Laser resurfacing for facial rejuvenation.

The ageing process is never kind, especially to the face, where wrinkles and sagging skin readily appear. Most of the changes that we attribute to ageing, are in fact caused by sun damage, leading to damaged collagen fibres, which are the major support structure for the skin.

Laser resurfacing, has revolutionised the treatment of wrinkles caused by sun damage, by removing damaged collagen, and producing new collagen fibres. This produces a long lasting correction of wrinkles, without requiring any cutting, lifting, stitching or scars.

How does laser resurfacing work?

Laser resurfacing uses a laser beam, either Carbon Dioxide or Erbium, to selectively remove damaged areas of the skin. The laser beam must be used very precisely in order to only remove damaged skin, but leave normal skin intact.

Once the damaged skin is removed, new skin will form, from the hair follicles and oil glands, where it has been protected from the sun’s rays. The new collagen forms tight bands, giving the skin greater strength and elasticity, while tightening the skin surface. Wrinkles disappear, and are unlikely to reform unless further sun damage occurs.

Which lasers are used for skin resurfacing?

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The original laser used for skin resurfacing was the Carbon Dioxide laser. Even though the results were often dramatic and long lasting, there were some problems which limited its use. Side effects occurred due to the heat generated by the carbon dioxide laser, which led to prolonged redness, and some loss of skin pigment in certain individuals.

The Erbium laser can remove damaged skin more precisely, without any heat being released into the skin. The result is that there is less redness, and less alteration in the skin pigment. The results have been excellent, although it is difficult at this stage to compare long term results to the Carbon Dioxide laser.

Who may benefit from laser skin resurfacing?

People with wrinkles, due to sun damage, benefit most from laser resurfacing. Wrinkles around the eyes, cheeks, and mouth achieve the best results, while movement lines tend to recur. People of all age groups may benefit, from 30’s to 80’s, often the more wrinkles, the better the result.

Is skin colouring important for laser resurfacing?

Carbon dioxide laser resurfacing is only suitable for patients with lighter skin, and preferably female. The Erbium laser is much more versatile, being suitable for patients of any skin colour, age or sex.

How long does healing take after laser resurfacing?

The healing time after laser resurfacing will depend on the degree of wrinkling ,and the depth of laser resurfacing that is necessary to remove them. Following Carbon Dioxide laser resurfacing, healing normally takes 10-14 days, while Erbium laser treatment will normally heal in 7-10 days.

After healing, redness may be present for up to 6 months, following carbon dioxide laser treatment, or 6 weeks following Erbium treatment. Makeup will usually successfully cover skin redness after 14 days.

Is laser resurfacing painful?

When laser resurfacing is performed, local anaesthetic is usually necessary, otherwise it may be uncomfortable. If large areas are being treated, a light sedation, will produce maximum comfort. Following laser resurfacing a special dressing is used, to promote healing, and minimise pain. If a dressing is not used, stinging may occur following treatment.

Is hospitalisation necessary for laser resurfacing?

No. Laser resurfacing is performed as day surgery, so you can go home the same day.

What happens after the laser procedure?

After the operation, a dressing is applied to the skin. This will aid in the healing process, and will help to minimise discomfort. This dressing will require changing the next day, and then when necessary for the first week. Our staff is highly trained and skilled in post laser care, and will manage all these dressings for you.

Usually after 7-14 days, the skin will be healed sufficiently for makeup to be applied. Most people can return to work at about 2 weeks, with make up.

What other problems may occur with laser resurfacing?

Pigmentation. This is a common but self limiting problem following laser resurfacing. It is more likely to occur in patients with darker skins, and may occur in the absence of sun exposure. For this reason, many patients who undergo laser resurfacing, will require a special bleaching cream, to prevent pigmentation. Some small problems may occur following laser resurfacing, which are readily treated, and will go away quickly. It is important to wear an ultraviolet A blocking sunscreen.

Infection. This is a rare problem following laser resurfacing, as long as proper post operative care is carefully adhered to. Antibiotics are prescribed routinely to further minimise this potential problem.

Cold sores. Because the risk of developing cold sores is high, patients with a history of cold sores should take anti cold sore tablets (Famvir).

Pimples and whiteheads. This may occur after laser resurfacing if greasy creams or ointments are used. CDC Clinics will recommend suitable products.

Itchy skin. This may be a temporary problem after laser resurfacing, but will respond to special creams. Scarring. Although this is the most feared consequence of laser resurfacing, it is less common with the improved laser technology, especially with the introduction of the Erbium laser.

Scarring may occur in some individuals for no particular reason. If it does occur, it must be treated early with injections of Kenacort and/or 5FU. In most cases, it will largely resolve.

Loss of skin pigment

This problem may be seen many months after laser resurfacing. It was very common with the carbon dioxide laser, but is much less common with the Erbium laser. It tends to occur in people with lighter skin. Once it occurs, it rarely resolves.

How long does the improvement last after laser resurfacing?

Improvement in wrinkles will last for many years after laser resurfacing, if the skin is looked after. Smoking, and excessive sun exposure will lead to new damage to collagen fibres, so new wrinkles can appear.

How much improvement can be expected with laser resurfacing?

It is possible to obtain 70-90% improvement in wrinkles caused by sun damage, which includes wrinkles around the mouth, eyes, cheeks and forehead. Furrows, which are related to movement, tend to recur, eg- frown and smile lines. However, if laser resurfacing is combined with special injections, frown and smile lines improve dramatically. Even deep lines especially around the mouth will improve dramatically.

Acne scarring

Although laser resurfacing was used in the past, acne scarring responds better to the Fraxel laser.

Sun damage, brown spots

Laser resurfacing is also a treatment for people with extensive sun damage of the face. However Photodynamic therapy is a better option for sun damage and sun spots.

Can laser resurfacing be performed on the neck?

The neck is a very hazardous area for laser resurfacing, as scarring and loss of skin pigment will easily occur. It is not possible to remove wrinkles on the neck, but brown discolouration will respond.

What other treatments are available for acne scarring?

The treatment of choice for acne scarring nowdays is the Fraxel laser. The Fraxel is a unique technology which has proven to be a big breakthrough in the treatment of moderate to severe acne scarring.

The Fraxel works by producing vertical columns of laser beams which penetrate deeply into the skin and stimulate new collagen formation at the base of the acne scars. This ‘lifts’ and fills the acne scars with your own body’s collagen. The skin appears smoother and firmer. At the same time the surface of the skin remains intact so healing is quick, and there are fewer risks than with laser resurfacing.

Fraxel is suitable for all skin types, and can be used on the neck, chest and back.

Some acne scars can be treated with injectable fillers. These may be temporary or permanent.

What other treatments are available for wrinkles?

There are a number of newer treatments available for wrinkles. They included the Plasma Portrait PSR, Fraxel, injectable fillers and muscle relaxants.

Plasma PSR

This is the latest technology use for treating wrinkles. It is a non laser plasma cloud that heats the top layers of the skin. This destroys the old wrinkle layers and stimulates new skin to form. The new skin is not sun damaged so is smoother and fresher. Plasma PSR is safe and effective. It usually produces about 50-60% improvement in wrinkles in one treatment.

Plasma produces lasting improvement especially in people who wear sun protection, avoid smoking and use suitable skin care. The treatment is simple (performed in doctor’s surgery) with healing time of approximately 5 days. Complications of Plasma PSR are uncommon but theoretically could include:

1. Scarring
2. Increased skin pigmentation
3. Decreased skin pigmentation
4. Infection
5. Synged eyelash tips

Injectable fillers

Wrinkles can be ‘filled’ by using injectable fillers. These may be temporary or permanent. There are many varieties of temporary fillers. They generally last 3-4 months. They are suitable for fine lines around the eyes and mouth. They can also be used for lip enhancement, and acne scars.

Permanent fillers are suitable for deeper folds. They last several years. Once placed in the skin, permanent fillers cannot be removed.

Muscle relaxants

Movement lines eg. forehead, frown lines, crow’s feet are best treated with muscle relaxant injections. These are injected into the muscle which causes the frown or smile lines. Muscle relaxant injections generally last 3-4 months. They are safe, effective and have few side effects.

What other treatments help aging skin?

1. Vitamin creams - Vitamin A, C, E creams are useful in treating and and preventing sun damaged skin. Vitamin A is available in various forms including Retinol, Retin A, Stieva A, ReTrieve. To be effective it needs to be used in high enough concentrates. Vitamin C is highly unstable and penetrates poorly through the skin. Some preparations of Vitamin C are more stable and can penetrate better through the skin eg. C Boost.
2. Photodynamic Therapy - This is a very useful treatment for sunspots, precarious skin lesions and some skin cancers. During the treatment a liquid is applied to the skin followed by the use of light (blue, red, yellow). The light activates the solution which removes sun damaged skin. New non sun damaged skin forms, which has a rejuvenating effect.