Laser Skin Treatments

Lasers have an incredible variety of applications in treating many skin conditions. They are widely used in cosmetic dermatology to help eliminate or reduce the signs of aging and rejuvenate the skin. They are also used in the treatment of birthmarks, such as hemangiomas and port-wine stains, and are frequently used to remove moles, warts, tattoos, and unwanted body hair.

What Is a Laser and How Does It Work?

The word laser stands for Light Amplification by Stimulated Emission of Radiation. A laser is a device that creates an intense monochromatic coherent beam of visible, infrared, or ultraviolet light that is capable of delivering enormous amounts of energy. Coherent means that all the light waves line up, unlike regular light, which has the waves scattered in every direction. Monochromatic means that it is all one wavelength, which is the same as being all the same color in visible light.

A laser can be focused onto a very small spot. When it strikes an object, such as the skin, it can be reflected, transmitted to deeper layers of skin, scattered, or absorbed. If laser light is absorbed, it is converted to heat, which can burn or coagulate the targeted tissue. Different lasers come in different wavelengths, which are absorbed by different colors or at different depths of the skin. These different absorption characteristics mean that different lasers are used for different types of tissue or purposes. For example, alexandrite laser can be used to remove tattoos of black or blue ink, black spots, and darker hyperpigmented spots. Other lasers would be needed to removing tattoos of other colors. The most commonly used laser in laser skin treatments are carbon dioxide (CO2), erbium, and pulsed dye.

Some lasers are pulsed, which means that the beam is automatically turned on and off in short pulses. Others are continuous wave, which means the beam is continuous.

How Lasers Can Be Used To Treat Skin Conditions

Lasers that are used to treat skin conditions come in two basic varieties: ablative and nonablative. Ablative lasers remove a portion of the top layer of skin tissue, which means they resurface the skin as in a laser peel. Nonablative lasers heat up tissue under the top layer of skin and stimulate it to thicken the underlying collagen structure. Ablative lasers are more damaging and invasive than nonablative lasers. They actually remove the top layer of skin and the fine wrinkles or scars along with it. The treated skin may be very red for a week or two while you heal. With nonablative lasers, you may have some swelling or pinkness, but it will not look too bad.

You may not be a good candidate for any laser skin treatments if you are prone to pigmentation problems such as hyperpigmentation (skin darkening) or hypopigmentation (pale or white areas of skin) or are prone to formation of keloids scars. If you have occasional herpes infections (cold sores or fever blisters) on the lips or mouth, you may be asked to take an antiviral medication before your laser treatment. This will help prevent an outbreak that could spread to the treated area while your skin is healing.

Laser Skin Resurfacing (Ablative)

Laser skin resurfacing (also called a laser peel and laser rejuvenation) is used to remove or improve fine lines and wrinkles, hyperpigmented areas and other blemishes, and can improve the appearance of acne scars. An ablative laser is used to remove all or part of the top layer of skin, the epidermis. For fine lines and wrinkles, the wrinkled layer of skin is removed. For acne scars, the skin is basically leveled down or nearly down to the depth of the scar. To be blunt, the laser will be burning off the topmost layer of your skin. Your skin will form a new epidermis that is smoother and younger looking.

Other forms of skin resurfacing or peels include chemical peels and dermabrasion which also remove all or part of the epidermis. Some skin problems—and some skin types—respond better to other forms of skin resurfacing and your physician may make a recommendation for something other than laser resurfacing after he or she examines your skin.

Laser skin resurfacing can be done to different depths of skin or over a larger or smaller area of your face. The length and difficulty of the recovery period varies depending on those factors. A deep peel over a small area may involve less discomfort and crusting than a light peel over the whole face. A deep laser skin peel will involve redness and swelling in the treated area and a few days where your skin will develop a crust and may even have clear fluid seeping out. You will feel like you have a bad sunburn.

Your physician will tell you how to properly care for the treated skin. Follow those instructions closely. If you are told to change bandages or apply medications, your must first wash your hands thoroughly with soap to help prevent infection. Do not pick at any crusts or scabs that form because this will cause scarring!

Recovery After Laser Skin Resurfacing

How long it takes your skin to heal after a resurfacing depends on the depth of the peel. You may be rather unsightly for 1 to 2 weeks. After the crusting has resolved, the new skin will be extremely sensitive to sunlight. You must wear a strong sunscreen whenever you go out and your doctor may advise you to wear a hat with a brim as well. If you sunburn the treated area, you may completely undo the effects of the peel.

Laser Skin Resurfacing Risks

The major risk of laser skin resurfacing is a burn. It is also possible to have an infection set in on the treated area. Other risks include hyperpigmentation or hypopigmentation in the treated areas. Some people with darker skin are more likely to have pigmentation problems after laser skin treatments.

Laser Skin Tightening (Nonablative)

A nonablative laser does not remove any layers of the skin. Instead, it can improve or eliminate wrinkling by causing the skin to create more collagen, which tightens it. Collagen is the skin protein that helps keep the skin elastic, and is more plentiful in younger skin. This tightening effect is noticeable immediately after the treatment and more tightening occurs over the course of a few months. Popular laser skin tightening treatments include the Titan® or Polaris™ systems.

Another treatment for tightening the skin and reducing wrinkles is intense pulsed light (IPL), which is occasionally called a laser treatment. However, the light used in IPL, while very strong, is not a laser. IPL is a nonablative light and it heats up the skin.

Laser skin tightening is one form of a nonsurgical face lift.

The risks of laser skin tightening include burns, permanent or semipermanent reddening of the skin, scarring, and hyperpigmentation or hypopigmentation in the treated areas.

Most cosmetic physicians recommend up to six treatments of laser skin tightening, depending on your needs and the area to be treated. Treatments are generally about 3 weeks apart.

Who Can Perform Laser Skin Treatment Procedures?

If you are considering having any laser skin treatments—ablative or nonablative—choose a surgeon who has been trained in and is experienced with using lasers on the skin. Check out his or her background and credentials before you have a consultation. Laser resurfacing and laser skin tightening (as well as laser treatments for other skin problems) can be performed by either dermatologists or plastic surgeons. The best choice is someone who is board certified in his or her field of medicine.

At your consultation, you will discuss your goals and your health history. The surgeon should explain the various techniques and lasers that are appropriate for your needs. Your surgeon may recommend some other type of treatment for your skin. He or she may also recommend treatments in 2 or 3 sessions rather than one very deep peel. If you have a history of cold sores, fever blisters, herpes, chicken pox, shingles, or other viral infections, tell your surgeon.

At the consultation, your surgeon should describe what your recovery will be like and how long it will take for the treatment you are having. You will also discuss anesthesia at your consultation. The choice of anesthesia for a laser skin treatment can range from nothing or a little local anesthetic to general anesthesia where you sleep through the whole treatment. Most laser resurfacing procedures are performed under light sleep sedation or general sedation, but some small procedures may need only a topical anesthetic.

How a Laser Treatment Is Performed

Laser resurfacing can take from 30 minutes to more than an hour, depending on the size of the area being treated, the depth of the treatment, and what you are having done.

At the beginning of your treatment, anesthesia will be administered and your face will be scrubbed with an antibacterial solution to remove surface bacteria. The laser beam will be applied to your face through a hand-held wand or paddle. The surgeon passes the wand over the area to be treated once or several times, depending on the type of laser, your skin, and how much resurfacing your skin needs.

If you are having a laser skin peel, your surgeon may cover your face with a thin film of antibiotic ointment or cream or with bandages; again, this depends on what kind of treatment you are having. Some surgeons use a layer of synthetic skin to protect the newly resurfaced tissue during its healing process. Generally, you will be ready to be released in about 2 hours. Your face may feel tight and quite tender as the anesthesia wears off.

You will not be allowed to drive yourself home if anesthesia was used. You will still be groggy and must be driven home by a responsible adult.

Recovery

Recovery, as with almost everything else to do with laser skin treatments, depends on what kind of treatment you had and the size of the area being treated. For a deep skin peel, your face will look very swollen the first 2 or 3 days. Most other laser treatments have less intensive recovery periods. The bulk of the swelling will go away over the course of a few days to a week. Your surgeon will tell you how to take care of your treatment area. You may be instructed to apply ice, gel masks, or vinegar soaks on your treatment area for the first 48 hours. Your skin will feel as if you have a bad sunburn.

As you heal after a deep peel, you will develop crusts and scabs. Do not pick at them because that can cause scarring. Do not wear makeup or use exfoliating skin products until your doctor gives you the OK, which will usually be after any crustiness is gone. Your skin will be sensitive for several weeks or months.

After any kind of skin resurfacing, you must use sunscreen to protect your new skin. Your skin will be very delicate and susceptible to sun damage. Avoid using alpha hydroxy acids, vitamin A (Retin A).

When your skin has healed after a resurfacing, it will be very smooth and young looking. You skin may be pinker than usual for up to 5 months or more, depending on your skin's ability to heal. You must take care of your skin to keep it looking vibrant and fresh.

After laser skin tightening, your skin will also be sensitive to the sun. Protect it with a good sunscreen. Your skin will be red for a few days, but it will usually look normal otherwise in the days after a treatment. The tightening action of the laser will start to show up in a day or two and will continue to develop over several weeks.

No procedure can keep your skin from aging, but laser skin resurfacing and laser skin tightening can give you a more youthful appearance and reset the clock for you.

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