser dermatologist may advise the following:
Stop skin-sensitizing treatments that increase your risk of laser burns. They include hydroxy acids, oral isotretinoin (Accutane), and some acne antibiotics like minocycline.
Avoid drugs and supplements that can interfere with the wound-healing process. They include blood thinners, ibuprofen and similar painkillers, steroids, vitamin E, and many others.
Abstain from smoking and drinking, which can also disrupt the skin&#;s repair mechanisms.
Start using sun protection regularly. Avoid tanning beds and sun exposure, which increase the risk of post-inflammatory hyperpigmentation (PIH).
Take a cold sore medication, as the procedure can trigger a relapse.
A few weeks of topical tretinoin or hydroquinone pre-treatment to help speed up recovery and prevent PIH.
Cleanse your face and leave it makeup-free before coming in for your appointment.
During Your Session
At the start of your procedure, your specialist will ask you to change into a comfortable patient gown and wear eye protectors. Once you get settled down, they will use numbing medication in the treatment area. After about 30 minutes, they will apply the laser in pulses.
Your session may last about 1-2 hours, depending on the extent of the treatment area. Most patients are awake or mildly sedated throughout the procedure and feel little to no pain.
After Your Session
Once done, your specialist will clean up the treated skin and apply a thick layer of ointment to it. In some cases, they may use an airtight dressing to protect the area. The doctor will send you home with aftercare instructions. You may have a companion assist you when you leave the clinic.
The downtime depends on the procedure and the extent of the treatment area. Non-fractional CO2 laser treatments result in significant inflammation. The skin heals in one or two weeks, but some patients may experience redness lasting several weeks to months. By comparison, the recovery after fractional laser resurfacing ranges only from four to ten days due to less inflammation.
Aftercare
Post-treatment care regimens after CO2 laser treatments widely vary among practitioners. Yours may recommend the following:
Remove any dressings after 24 hours. Replace as instructed.
Cleanse the treated skin twice daily or as instructed. If you&#;re not advised to dress it, you must keep it moist with a thick layer of ointment throughout the day to prevent scabbing. Do this until the skin closes up.
Some practitioners advise vinegar soaks several times a day while the skin has not healed over. Doing so protects the area from microbes. Others choose to prescribe an oral antimicrobial as an alternative.
Protect the skin from trauma, pressure, and irritants while it&#;s actively healing. Skin under repair is highly irritable and may scar or develop pigmentation problems if without protection.
For pain relief, you may apply ice packs throughout the day or take acetaminophen.
Sleep with your head upright in the first few nights after your session. This prevents swelling, oozing and heavy pressure on the treated area.
Use hats and other physical forms of sun protection in the first three or four weeks after the procedure. Once the skin heals fully, you may start applying a gentle sunscreen formulation.
Avoid alcohol and cigarettes while the skin hasn&#;t completely closed up.
You may start using mineral makeup a week after the skin heals or as advised by your specialist.
Follow your dermatologist&#;s aftercare instructions meticulously to avoid complications and speed up your recovery.
Timeline of Skin Changes After CO2 Laser Skin Resurfacing
In the first few days after your procedure, you will notice inflammation of the area. This is a normal part of the healing process, though it can be uncomfortable. Remember that the treated skin has no protective barrier at this time. The typical symptoms are burning pain, redness, and swelling, which will go away spontaneously. Skin repair begins at the end of this phase.
After a week or two, the skin will close up in a process called &#;re-epithelialization.&#; You will see the epidermis growing back, completely covering the treatment site.
Collagen production begins to pick up as soon as the repair process starts. It will peak in the third month, by which time you will see a significant improvement in skin texture. Sagging areas and other skin imperfections will continue to improve for several months up to a year due to sustained collagen remodeling.
Risks of CO2 Laser Resurfacing
No treatment is completely risk-free, no matter how good the outcomes are. In the case of CO2 laser surgery, the most common side effects are swelling, pain, and redness, which are all normal reactions to the procedure. As previously mentioned, these symptoms will resolve on their own after a few days.
The following are some of its possible complications:
Laser burns&#;may occur if the equipment is not set up properly or the patient has overly sensitive skin.
Acne and small, white lumps called &#;milia&#;&#;develop as a reaction to dressings and ointments.
Contact dermatitis&#;manifests as an itchy rash that forms in reaction to cleansers, moisturizers, and topical medications used during recovery.
Persistent redness&#;prolonged inflammation that can occur when the wrong laser settings are used.
Pigmentation problems&#;patients with darker skin tones are more prone to PIH. Hypopigmentation has also been observed in some individuals.
Infection&#;either bacterial, fungal, or viral.
Treated skin doesn&#;t have an intact barrier during the active healing phase and is vulnerable to microbes.
Scarring&#;may occur in susceptible individuals or when the provider doesn&#;t perform the procedure properly.
Aggravation of lower eyelid surgery&#;the eyes&#; supporting structures weaken after blepharoplasty (eyelid surgery). CO2 laser treatment near the area can worsen it.
Visual problems&#;may occur if the eyes are not protected during the procedure.
The contraindications of CO2 laser treatment include the following:
Active infection or inflammation in the treatment site
Ongoing oral isotretinoin therapy
A history of bad scarring
Skin of color with a positive CO2 laser spot test and is, thus, PIH-prone
Conditions associated with poor healing, such as collagen disease, diabetes mellitus, immune problems, malnutrition, and others
Recent UV exposure or chemical peel
You can minimize these risks by following the pre- and post-treatment recommendations carefully and choosing a bona fide laser expert to perform your procedure.
Zap Away Sun Damage and Other Lesions Effectively
If you have photoaging symptoms or any skin concern unresponsive to at-home therapies, it may be time to consider CO2 laser resurfacing. The treatment effectively and safely corrects various skin issues and evens skin tone and texture. Most patients need only one session, and its cosmetic effects last long. Fractional laser treatment reduces inflammation and downtime while producing results comparable to its non-fractional counterpart.
Book Your Appointment Today!
Lastly, to get the most from your CO2 laser procedure, trust only a highly-trained, board-certified dermatologist to do it. Only a real laser expert can ensure the safety and effectiveness of your treatment. At BHSkin Dermatology, you can expect to get that guarantee as well as a satisfying therapeutic experience.
Book your appointment today!
References:
Don Mehrabi, MD, FAAD, is LA&#;s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online
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