Laser Resurfacing

What can be expected during & after the laser resurfacing procedure?

In general, carbon dioxide laser resurfacing is performed on an outpatient basis using local anesthesia in combination with sedative medications given by mouth or through a vein. The areas to be treated are numbed with a local anesthetic. General anesthesia may be used when the entire face is treated. Wrinkles around the eyes, mouth, or forehead may be treated individually, or a full-face laser resurfacing may be performed.

Following the laser resurfacing procedure, the patient then cleans the treated areas two to five times a day with saline or a dilute vinegar solution. An ointment such as Vaseline®, Eucerin®, or Aquaphor® is then applied. This wound care is intended to prevent the forming of any scabs which can increase the chance of scarring and prolong the healing time. In general, the areas heal in 10 to 21 days, depending on the nature of the condition that was treated and the intensity of the laser settings. The stronger the settings, the longer the recovery time.

Once the areas have healed, oil-free makeup may be worn to camouflage the pink-to-red color that is generally seen after laser resurfacing. Green-based makeup is particularly suitable for the redness in the skin. The redness in the laser-treated sites generally fades in two to three months, but may take as long as six months to disappear. It generally persists longer in blondes and redheads.

Patients with darker skin tones have a greater risk of healing with darker pigmentation (hyperpigmentation), although anyone can be affected by this condition after laser treatment. This may be minimized by the use of a bleaching agent before surgery. It also may be reduced with the continued use of this agent after healing. Patients should be advised to avoid sun exposure for four weeks before their laser treatment and to liberally apply sunscreens pre- and post-procedure.

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What are the possible side effects?

• Milia, which are small white bumps or cysts, may appear in the laser-treated areas during healing. These may be removed by gentle cleansing with a washcloth or by a dermatologist in the office by nicking the surface with a blade and expressing the cyst material out of the skin.
• Acne flares may occur after laser resurfacing. This may resolve on its own or can be treated with conventional acne therapies.
• Hyper-pigmentation, and more rarely, hypo-pigmentation, may result in the laser-treated areas. In general, the hyper-pigmented areas may be treated with bleaching cream to ease fading of the pigment. Hypo-pigmentation is more difficult to treat.
• Reactivation of a herpes simplex cold sore may occur especially after laser resurfacing around the mouth. This can be prevented by giving an antiviral medicine prior to the surgery and continuing it for 7 to 10 days post-procedure.
• Bacterial infections can be prevented by taking an antibiotic prior to the surgery and continuing for 7 to 10 days post-procedure.
• Post-operative swelling is to be expected and is lessened by administration of intramuscular steroids.
• Patients are encouraged to sleep on an extra pillow at night to help reduce the swelling. Ice pack application is also helpful in the first 24 to 48 hours.
• Scarring, although very rare, may occur in laser-treated areas.
• Cessation of smoking is highly recommended because of its documented harmful effects on the healing process.

How is the skin cared for afterwards?

Daily sunscreen application is necessary after healing to protect the newly laser-resurfaced skin. A broad-spectrum sunscreen is recommended which screens both ultraviolet B and ultraviolet A rays. A sunscreen specifically formulated for use on the face with a sun protection factor (SPF) of at least 30 should be used daily.

Liberal moisturizer application is also recommended after healing. Patients may resume application of Retin-A and/or glycolic acid products approximately six weeks after the procedure, or as directed by a physician.