Ablative Laser Resurfacing

Ablative Laser Resurfacing

There are basically three types of ablative laser used for skin resurfacing-

  • CO2 laser
  • Er: YAG laser
  • ablative fractional laser

Laser skin resurfacing (eg, carbon dioxide laser, erbium:yttrium-aluminum-garnet [Er:YAG] laser) is one of the latest yet ablative treatments to tackle wrinkles, lines and age spots without facial surgery. With the laser, a skilled plastic surgeon can precisely target just the area requiring treatment rather than removing the whole surface of the skin as happens with dermabrasion or a peel. A beam of light from a laser over your skin was passed to vaporize the outer layers of damaged skin. The level of penetration required can be varied to remove deeper scars or stubborn age spots, and wrinkles. The procedure is always done under an anesthetic. For small areas – a local anesthetic and possibly an oral sedative will be enough. If the whole face was to be resurfaced then intravenous sedation or a general anesthetic is the usual approach. Scabs may form, and last for about 10 days. After that skin redness may persist for several weeks, or longer. The redness gradually lightens to pink, and then to a lighter, more natural color. You need to be even more careful to protect your newly resurfaced skin from the sun. Most laser skin resurfacing procedures are successful but there are still risks. Skin can become permanently lighter or darker as a result of laser resurfacing. Heat from the laser can cause burns or injuries. Research very carefully before deciding.

Fractional laser treatment is now also available for ablative skin resurfacing using CO2 and Er:YAG fractional laser. The advantage of ablative fractional laser is less risk of side effect and recovery time due to the fractional hundreds of microscopic microbeams that do not injure the surrounding tissues. Both Fraxel and Starlux brand have versions of ablative laser products. Visit our “ablative laser skin resurfacing” part for more product information.

There is a considerable variety in the equipment and treatment techniques user for laser resurfacing. The two most common lasers for wrinkle removal are carbon dioxide and Erbium:YAG lasers. Carbon dioxide laser appears to be somewhat more effective for treating deep wrinkles but has longer recovery time and tends to cause greater adverse reactions. Some surgeons use both carbon dioxide and erbium:YAG lasers in the same procedure: erbium laser for fine lines and small wrinkles and carbon dioxide laser for deeper wrinkles. Such an approach may provide the best risk-to-benefit ratio.

Another important technical aspect is the number of passes the surgeon makes when treating skin with a laser. Multiple passes, particularly with carbon dioxide laser, produce greater thermal injury and lead to greater side effects and longer recovery. Some surgeons assume that more passes results in a greater wrinkle reduction. However, research indicates that the benefit from additional passes may be small whereas additional risk is substantial. Some surgeons use a combination protocol where problem areas (around eyes, mouth and on the forehead) are first treated with one pass of carbon dioxide laser and then with one or more passes of less injurious erbium laser. The rest of the face may be treated with one pass of erbium laser.

Recently, there are ablative fractional laser systems launched on the market. The fractional laser is the type of laser resurfacing using a technology which apply hundreds or thousands of microscopic laser columns -treat a fraction of the skin at a time without affecting the surrounding tissue in an attempt to retain the effectiveness of treatment as classic ablative laser resurfacing, but reduced invasiveness and the risk of side effect, downtime coming with the traditional ablative laser resurfacing procedures.

Ablative Laser Resurfacing - Classification And Comparison

Laser Typeeffectivenessrecovery time safety
carbon dioxide (10.6 µm)deep wrinklelonger recovery time than Er: YAG lasergreater adverse reactions than Er: YAG laser
Erbium:YAG lasers. (2.94 µm)fine line, small wrinkle
ablative fractional laser (CO2 or Er:YAG)same as the classic systemsreduced downtime compared to classic ablative laser resurfacingreduced risk of side effects

Ablative Laser Resurfacing – Postoperative Care

Laser skin resurfacing (LSR) for the rejuvenation of facial skin remains a popular cosmetic procedure. Meticulous postoperative care is essential and is as important as intraoperative technique in achieving optimal results after laser ablation. Epidermal regeneration following the thermal injury of LSR is improved in a moist environment, since a dry crust or scab impedes keratinocyte migration.1 Both open and closed wound care methods can be applied to minimize morbidity and expedite postoperative wound healing. Numerous studies indicate that closed wound care regimens utilizing occlusive dressings for 48-72 hours postoperatively may hasten reepithelialization and reduce crusting, discomfort, erythema, and swelling.2-4 Appropriate medications and management techniques can also minimize the predictable effects of LSR.

Resurfacing with carbon dioxide (CO2) or Erbium:YAG lasers results in ablation of the epidermis and upper papillary dermis. During reepithelialization, the wound produces copious serous discharge along with sloughing of denatured collagen. Resultant crusting may predispose the wound to secondary infection. Other immediate expected sequelae of LSR include discomfort, pruritus, erythema, and edema. Reepithelialization after resurfacing occurs at a mean of 8.5 days after CO2 and a mean of 5.5 days after Erbium:YAG lasers.


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