Fractional and fully ablative CO2 laser resurfacing are among the most effective tools we have in medicine to address deep, etched-in wrinkles around the mouth, eyes, and cheeks. Ablative lasers work through administration of energy that is converted to heat, leading to controlled damage of the epidermis (skin), subsequent collagen remodeling, and new, healthy, youthful skin. Laser resurfacing treatments can be personalized to the patient’s desires allowing for a more aggressive approach with treatment of the entire face or a more targeted approach treating only specific problem areas (such as around the eyes or mouth).One must keep in mind when choosing an approach, the larger the area treated, the more intense the downtime will be. In my experience, patients who are willing to put in the downtime for the procedure forever set the aging clock back at least 10 years. An added benefit of laser resurfacing is the removal of sun damage and precancerous lesions called “actinic keratoses”. In the greater Spokane and Inland Northwest area, many of us have experienced extensive sun exposure. Laser resurfacing allows us to erase much of that sun damage, allowing for a clean slate.
What to Expect
Before the procedure, numbing cream is applied to the face for one hour. Depending on the intensity of the treatment, injectable numbing may also be used to maximize patient comfort. During the procedure, the targeted area is treated with the laser at which time one might expect to feel the faint warmth of the resurfacing procedure through the anesthetic. After the procedure, patients can expect redness and weeping of the areas treated, similar to a “scraped knee” for the first eight days after treatment; new collagen is forming during this portion of the healing process. The skin can be slightly red for three weeks to a month during the final stages of healing. Depending on intensity of the treatment, multiple treatments (one to three) may be required to reach your skin care goals.
When used on the upper and lower eyelids, patients can have significant tightening and improvement in eyelid skin laxity, mimicking blepharoplasty. Studies show up to 90% reduction in wrinkles and significant skin tightening. This is a great option for those that desire to avoid surgery. This procedure can also be coupled with surgeries such as a facelift or blepharoplasty. Placement of metal eye shields with numbing eye drops is required when using this laser around the eyes.
Additionally, when treating the peri-oral region, laser resurfacing can be coupled with filler and/or neurotoxin (such as BOTOX® Cosmetic). Peri-oral rhytids or wrinkles are formed by contraction of the orbicularis oris muscle leading to “pursing of the lips” or “smoker’s lines”. Filler can be used to build the foundation of collagen loss related to age. Neurotoxin can be utilized prior to the resurfacing procedure to avoid reforming peri-oral lines during the healing process. A combination of filler, neurotoxin, and an ablative laser treatment often maximizes patient results.
Benefits & Risks of Laser Resurfacing
The most beneficial outcomes of laser resurfacing include boosted confidence as years are erased. Other benefits include:
- Permanent improvement (not complete resolution) of etched lines and wrinkles
- Minimization of discoloration and overall improvement in pigmentation
- Skin tightening
- Treatment of sun damage and pre-cancerous actinic keratoses
Though non-invasive, there are some risks to keep in mind:
- Low risk of prolonged redness, hyperpigmentation, infection, and scarring
- Many patients are pink to red in the areas treated for up to a month, which is considered part of the regeneration and repair process
To reduce the risk of hyperpigmentation (brown spots), we typically recommend this procedure be done during what I like to call “Laser Season” (fall, winter, or early spring) to allow for minimal sun exposure during the healing and regenerative process.
The recovery process consists of keeping the treated area moist and protected. Aftercare includes vinegar soaks every four to six hours for two to three days followed by consistent application of Vaselineâ or Aquaphorâ to the entire treated area to provide a moist healing environment. After one week, or after complete healing, we recommend daily application of a tinted physical blocking sunscreen with SPF 30 or greater. The tint or pigment in the sunscreen is necessary to filter visible light that can worsen pigmentation and melasma. Regular physical and chemical blockers are not as effective at filtering visible light.