Laser Skin Resurfacing
The goal of laser resurfacing is to remove wrinkles, smooth and tighten the skin. Unlike photo-rejuvenation, which aims to remove selective concerns such as brown or red spots, reduce fine lines and make pores less obvious, laser resurfacing aims to replace the older skin with the one that is more rejuvenated. Both techniques result in brighter, more luminous and newer skin, with smooth even skin tones.
[nggallery id= 1]
Two Types of Laser Resurfacing
Nonablative Fractional Resurfacing (NFRS)
- Various lasers at 1410-1550nm wavelength or Radio-frequency with Diode or infra-red system.
- Laser beam drills cylindrical shaft to varying depths and injures a ‘fraction’ of the skin each time.
- Does not create open wound with the risks and down time like ablative lasers.
- Epidermis heals with peeling and the thermal injury and heals with new collagen production.
- Does not tighten skin the way ablative methods do.
- Indications: Best suited for mild wrinkles, younger patients with photodamage, on the face and areas that cannot be ablated safely – the neck, chest, hands, and legs. It has become the standard of care for acne scarring, but is used for all types of scarring. Also approved for deep melasma the kind that is negative on Wood’s light examination.
Ablative Conventional or Fractionated
This technology is able to achieve superficial effects without any tightening although variable pulse erbium lasers can also produce skin tightening. It is used to remove epidermal problems such as sun damage and age related lesions (actinic and flat seborrheic keratoses). The fractionated erbium has more limited effects, but is popular due to its good safety profile and minimal downtime. For contouring, tightening or if the lesion has any thickness, pure erbium (not variable pulse) tends to be less effective than CO2.
- New research has used the portals created by the ablative energy to deliver stem cells – it provides a unique access to the skin for repair therapy. Fractionation lowers downtime and risk of side effects, and is able to approach the benefits of conventional CO2 treatment if performed by an experienced surgeon with a more aggressive approach.
Carbon Dioxide (CO2) Resurfacing
The best technique for skin tightening and removal of deep wrinkles continues to be conventional CO2 ablation. It is important to say that variable pulse erbium lasers can achieve similar results to the traditional CO2 lasers. It is the most effective technique for removing thickened skin when papules, nevi, thick keratoses, etc. are present. It is also effective for re-contouring or remodeling scars and thickened noses (Rhinophyma). All of the epidermis and a considerable portion of the dermis are removed with CO2 resurfacing. This results in an open wound which allows for a significant effect on collagen, tightening and re-modeling.
Another modulated option of ablation is fractionated CO2. This method still allows for skin tightening but it offers the laser surgeon the ability to regulate benefits against the risks and the length of down time. The laser surgeon is able to remove a variable degree of the dermis, depending on the desired outcomes. Fractionation generally involves a series of treatments which gradually and cumulatively achieve the results of one conventional ablation.
Using the fractionation technique, the laser surgeon is able to control the depth of the cylindrical shafts drilled by the laser as well as the spacing between the shafts. Each of the shafts will ooze after treatment but generally heal within 72 hours. The creation of these shafts results in healing via body tissue repair mechanisms, cell messengers and proteins, which extend from the unaffected skin edge into the ablated zones. In non-ablative fractionation treatments, the laser creates zones of micro-thermal injury without removing much of the skin. This results in rapid repair process as it is associated with minimal injury.
Ablative resurfacing is used for severe wrinkling and re-contouring thickened and badly photo-damaged skin. It has a slower healing process and more discomfort due to the open wound and a higher risk of side effects.
Fractionated ablation offers a new horizon for therapy. The ablated shafts provide a delivery portal for topical drugs such a steroids for scar therapy.
Conventional ablative resurfacing can make you look 10-15 years younger. Non-ablative procedures are intended for younger patients with less pathology and makes you look vibrant and 5-10 years younger.