Laser Resurfacing
Treatment of Scars and Wrinkles

Laser resurfacing uses heat induced by laser light to destroy and remove (vaporize) the upper layers of the skin. This causes new skin to grow. It is typically used to remove or improve the appearance of wrinkles, shallow scars (from acne, surgery or trauma), tattoos and other skin defects.

The laser sends out brief pulses of high-energy light that are absorbed by water and certain substances in the skin called chromophores. The light is changed into heat energy, and the heat then vaporizes thin sections of skin, layer by layer. As the wounded area heals, new skin grows to replace the damaged skin that was removed during the laser treatment.

The CO2 (carbon dioxide) laser is the most common type of laser used for resurfacing. Erbium lasers are also used frequently and are growing in popularity because they do a similar job, but penetrate less deeply and therefore heal more quickly. Laser resurfacing is usually very precise and causes little damage to the surrounding skin and tissue. It is done most often on the face, but it may be done on skin in other areas of the body. The hands, neck and chest are usually avoided because skin in these areas tends to thicken and scar as a result of the laser treatment and does not heal as well as it does in other areas. Some surgeons are willing to treat the neck with a lower-energy laser but many doctors believe this is too dangerous.

What Happens During a Treatment?
The areas to be treated are cleaned and marked with a pen. A nerve block with a local anesthetic is usually used to numb the area before treatment. You may also be given a sedative or anti-anxiety medication such as diazepam (Valium) to help you relax. If your entire face is going to be treated, you may need stronger anesthesia (in some cases, general anesthesia), pain relievers or sedation. You may be given goggles to wear to prevent eye damage by the laser, and wet towels will be placed around the area to absorb excess laser pulses.

The laser is passed over the skin, sending out pulses. Each pulse lasts less than a millisecond. Between passes with the laser, the skin will be wiped with water or a saline solution to cool the skin and remove tissue the laser has destroyed. The number of passes required depends on how large the area is and what type of skin is being treated. Thin skin around the eyes, for instance, requires very few passes with the laser. Thicker skin or skin with more severe lesions requires a greater number of passes.

The pulses from the laser may sting or burn slightly, or you may feel a snapping sensation against your skin. Little or no bleeding occurs in most cases, although severely damaged skin may bleed. When the treatment is finished, the area is covered with a clean dressing or ointment.

Laser resurfacing is usually done in a doctor’s office or outpatient surgery center. The time needed for healing and recovery after laser resurfacing varies according to the size and depth of the treated area. Someone who has the full face resurfaced, for example, will require a longer recovery time than someone who has only a small area of skin treated.

In general, the wounded area will be weeping, tender and swollen for at least several days. Rarely, this can go on for two to three weeks. Cold packs and anti-inflammatory medications (such as acetaminophen or ibuprofen) may help reduce swelling and pain. Once skin regrowth occurs, the skin will remain red for several weeks. Proper care of the treated area while the skin is healing is extremely important.

  • Rinse the skin several times a day with cool vinegar-in-water mix to avoid infection and to wash away the crusting that sometimes develops. Avoid soaps and perfumes.
  • Change the ointment or dressing on the treated area to keep the area moist and to promote healing.
  • Avoid sun exposure and, after peeling has stopped, use sunscreen every day. New skin is more susceptible to sun damage.

Do I Have to Take Any Medications?
Your doctor may give you an antiviral drug called acyclovir to prevent infection if a large area of the skin was treated or if you have a history of infection with the herpes simplex virus. Several follow-up visits to your doctor will be needed to monitor the skin’s healing and regrowth and to identify and treat early signs of infection or other complications.

What is Laser Surgery Used For?
Laser resurfacing may be used to remove or improve the appearance of:

  • Wrinkles.
  • Superficial scars caused by acne, surgery or trauma that are not growing or getting thicker.
  • Color (pigment) changes or defects in the skin, such as liver spots (lentigines), port-wine stains or coffee spots.
  • Lesions or growths in the upper layer of skin, such as actinic keratosis, rhinophyma or birthmarks. (Any growth that could be malignant should be evaluated using a biopsy before laser resurfacing is done.)
  • Tattoos.

Is Laser Resurfacing Good for Everyone?
You may not be a good candidate for laser resurfacing if you:

  • Have had skin color changes, scarring or thickened tissue (fibrosis) as a result of earlier treatment.
  • Have a skin, blood flow or immune disorder that could make healing more difficult.
  • Have a history of abnormal scarring (keloid or hypertrophic scars).
  • Are currently using isotretinoin (Accutane, a drug used to treat acne) or have used it within the last six to 12 months. This increases the risk of scarring after the procedure.
  • Have a bacterial infection of the skin.

What Things Can Affect the Outcome of Laser Surgery?
Your skin type, the condition of your skin, your doctor’s level of experience, the type of laser used and your lifestyle following the procedure can all affect the short-term and long-term results of laser resurfacing. Some types of skin problems or defects respond better to laser resurfacing than others. People with lighter skin who limit their sun exposure after the procedure tend to have better results than those with darker skin and those who continue to spend lots of time in the sun. People with darker skin may benefit from laser resurfacing, but their skin may not heal as well.

Is Laser Surgery Dangerous?
In general, laser resurfacing tends to have good results with fairly low risks. Wrinkles caused by aging and long-term sun exposure, such as those around the eyes and mouth, respond well to laser resurfacing. The long-term results for these types of wrinkles are unknown, and you should keep in mind that new wrinkles will probably appear as your skin continues to age. Wrinkles caused by repeated movement and muscle use (such as those on the forehead or along the sides of the nose) may be improved but not eliminated. They often come back months or years after treatment because the muscles continue to perform the activities that caused the wrinkles before treatment.