Laser resurfacing

Laser resurfacing uses focused light to remove or heat layers of skin in a controlled way. Ablative lasers remove the surface and need a longer recovery; non-ablative lasers heat beneath an intact surface and need less. The physician or practitioner who performs it sets the recovery plan.

The protocol is the treating professional's clinical decision.

What it is

A laser emits light at a single wavelength, and different wavelengths are taken up by different targets in the skin. Resurfacing lasers are chosen because water in the skin takes up their light and turns it into heat.

• Ablative lasers vaporize the outer layers and heat the tissue beneath. Carbon dioxide and erbium lasers are the two classic types.
• Non-ablative lasers heat the tissue beneath the surface and leave the surface in place.
• Fractional treatments, ablative or non-ablative, treat a grid of narrow columns and leave the skin between them untouched, which shortens recovery.

Practitioners use resurfacing for the look of fine lines, uneven texture and firmness, and for the look of uneven tone. It is one of the professional treatments explained in this section.

Who performs it

A physician, or a licensed professional under the supervision the jurisdiction requires, performs it; who may operate which laser varies by state, province and country.

What the skin goes through

Heat is the common thread. Published reviews describe an immediate thermal injury followed by a recovery and remodeling response that continues for months after the surface has closed.

After an ablative treatment the surface is open. It weeps and crusts before new skin covers it, and the physician directs wound care throughout that period. After a non-ablative treatment the surface stays in place, and redness, swelling and a bronzed or rough texture are commonly described for some days.

Recognized risks include prolonged redness, changes in pigment, infection, reactivation of cold sores and, less often, scarring. A chemical peel is the acid-based route to similar goals, and IPL is a broad-spectrum light treatment, distinct from laser.

Recovery

The physician or practitioner who performed the treatment describes the expected course, and that description is the reference. After ablative work, recovery follows a physician-directed wound-care plan, and nothing else goes on the skin until they say so.

Typical aftercare avoids heat, makeup, actives and sun until each restriction is lifted. Increasing pain, spreading redness, discharge, blistering or fever is a reason to call the practitioner the same day.

Questions to ask your practitioner

• Is this an ablative, non-ablative or fractional treatment, and why that one for me?
• Who will operate the laser, and what is their license and supervision?
• What is the pigment risk for my skin tone, and how do you prepare for it?
• I get cold sores. Do I need anything before the treatment?
• What goes on my skin during recovery, and who provides it?
• What will my skin look like each day, and what would be outside that?
• When can I restart my normal skincare and my actives?

Caring for skin once it is intact

Once skin is intact, keep the routine short and free of actives until the restart date:

• Cleanse gently. Comfort Cleansing Milk with cool to lukewarm water.
• Hydrate. One 1.5 ml application from a sealed vial of Hyaluronic Skin Repair NanoSerum on damp skin.
• Moisturize. AquaCell Moisturizer, with Barrier Repair Cream at night where the skin feels tight.
• Protect. Daily broad-spectrum sun protection from any brand, chosen with the UV filter guide. Vegalab does not sell an SPF product.

Related professional protocols

• Consultation and skin mapping: the assessment and photographs that come before any treatment plan.
• Post-treatment calming: comfort care on intact skin, with clearance from the performing professional.
• At-home maintenance after a professional treatment: the written week after the appointment.
• Uneven tone support: a treatment-room protocol for the look of uneven tone, once the skin is fully settled.

For heat-based treatments without a laser, see radiofrequency and RF microneedling.

References

The studies below describe the procedure.

• Preissig J, Hamilton K, Markus R. Current laser resurfacing technologies: a review that delves beneath the surface. Seminars in Plastic Surgery, 2012;26(3):109-116.