Overview

Laser resurfacing is a facial rejuvenation procedure that uses a laser to improve the skin's appearance or treat minor facial flaws. It can be done with:

• Ablative laser. This is a wounding laser that removes the thin outer layer of skin (epidermis) and heats the underlying skin (dermis), which stimulates the growth of new collagen fibers. As the epidermis heals and regrows, the treated area appears smoother and tighter. Types of ablative treatments include the carbon dioxide (CO2) laser, the erbium laser and combination systems.
• Nonablative laser. This is a nonwounding laser that stimulates collagen growth, which over time helps improve skin tone and texture. This approach can be done with various types of lasers as well as intense pulsed light (IPL) devices. Nonablative laser resurfacing is less invasive and requires less recovery time than does ablative laser resurfacing. But it's less effective.

Both methods can be delivered with a fractional laser, which leaves microscopic columns of untreated tissue throughout the treatment area. Fractional lasers were developed to shorten recovery time and reduce the risk of side effects.

Laser resurfacing can decrease the appearance of fine lines in the face. It can also treat loss of skin tone and improve your complexion if you have scars or sun damage. Laser resurfacing can't eliminate excessive or sagging skin. Understanding the specific techniques, risks and possible results can help you decide if laser resurfacing is right for you.

Why it's done

Laser resurfacing can be used to treat:

• Fine wrinkles
• Age spots
• Uneven skin tone or texture
• Sun-damaged skin
• Mild to moderate acne scars

Risks

Ablative laser resurfacing can cause various side effects, including:

• Redness, swelling and itching. Treated skin may be itchy, swollen and red. Redness may be intense and might last for several months. The aggravation of a previously existing skin condition, such as rosacea, can contribute to redness.
• Acne. Applying thick creams and bandages to your face after treatment can worsen acne or cause you to temporarily develop tiny white bumps (milia) on treated skin.
• Infection. Ablative laser resurfacing can lead to a bacterial, viral or fungal infection. The most common infection is a flare-up of the herpes virus — the virus that causes cold sores. In most cases, the herpes virus is already present but dormant in the skin.
• Changes in skin color. Ablative laser resurfacing can cause treated skin to become darker than it was before treatment (hyperpigmentation) or lighter (hypopigmentation), beginning weeks after laser resurfacing. Permanent changes in skin color are more common in people who have darker skin.
• Scarring. Ablative laser resurfacing poses a slight risk of permanent scarring.
• Turning of the eyelid (ectropion). Rarely, ablative laser resurfacing done near the lower eyelid can cause the eyelid to turn out and expose the inner surface.

Nonablative laser resurfacing also can cause side effects, including:

• Infection. Nonablative laser resurfacing can cause a flare-up of the herpes virus.
• Changes in skin color. Nonablative laser resurfacing can cause treated skin to become temporarily darker than it was before treatment (hyperpigmentation).
• Mild swelling and redness. Swelling and redness typically last only hours or days.

Laser resurfacing isn't for everyone. Your doctor might caution against laser resurfacing if you:

• Have taken the acne medication isotretinoin (Claravis, Myorisan, Zenatane) during the previous year
• Have an autoimmune disease or a weak immune system
• Have a tendency to form scars
• Have had radiation therapy to the face
• Are prone to cold sores or have had a recent outbreak of cold sores or herpes virus
• Have a darker skin tone
• Are pregnant or breastfeeding

How you prepare

Before you have laser resurfacing, your doctor will likely:

• Ask about your medical history. Be prepared to answer questions about current and past medical conditions and any medications you're taking or you've taken recently, as well as any cosmetic procedures you've had in the past.
• Do a physical exam. Your doctor will inspect your skin and the area that will be treated. This will help him or her determine what changes can be made and how your physical features — for example, the tone and thickness of your skin — might affect your results.
• Discuss your expectations. Talk with your doctor about your motivations, expectations and the potential risks. Make sure you understand how long it'll take to heal and what your results might be.

Before laser resurfacing, you might also need to:

• Take medication to prevent complications. If you're having ablative laser resurfacing — or nonablative laser resurfacing and you have a history of herpes infections around your mouth — your doctor will prescribe an antiviral medication before and after treatment to prevent a viral infection.
• Avoid unprotected sun exposure. Too much sun up to two months before the procedure can cause permanent irregular pigmentation in treated areas. Strong sun exposure can also reactivate herpes virus in some people. Discuss sun protection and acceptable sun exposure with your doctor.
• Stop smoking. If you smoke, try to stop at least two weeks before and after your treatment. This improves your chance of avoiding complications and helps your body heal.
• Arrange for a ride home. If you're going to be sedated during laser resurfacing, you'll need help getting home after the procedure.

What you can expect

During the procedure

Your doctor may do laser resurfacing as an outpatient procedure. Your care team will numb skin with medication. For extensive resurfacing, such as treatment to your whole face, you might be sedated.

During ablative laser resurfacing, an intense beam of light energy (laser) is directed at your skin. The laser beam destroys the outer layer of skin (epidermis). At the same time, the laser heats the underlying skin (dermis), which stimulates collagen production over time, resulting in better skin tone and texture. Ablative laser resurfacing typically takes between 30 minutes and two hours, depending on the technique used and the size of the area treated.

If you're undergoing nonwounding laser or nonablative laser treatment, a series of treatments is typically scheduled over the course of weeks or months.

After the procedure

After ablative laser resurfacing, the treated skin will be raw, swollen and itchy. Your doctor will apply a thick ointment to the treated skin and might cover the area with an airtight and watertight dressing. You may take a pain reliever and use cool compresses. New skin usually covers the area in one or two weeks. During this time do not use products that may irritate your face, such as cosmetics and sunscreens. And avoid situations that increase your risk of infection, such as swimming.

After nonablative laser resurfacing, recovery time is minimal. You may have some redness, swelling and discomfort. Use cool compresses as needed. You can resume your normal activities and skin care routine immediately.

Results

After ablative laser resurfacing, your skin might stay red or pink for up to several months. But once the treated area begins to heal, you'll notice a difference in your skin quality and appearance. The effects can last for years.

Results after nonablative laser resurfacing tend to be gradual and progressive. You're more likely to notice improvements in skin texture and pigment than in wrinkles.

After laser resurfacing, avoid unprotected sun exposure for one year to prevent irregular pigmentation. Keep in mind that your results might not be permanent. As you age you'll continue to get lines by squinting and smiling. New sun damage also can reverse your results.