Laser Resurfacing

Types of Lasers Used at Mayo Clinic

Ablative Laser Resurfacing

Ablative lasers remove the top layer of the skin (epidermis). The heat produced by the laser also burns the skin layer under the epidermis (the papillary dermis) and a portion of the middle layer of skin (dermis). The skin responds as if it was repairing a wound and regenerates collagen, a protein that gives skin its texture and elasticity. Healing brings about smoother, and more even, tightened, toned skin.

The doctor may request six weeks of pretreatment with tretinoin, a prescription cream containing retinoic acid (a synthetic derivative of vitamin A) prior to laser treatment. This cream can improve fine wrinkling, roughness and pigment changes. Tell your surgeon if you have taken Accutane™ for acne or used any other facial creams.

Two to three days before laser resurfacing, you may be given an antiviral pretreatment and antibiotic to prevent cold sores and thereby reduce the possibility of infection and scarring. You also may be pretreated with hydroquine cream, a skin bleaching agent, to decrease the risk of hyperpigmentation (skin darkening).

Pain is an issue with ablative laser resurfacing. The technique creates a burn on the skin which will be red, and will blister and weep for 10 to 14 days. Care following treatment is time consuming and requires a routine of washing the face two to four times a day for seven to 10 days.

Nonablative Laser Resurfacing

Nonablative lasers affect only the dermis without damaging the epidermis. The procedure heats the dermis and causes new collagen to form. Healing time is shortened, compared to the ablative procedure, while still resulting in tighter, smoother skin. But the effect is less dramatic than the ablative procedure, and sessions typically need to be repeated more often. This technique can effectively diminish the appearance of fine wrinkles and brown skin discoloration.

What to Expect

To prepare for laser resurfacing, the surgeon evaluates the color, quality and thickness of the patient's skin and may take photographs for the medical record. Issues you should discuss with the physician include:

• Other resurfacing treatments you have had
• Any existing skin conditions, including viral infections that involve the face or lips
• Sun sensitivity
• Prior or current use of vitamin A-based medications, nutritional supplements or herbal remedies

Patients with a history of cold sores or fever blisters may have medication prescribed to prevent complications. Avoid sunburn for at least six weeks before any laser treatment.

When the procedure is completed, the face may be covered with a protective ointment. Some conditions may require more than one laser treatment. Treated skin should be protected with sunscreen that is SPF 15 or higher.

Risks

Risks associated with laser resurfacing include, but are not limited to:

• Burning the skin
• Swelling lasting for weeks and redness persisting for months. As a result, time off from work is a consideration.
• Whitening of the skin (hypopigmentation) or a blotchy discoloration (hyperpigmentation), which usually fades in a few weeks, but can last longer.
• If laser resurfacing is performed near the eyes of a person who has poor skin tone, the skin may contract and pull down the skin of the lower eyelids. Surgery may be required to correct this problem.
• Skin sensitivity