Sunday, October 30, 2011

Laser Skin Resurfacing: A Primer

Laser Skin Resurfacing: A Primer

Reviewed by Yael Halaas, MD

Lasers are all the rage when it comes to revitalizing and rejuvenating aging and sun-damaged skin. It seems as if there's a new anti-aging laser being touted as the best one yet each time you flip through a beauty magazine, doesn't it?

But what can lasers really do for your skin? Are any of the latest lasers really the greatest? We'll help you sort out the hope from the hype with our primer on laser skin resurfacing, also called laser rejuvenation, laser skin tightening or laser surgery.

Lasers can treat aging and sun-damaged skin, but that's not all — not by a long shot (or zap, as the case may be). Other applications include:

Removal of birthmarks and vascular lesions (such as hemangiomas and port wine stains)
Moles and warts
Unwanted body hair
Skin diseases such as vitiligo and psoriasis. Vitiligo is marked by white patches caused by the destruction of melanocytes, the cells that give skin its color. Psoriasis is a chronic skin problem that occurs when skin cells grow too quickly, resulting in thick patches of skin.

The word "laser" is actually an acronym for light amplification by stimulated emission of radiation. Lasers create intense beams of visible, infrared or ultraviolet light. When laser light is absorbed by your skin it's converted to heat, which can result in the burning or coagulation of the targeted tissue.

Different lasers emit different colors and wavelengths. These colors of laser energy are absorbed by different facets of the skin or tissue, which is why certain lasers are recommended to treat certain conditions or skin types over others.

Some lasers are pulsed, which means that the beam is turned on and off in short pulses. Others are continuous wave, which means they emit a continuous beam of laser light.

To understand how and where lasers affect your skin, you must understand the layers and structure of your skin. The skin has three basic layers: the epidermis, dermis, and subcutis. The epidermis is the outermost layer of the skin. It is comprised of the stratum corneum (mostly dead skin cells called keratinocytes), live keratinocytes and the basal layer (which makes the keratinocytes). The epidermis also contains the melanocytes, or pigment-containing skin cells that give our skin its color. The dermis, or middle layer, is mostly made up of skin cells, hair follicles and sweat glands that are held together by collagen. Collagen is the main structural protein found in our skin and is produced by skin cells called fibroblasts.
Ablative vs. Non-Ablative Lasers

Facial resurfacing is usually done with an ablative laser (e.g., CO2 laser). Ablative means that the laser is removing some of your skin. By contrast, non-ablative lasers do not remove skin. Instead, they heat up fibroblasts and stimulate them to thicken the underlying collagen — in essence treating wrinkles from the inside out. Ablative lasers are more damaging and invasive than non-ablative lasers. Another difference is that non-ablative lasers require multiple treatments, while ablative lasers usually require just one.
Laser Types

There are many types of lasers that are used for various types of skin conditions or problems, and new ones seem to be introduced on a regular basis. Among those used most commonly are:

Carbon Dioxide Laser (CO2): The oldest type of ablative laser, the CO2 laser can improve skin texture, skin tone and wrinkles. The main drawback is that it's invasive, which means that there is a significant recovery period and you will have some residual pinkness in the treated area for about a month. Hyperpigmentation and hypertrophic or raised scarring may occur in people with darker, ethnic skin.
Erbium-YAG (yttrium/aluminum garnet) or Er:YAG: The energy from this laser is absorbed by superficial layers of the epidermis, dissolving damaged or unwanted tissue. The pulsing actually lessens the heat on the skin, so there is less damage. It can greatly improve sun-damaged skin. This is a less invasive alternative to CO2 lasers. It is not as effective for deeper wrinkles, but the recovery period and downtime are shorter, so it's a trade-off.
Q-switched Nd:YAG laser: This system can remove pigmentation lesions and blue or black tattoos. Tattoo removal usually takes between eight and 12 sessions.
High-Power Long-Pulse Nd:YAG: This system was designed to remove both vascular lesions and hair. This laser can be used on dark skin.
Long-Pulsed Nd:YAG laser: This laser is good for vascular lesions, facial flushing, redness, broken capillaries, and telangiectasia (purple or blue spider veins on the face).
Fractionated lasers such as Fraxel target the small areas of skin where damage has occurred, leaving the surrounding skin untouched. The Fraxel laser or other fractionated lasers may be best for wrinkles around the eye. For more information, please visit our comprehensive article about the Fraxel laser.

Are You a Candidate for Laser Resurfacing?

As good as it may sound, laser resurfacing is not for everyone. If you are prone to raised, red keloid scars, hyperpigmentation or hypopigmentation, or if you scar excessively from minor cuts and abrasions, laser resurfacing is probably not an option.

A consultation with a qualified physician can help determine if you are an appropriate candidate for laser skin resurfacing, and which laser is best suited to your skin type and/or condition. There is no one-size-fits-all laser, and the latest laser is not necessarily the greatest for you.

Make sure the physician you choose has your complete medical history and a list of any medications, supplements or herbal products that you take. If you have a history of cold sores, fever blisters, herpes, chicken pox, shingles or other viral infections, tell your surgeon. These viruses lie dormant in your body between outbreaks and can flare up after laser skin resurfacing.
Laser Resurfacing Risks

Laser resurfacing isn't risk-free. Risks may include:

Allergic reactions to the anesthesia
Burns or blisters
Abnormal pigmentation
Dormant viruses such as herpes or infections may be awakened by laser treatment.

These risks are minimized when you choose a qualified physician with extensive experience in laser skin resurfacing who is able to best match a specific laser to your skin type or concern.
Your Laser Resurfacing Procedure

Laser resurfacing can take from 30 minutes to more than an hour, depending on the size of the area being treated. Exactly how many treatments will be needed depends on the type of laser as well as the specific skin condition being treated.

At the beginning of the procedure, your face is scrubbed with an antibacterial solution to remove surface bacteria. Most laser resurfacing procedures are performed under light sleep sedation, where you are awake but not fully aware. Some less invasive and extensive laser procedures may only require topical anesthesia. General anesthesia may be recommended if a large area is being treated.

The laser is a big machine, but the light beam is passed down through a hand-held wand or paddle. Your surgeon passes the wand over the area to be treated. This may be done once or several times, depending on the type of laser, your skin type and treatment goals. The laser literally evaporates the targeted areas of skin, leaving only a faint trace of "smoke and steam" and revealing undamaged, pink skin.

After the laser skin resurfacing is completed, your surgeon may cover your face with a thin film of antibiotic cream or a layer of synthetic sheeting. Recovery varies based on the type of laser used and the size and scope of the treated area. Expect redness, puffiness and some pain after laser skin resurfacing. It can take a few months for all the redness to fade. You can usually use makeup to camouflage the redness within a week. Follow your doctor's instructions carefully to avoid any complications.

Keeping your skin moist is crucial. You may be told to wash your face several times a day to help get rid of dead skin cells. Avoiding sun exposure is also important. Most physicians recommend wearing a wide-brimmed hat and applying sunscreen with a sun protection factor (SPF) of 15 or higher to your skin because it is very susceptible to sun damage after a laser resurfacing treatment.
Laser Resurfacing Cost

The approximate prices for laser resurfacing range between $1,500 and $6,000. The cost varies based on the type of laser, area treated and the number of sessions required. Find out the cost of the laser resurfacing before booking your treatment(s). If the cost is prohibitive, inquire about payment plans or financing options.

In addition to discussing laser skin resurfacing, All About Facial Rejuvenation addresses numerous non-surgical treatments, including Botox injections and chemical peels, in addition to surgical procedures for the face such as facelift, rhinoplasty and eyelid lift surgery. Please visit the other pages of this site to learn more.

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