Laser resurfacing is indicated in patients who have a sun-damaged, wrinkled appearance to the skin sometimes associated with uneven skin tones and/or large pores. Acne scarring, surgical or traumatic scars, and stretch marks can all be softened with laser resurfacing.
History of Laser Resurfacing
Laser resurfacing of the skin can be done in several ways. The older C02 lasers delivered a beam of laser energy that covered the entire surface of the skin. Healing took place slowly and, while the heat of this laser did tighten the skin, it did so with late complications of permanently lightening the skin color such that there was a line of demarcation where the laser treatment ended. Several years ago, the concept of a fractional approach was introduced. In Fractional Laser Resurfacing, the laser is applied in very small channels, leaving a fair percentage of the skin untreated such that healing can take place more rapidly. There are two different types of fractional lasers. Non-ablative fractional lasers such as the Fraxel® and Affirm® (the one we have) use wavelengths of light that do not remove this column of skin. The energy causes a micro-channel of injury that, as it heals, causes new collagen to grow, improving the texture of the skin. The non-ablative lasers work slowly and more subtlety and require multiple treatments due to the small percentage of skin surface that can be lasered in each treatment session. In contrast to non-ablative technology, both C02 and Erbium lasers can be delivered in a fractional approach. Both of these wavelengths actually remove the column of skin exposed, leaving a proportion of the skin untreated to allow for faster healing. The C02 wavelength has characteristics that, for every amount of skin column that is removed, about the same amount of skin is heated and injured. This injury causes the tightening effect but also has the deleterious side effects seen in the old C02 lasers: namely persistent redness and loss of skin color. Erbium (Sciton Profractional®) also removes this micro-channel of skin but does so without the attendant heat. This laser can be adjusted to add the heat of a C02 laser or mimic the wavelength characteristics of the Pearl® laser. We can adjust the level of heat for each area of the face. We may use some heat to treat acne scars or tighten eyelid skin. We can also remove all heat to remove wrinkles around the mouth or the neck or hands.
This Sciton Profractional® laser is truly customizable for each patient’s unique requirements of effectiveness and tolerance of downtime. Like the other fractional lasers, repeat treatments are additive to the overall effect. Usually, 2-3 treatments will suffice.
The newest way to deliver fractional laser is the Halo® laser. Halo® is actually a combination of a fractional ablative and non-ablative lasers. These two lasers are delivered one on top of the other such that the virtues of both types of lasers can be combined. This laser has minimal downtime and patients are usually in makeup in 3 days. As the skin heals, tiny brown specks appear at the skin surface and eventually clear up. This Halo® laser is often combined with a BBL® (intense pulsed light) to increase and accelerate the removal of unwanted brown color.
All of the laser resurfacing procedures done in our office can be made more comfortable by the use of ProNox®. ProNox® is a nitrous oxide (laughing gas) delivery system where both oxygen and nitrous oxide are delivered in 50% increments. Our patients have found the pain, anxiety relief and amnestic affects to be quite beneficial. No longer are you required to have someone drive you and take you home because of the necessity for oral sedatives such as Valium or Ativan. The effects of the nitrous oxide are out of your system in 15 minutes or less.
Halo® is done after application of a topical numbing cream for 30 minutes. Most patients also choose to use the ProNox® as well.
The Affirm® laser requires no anesthesia other than the cold air blowing on the face through the handpiece. Most patients treated with the Affirm® laser can return to their regular activities the very next day.
Sciton Profractional® laser patients require some type of topical cream anesthetic applied 40 minutes before the procedure. Depending on the depth of the laser treatment, other types of local anesthesia including local nerve blocks or tumescent infiltration of dilute local anesthetics under the skin may be necessary for a comfortable treatment. ProNox® nitrous oxide is usually added. The downtime of this laser is completely adjustable to the patient’s needs. We usually combine a MicroLaserPeel®, in which the superficial layer of the skin is removed with the fractional treatment done in the face and neck where wrinkles and skin discoloration need to be addressed. After the Profractional® treatment, the skin may ooze for a few hours and then appear like a moderate sunburn with some swelling of the treated area. Healing can last from 2-3 days to 7-8 days, depending on the depth and percentage of skin that is treated. Repeat treatments can be done in a few weeks. Usually, 2-3 treatments are required for maximal effect, but results are seen in just one treatment.
Since we have so many options for improving texture, pore size, wrinkles, acne scars, Rosacea, Melasma, actinic keratoses, brown and red discoloration of the skin, all of our treatment regimens are tailored and customized for each patient.
Sciton Profractional® laser treatments often times are combined with the Affirm® laser where one aggressive Profractional® laser is done first, then a series of Affirm® laser treatments are spaced out over many months to keep the new collagen forming over a longer period of time and enhancing the overall result. Dermal fillers such as Restylane®, Juvederm®, or Radiesse®, and neurotoxins such as Botox® or Dysport® can be added to the treatment regimen to enhance the overall result by filling folds and minimizing movement wrinkles. We will also sometimes recommend BBL® Intense Pulsed Light (IPL) treatments for brown or red color removal after the Profractional® laser has healed. Combinations of BBL® with MicroLaserPeel are popular short recovery (1-2 days) procedures done in the Skin Spa by Salzman.