Lasers can be used to resurface the skin, improve wrinkles or improve scars such as those found in acne. The laser delivers fine beams of energy into the skin, causing targeted thermal damage. This encourages the skin to naturally repair itself and form new collagen, thereby improving scarring, complexion and overall skin quality. The Carbon Dioxide(CO2) and fractionated lasers (FRAXEL®) are commonly used for this purpose. Common areas treated include the face, neck, decolletage and the backs of hands
Carbon Dioxide (CO2) laser
The CO2 laser has been used since 1994 and gives the most dramatic results in comparison with any other method. It is able to target both the superficial and deep layers of the skin so is the most effective treatment method for scar revision, deeper scars and for dramatic skin rejuvenation. The CO2 laser causes a degree of skin tightening on treatment. In addition, it causes microscopic columns of targeted damage within the skin. These areas then heal and repair, forming new collagen and tissue in the process. Collagen formation can continue for up to 2-3 years so the skin will continue to improve long after the treatment has been completed. The tradeoff of having such dramatic results is a longer downtime of 7-10 days (time to heal and redness to settle)
The Fraxel® dual laser is a non ablative laser which can deliver 2 different frequencies of energy. One frequency is efficient in improving pigmentation, tone and texture. The second frequency is more effective in deeper skin rejuvenation, thereby helpful in improving wrinkles and scars. The laser can be tailored to your requirements so one or both frequencies can be used. The laser causes microscopic columns of targeted damage within the skin. These areas then heal and repair itself, forming new collagen and tissue in the process. Collagen formation continues for 3-6 months so the skin will continue to improve long after the treatment has been completed. The difference between the Fraxel® and CO2 laser is that the Fraxel® causes less damage so its effects are not as profound however the advantage is that the downtime is shorter at 3-5 days (time to heal and redness to settle) thereby making it appropriate for patients who are unable to take the required time off for healing with a CO2 laser. Patients often require three treatments with treatments spaced 2-3 months apart to achieve the desired results
What should I expect ?
Your requirements will be discussed during the consultation and your suitability for treatment will be assessed. If appropriate, the merits and drawbacks of the individual lasers will be discussed. If you suffer from cold sores, it is advisable to have a course of antiviral medication such as acyclovir prior to and after treatment to avoid an outbreak. This will be prescribed for you before treatment. A test patch is then required to determine the appropriate treatment settings. The majority of treatments can be undertaken using local anaesthetic however larger areas may require the use of a general anaesthetic. Local anaesthetic is applied an hour before your treatment. There may be some slight discomfort during the treatment however this should not be intolerable. If it is, oral analgesia can be taken. The treatment can take between 15 minutes to an hour to complete depending on the area(s) to be treated. Following the treatment, you will experience a sensation similar to sunburn which should last a day or two at most. You will be given instructions on how to care for your skin as it heals. This depends in some ways on which laser is used however generally it involves keeping the treated areas moist with 50:50 ointment to promote healing whilst keeping it clean with a mild soap and water. The healing process is not painful however you will notice the natural flaking and peeling of the skin. With CO2 resurfacing, this last 7-10 days and with Fraxel®, 3-5 days. There will also be redness which can last 1-3 months with the CO2 laser, and up to a month with Fraxel®. This redness is easily covered up with makeup. You may also experience itching over the treated areas in the first few days. This can be treated with 0.5% hydrocortisone cream that can be purchased over the counter from a pharmacist. The skin will look better at 1 month and will continue to improve over a period of 6 months. During this time, it is important to apply sun protection with a minimum of SPF30 over the treated areas whenever you are out for at least 6 months to avoid pigmentation problems.
What is the follow up ?
You will be seen at 2 weeks to ensure that complete healing has taken place and at 3 months to review the results of the treatment
What are the risks and complications ?
Scarring : Laser resurfacing is very precise and delivers microscopic energy beams into the skin to stimulate healing and collagen production. This accuracy therefore makes scarring uncommon but not impossible. If the laser is set to too high a setting, it is possible to cause a deeper wound, delayed healing and eventual scar formation. This is why determining the appropriate setting with a test patch prior to treatment is important.
Hypo/hyper pigmentation : Hypo/hyper pigmentation are changes in the colour of the skin to either lighter or darker respectively than the pre-treatment tone. The risk of this is uncommon in Caucasians but higher in darker skinned individuals. In these cases, an anti-pigmentation medication is usually given prior to treatment. Additionally, it is important to adhere to sun avoidance and use of sun protection for 6 months following treatment
Redness : The treated areas will be red for up to 3 months following treatment. This is normal and resolves but it is important to use sun protection to avoid it getting worse
Infection : Infection is uncommon but if it occurs, a course of antibiotics will be required
Recurrence of wrinkles : Laser resurfacing reverses the effects of aging and smoothes wrinkles out whilst tightening the skin however it does not stop the process of aging so with time, wrinkles will re-develop. These can be re-treated again with laser resurfacing if required