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Like every other form of skin resurfacing, laser resurfacing involves the creation of a controlled burn. All burns heal by forming scar, and all scars are permanent. This means the results (both good and bad) from laser resurfacing will be long lasting.

Laser energy is absorbed by water. Since you are 70% water, when the laser power is delivered very quickly, the treated skin is literally vaporized. There is a light "laser scab" left behind. As you heal, your skin tightens, smoothing lines, wrinkles, and scars. The degree of improvement and time required to heal relate to the amount of laser energy used. Thicker, oily skin will tolerate more energy than thin, dry skin.

Although almost any area of the body can be treated, most laser treatments are done on the face. Risks of color change and/or scarring are higher in other body areas.

The most common facial treatment extends from your cheekbone to the jaw line, including your eyelids. Although you may not have significant lines in your cheeks, the overall tightening effect in the cheek skin contributes to your facial rejuvenation. From the perspective of healing, this larger regional treatment area is easier to conceal.

Smaller treatment areas are also common. The advantage is the smaller area to heal. The disadvantage is the potential line of demarcation between treated and untreated areas. This demarcation can be either (or both) the result of differences in skin color or texture.

When treating the forehead, not only can you smooth lines on your forehead, you may experience a functional brow lift.

In my practice, laser resurfacing has essentially eliminated the need for traditional lower eyelid surgery. Laser gives the best improvement in texture, while minimizing the risk of changing the shape of your eyes. Some patients with complaints of dry eyes or tearing have seen their symptoms improve after laser resurfacing.

There is no absolute "best" or "worst" time for laser treatment. Once you have decided to proceed with laser treatment, if you have dark skin, you will minimize the risk of sun-induced darkening of laser treated areas by having your treatment during the fall or winter. Similarly, you wish to allow 2-3 months before exposing laser treated skin to prolonged periods of sun. This includes sun reflected from snow or water.

Typically, you will pre-treat your skin with pigment cream. This cream helps to minimize risk of post-treatment color change, as well as helping to keep your pores open. If you have a history of acne, additional skin care treatments may be recommended.

Most laser treatments are performed in the office, using local anesthesia. Depending on your age and medical history, or if you are very anxious, treatment may be done at the surgery center.

Laser scab resulting from treatment will be left intact. Treated areas will be lubricated, usually with antibiotic ointment, at the end of treatment.

Laser treated areas are treated with a combination of cleansing and lubrication. During recovery, most patients feel "they look worse than they feel." Discomfort is expected, but if you experience significant burning pain, contact the office.

You will use baby shampoo to clean treated areas. The purpose of washing is to remove the loose "grunge" that develops. You should not "scrub." The laser scab should be allowed to separate spontaneously. You may wash as frequently as you wish, but you should wash at least once daily.

Lubrication is a combination of SilkCoat and Dermagran-B. SilkCoat spreads easily, but tends to "melt," adding to the drainage. Dermagran-B does not "spread" as easily, but tends to be "soothing." Most patients apply Dermagran-B after they have washed.

You will use Santyl Collagenase to help your body separate the laser scab more quickly. Once the scab is gone, Santyl is no longer needed.

You will take several medications around the time of surgery. To limit risk of cold sores, you will be given an anti-viral medication. Low doses of an anti-depressant medication is used to reduce the "burning" feeling of any burn.

Once your laser scab has separated, you may begin using make-up to conceal redness. Patients who use little make-up may need assistance with make-up technique. We have specialists available to help you.

Maintain lubrication with any lubricant that does not cause a burning feeling. So long as you don’t experience small pimples, you may continue to use either (or both) SilkCoat or Dermagran-B. Dimethicone containing lubricants (like Moisturel) may help reduce redness. A combination of SilkCoat & Balmex (a diaper rash ointment) has been very effective in reducing redness.

You can usually return to work after laser scabs are gone, usually with two weeks. If you must wear special protective gear, or if you are exposed to harsh chemical, sun, or extremes of temperature, you may need more time to recover.

The risks from any surgery are the same (see below). Risks from laser surgery are the same as for any burn. These risks include, but are not limited to redness, lightening or darkening or your skin, and undesirable scars.

Like sunburn, every patient will experience redness. The degree of redness and how long it lasts will vary from patient to patient. Typically, redness fades significantly over the first month after treatment, but it can last for several months. Redness will vary from day to day, as well as during the day. Any activity that makes you feel "flushed" will temporarily increase redness.

Your skin may become lighter, darker, or stay the same color. Most patients will see no long-term change in skin color. Lighter skinned patients (particularly if you are prone to sunburn) are more likely to see lightening of their skin. Darker complexion patients are more prone to darkening of their skin, especially during the first several months after surgery. This temporary darkening usually responds to sun protection and fade creams.

The most common permanent change in skin color is the loss of "age spots." Most age spots are the result of accumulated sun damage. The laser removes this sun damage, as well as the age spots. The absence of the age spots can cause a line of demarcation between treated and untreated areas.

While eye protection is used during laser treatment, there is a extremely small risk of injury to your eye.

Similarly, there is a risk of undesirable scar(s) after laser treatment, though the risk is very small. I will use my best judgment and experience to select a laser energy level that should improve your appearance, while minimizing your risk of scarring. To get the best result from laser resurfacing, you may need more than one treatment.

Copyright © 2002 Denis F. Branson, M.D.  All rights reserved.
Revised: 10/28/02.