What does ablative laser resurfacing mean? Basically, we are using the heat generated by a laser to evaporate layers of skin. The most common uses of laser resurfacing are to improve the appearance of superficial lines to deeper wrinkles, blemishes or scars such as those produced by acne and uneven skin texture. Fully ablative laser resurfacing is the best treatment modality for moderately to deep wrinkles in a single session.
Lasers are selective of what structures they heat and destroy. Each type of laser is attracted to a certain chromophore, a part of a molecule that gives it its color. For example, lasers used for hair removal have brown pigment as their chromophore; lasers that treat enlarged blood vessels have red pigment as their chromophore. Lasers that are used for skin resurfacing have water as their chromophore. The skin is made up of 64% water. There are two types of lasers that generate enough heat to evaporate the skin – the CO2 laser and the erbium laser. The erbium laser has a much higher affinity for water compared to the CO2, meaning much less energy needs to be applied to the skin to cause vaporization of skin cells.
A little history of lasers
The CO2 laser was the first laser to be used for skin resurfacing in the mid 1990s. This laser is capable of producing remarkable reduction of wrinkles and treatment is not associated with bleeding, as there is so much heat generated that the blood vessels are also coagulated during the treatment. The downside to CO2 laser resurfacing is that the melanocytes that produce the skin’s pigment can also be destroyed, resulting in permanent white patches of skin. Additionally, due to the high levels of energy used during CO2 resurfacing, the treated area remains red for many months after treatment, even up to one year.
Due to these unwanted side effects of the CO2 laser, the erbium laser came into popular use for laser resurfacing. This laser results in efficient evaporation of skin with much less heat, unwanted loss of pigmentation and much shorter duration of redness.
It has been observed that greater amounts of heat generated in the skin does affect the degree of tightness in the skin. If skin tightening is the desired effect, it would appear that CO2 laser would be the laser of choice, but this would be need to be balanced by the desire to avoid unwanted side effects. The perfect solution became evident when the engineers at Sciton created an erbium laser which had the option of adding incremental amounts of heat to the treatment, even as much heat as to mimic the CO2 laser. This gives the physician ultimate flexibility and control to treat individual patients according to their needs, as well as individual areas of a patients face. This is the reason Restore Vein & Skin Centre invested in the Sciton platform, considered the Cadillac of laser systems.
Limitations to laser resurfacing
Not every patient is going to be a candidate for laser resurfacing. Patients with poor general health or smoke are not ideal candidates, as their skin healing may be delayed. Typically, this is a treatment that requires a committed 2 weeks of downtime. The surface of the skin has been fully evaporated; taking away the armour that prevents the body from losing water and increasing the susceptibility to infection. Caring for the treated area is a 24/7 job at least for the first several days. It is not recommended to leave the house for at least one week, until the new skin comes in. By the end of the second week, the face has usually totally healed. Pinkness can be covered by make-up and normal activities can be resumed.
While laser resurfacing does help to tighten the skin, it is not a replacement for extreme skin laxity that is better addressed with surgery. It is also not able to provide volume to the face which has been lost due to a loss of collagen in the skin and the underlying fat associated with aging. Volume loss is best addressed with dermal fillers after laser resurfacing.
Does laser resurfacing need to be retreated?
We get asked all the time how long will the results last? This is a very difficult question to answer as it really depends on several factors we can’t control, such as your heredity. Some families have the genetics that produce poor collagen leading to early skin aging. It has also been shown that certain ethnicities produce better quality collagen than others. Factors that you can control include how much time the skin is exposed to UV light, smoke, and pollution. The better the skin is protected, the longer the results will last.
Two weeks of downtime not for you?
You are not alone. Most people living in Kelowna and the Okanagan appreciate our region for the moderate climate and abundance of outdoor activities. While ablative laser resurfacing is the best treatment option for deeper wrinkles, skin improvement can be achieved with laser options that involve less significant downtime, as long as you are willing to have a greater number of treatments. See our blogs on Fractionated Laser Resurfacing and Halo.