Laser Treatments for the Skin

The use of lasers to treat facial problems is a relatively new procedure. Many different lasers have been, and are being developed to treat specific conditions.

They can be roughly grouped into two categories depending on their wavelength, i.e. ones that target specific types of cells, like hemoglobin (redness) in blood vessels (pulse dye laser) and those that are ablative, that just vaporize everything (resurfacing) they are focused at, like the erbium and carbon dioxide lasers (CO2).

The latter are the type primarily used in facial rejuvenation. The depth and extent of vaporization is controlled by various modalities, like the length of time that the laser is focused on an area, the size of the spot that comes out of the laser machine as well as the laser’s power setting and frequency of the pulses emitted. The smaller the spot size, the lower the power output and the longer it is focused on an area as well as how many times it is passed over the same area determines the amount of surface tissue it will remove and damage to the surrounding tissues it will cause.

Essentially, a burn is produced which may be superficial (1st degree) down to a deep or 3rd degree. The depth of the burn will determine how long it will take to heal. A superficial ablation or burn of the skin surface by the laser will produce some redness or inflammation and take a few days to go away. The deeper 2nd degree level will cause some blistering, scabbing as well as redness (inflammation), which should still heal within a two-week period. The latter though may persist for several months until it heals. If the depth of penetration of the laser causes a 3rd degree burn, then scarring would result.

Facial resurfacing with the CO2 laser became extremely popular because it was very effective in rejuvenating the skin, helping to reverse primarily the textural changes associated with aging, sun damage, and smoking. This laser almost totally replaced dermabrasion in the treatment of acne scarring. When properly used, the complications were minimal, but used incorrectly could be disastrous creating extensive scarring.

The side effects, such as prolonged redness (average of four months with limited sun-exposure) and difference in coloring from treated and non-treated areas became more troublesome. Both of these usually faded with time but others were left with whiter faces (caused by the removal of any existing tan which is confined to the outermost layers of skin) redundant creepiness and uneven coloration of the neck. Also, because only the face has “thick” skin, treatment was limited to this area. If these conditions were acceptable, the results of the treatment of the face could be quite dramatic!

In order to minimize these side effects, a “gentler” laser, the erbium (often referred to as “Fraxel”), was introduced for facial resurfacing. This increased the margin of safety, decreased the side effects, and length of healing, but also compromised the results. The Erbium does not penetrate as deeply as the CO2 laser. It takes about five passes of the Erbium laser to equal one of the CO2 laser! The Erbium laser treatment, however, no longer required an anesthetic but could be done with a topical ointment.

The next major advance was the introduction of a fractionated laser, first the Fractionated Erbium and then the Fractionated CO2 laser. The Fractionated Erbium and then the Fractionated CO2 laser are basically the same procedure. Essentially a grid is placed on the opening of the laser that blocks a portion of the beam that is emitted by the laser. So, instead of a whole area that is treated, the shutter effect limits the burned area by the laser to a certain percentage (about 50% plus) only to be ablated or burned. This limits the burn, which limits the pain and also allows treatment with only a topical anesthetic.

The untreated remaining skin suffers less damage/burn resulting in less inflammation (redness), usually minimal scabbing and a shorter time of healing. On average the recovery time is 5 to 7 days. The most visible results will appear within 2-6 months when new collagen has been formed. Many people are satisfied with 1 – 3 treatments that can provide lasting results.

The laser world has evolved and improved in its quest for the most effective treatment with the least amount of side effects or complications. The guidance of your plastic surgeon or dermatologist is still important to achieve the best possible improvement for your level of skin damage.

Approximate Length of Procedure: 15 – 30 minutes

Because of the above benefits, the Fractionated CO2 laser has become the instrument of choice for most plastic surgeons and dermatologists in treating sun-damaged, aging and smokers’ skin that show textural changes. The Fractionated Erbium laser, just like its predecessor requires many more passes or several treatments to achieve the results of the Fractionated CO2 laser. Contrary to popular belief, neither laser causes more than a temporary skin tightening.

Approximate Cost: Approximately $1500 – 2000 per area

Average Recovery Time: 5 -7 days per treatment

The untreated remaining skin suffers less damage/burn resulting in less inflammation (redness), usually minimal blistering and scabbing and a shorter time of healing. On average this is between one to two weeks with minimal, if any, redness persisting. Also, there is less of a need to protect oneself from the sun to prevent post-treatment color changes (hyper-pigmentation). Finally, and quite significantly, other areas besides the face, like the neck, chest or even hands can be treated.