How does an ablative CO2 laser work?
Carbon dioxide lasers, or ablative lasers have been used for many years to treat different mild to severe skin conditions. These ablative lasers have been used for skin conditions since the 1990s. Essentially, carbon dioxide lasers target and heat up water molecules in the skin. As the water molecules are heated up they turn into a gas and the adjacent skin cells are vaporized. The CO2 Laser uses very short pulsed light energy or continuous light beams that are delivered in a scanning pattern. These pulses last less than a millisecond or one thousandth of a second. With the intensity of the light being so extreme, the laser will precisely remove a thin layer of the skin as well as stimulate collagen production. The hope is that with removing layers of the skin we treat pigment as well as texture problems within the skin. After the treatment the skin begins the process of healing and recovery, which allows for the production of new and healthy skin cells, allowing the patient to achieve a more rejuvenated look.
What is the difference between a fractionated and non-fractionated CO2 laser?
You may have heard of both fractionated and non-fractionated CO2 ablative lasers. Fractionated lasers target the skin in a pixilated or segmented fashion. The fractionated laser leaves segments of untreated skin between where it has caused thermal injury. Since with fractionated laser treatments some of the skin is intact the recovery process is quicker and the patients have less anticipated reactions such as swelling and redness. Generally, the results from a fractionated CO2 lasers are not as dramatic as would be expected from a non-fractionated laser treatment, but the downtime and risks are less.
Image taken from www.elementaleesthetics.com
What skin conditions does CO2 laser resurfacing treat?
Laser resurfacing is the best single treatment for advanced skin damage and wrinkling. The CO2 laser will treat the following problems:
- Scars (including acne scars)
- Wrinkles and fine lines
- Age spots
- Uneven Coloration and Hyperpigmentation
- Skin Laxity
- Texture irregularities
Specifically, (CO2) lasers can be used to eliminate fine lines on the cheeks, forehead and upper lip, smooth and tighten the skin on both the lower and upper eyelids, improve crow’s feet around the eyes, soften deep frown lines, flatten scar tissue, reduce stretch marks and hyperpigmentation, remove sun freckles and age spots, repair smoker’s lines and rejuvenate the skin by smoothing and polishing the complexion. Often times laser resurfacing is done in combination with surgery such as a facelift or blepharoplasty to enhance the surgical results.
What skin conditions will not improve with CO2 laser resurfacing?
Although laser resurfacing can deliver dramatic results and significant improvement in wrinkles, as well as help smoothen out acne scars, it will not completely eliminate deep wrinkling or severely sagging skin. This is where the expertise of our facial plastic surgeon would help you determine whether surgical options combined with laser resurfacing are right for you. Laser resurfacing is also not an option for patients of skin type 4 or above, as it can result in hyperpigmentation during the healing process. Even skin types less than 4 are ideally placed on a combination of tretinoins and hydroquinone as a pre-treatment 6-8 weeks prior to performing their procedure. This pre-treatment regiment of tretinoin and 4% hydroquinone prepares the skin for the induced injury from the laser and optimizes healing and outcomes.
Will I need more than one laser resurfacing treatment?
For the majority of patients one laser resurfacing treatment is sufficient to address most skin concerns. Full and final results are seen typically six months after resurfacing is performed. Depending on the skin condition you are trying to treat, for example acne scars and deep wrinkles you may need more than one treatment. Follow-up resurfacing treatments may sometimes be performed with other modalities such as erbium resurfacing, micro-needling with PRP or chemical peels.
A physician who is trained and experienced with CO2 lasers should be the only individual to perform your resurfacing procedure. Dr. Jessica Kulak, our face and neck specialist at The Naderi Center is extremely well versed on CO2 lasers as well as other laser resurfacing techniques. Dr. Kulak can provide you with a variety of different resurfacing options depending on the results you are trying to achieve as well as the downtime that you can afford after surgery. During your consultation you will discuss problem areas with your skin, your recovery and downtime and invasive as well as non-invasive options.
How long can I expect to maintain my results after my laser resurfacing procedure?
CO2 Laser resurfacing treatment is fairly intense, but if you want dramatic improvement, the results will be worth it. You will have a fresh, rejuvenated complexion whose results can last for years. Combined with a good medical grade skincare regiment you can preserve your new beautiful skin for a longer period of time. Touch up treatments with other resurfacing lasers that are not as aggressive can be done to also help maintain the rejuvenated skin. Additionally, avoiding sun exposure is the single most important factor in preserving your more youthful skin.
How should I expect to look and feel after my CO2 laser resurfacing procedure?
Ablative CO2 laser resurfacing is often performed in an operating room setting under general anesthesia or deep sedation. Your skin will feel raw and stinging for the first few days and you will be provided with pain medication as well as a post-recovery kit with products that will aid with healing. Some patients do not have to take any strong pain medication and do well with other the counter pain medication such as Tylenol. The first few days you will be instructed to cover any raw surfaces of the skin with a thick layer of our post-recovery ointment. We advise that you keep the skin moist at all times in order to minimize crusting and drying out of the skin. It is extremely important that you stay out of the sun during the recovery period. Moderate to severe amounts of swelling is expected in the areas treated, especially around the eyes and lips. The swelling will get greater by the 2nd and 3rd day and should begin to subside by the 4th and 5th day. Keeping your head elevated when laying down, as well as walking around will help with swelling. Within 24-36 hours you will notice that the treated areas begin to look like a deep, raw sunburn. During the first 7 days the delicate skin is undergoing a “toughening up” process. By the 7th and 10th day most of the crusting will begin to disappear and the new skin will appear intensely pink or red. Within 10-14 days, most patients can begin to wear makeup.
The following are expected and normal to experience in the first few days of your procedure:
- Burning sensation, like having an intense sunburn
- Tightness sensation
- Pinpoint bleeding, which should stop after the first 24 hours
- Oozing which is yellowish
- Swelling of the face, especially around the eyes
When is it advised to go back into the sun after CO2 laser resurfacing?
Strict sun avoidance for the first eight weeks after treatment is crucial. YOU WILL BURN AND HYPERPIGMENT IF YOU HAVE DIRECT SUN EXPOSURE. Sun exposure will significantly hinder the healing process after laser resurfacing. If you must go outside wear a wide brim hat, sunglasses (if you had resurfacing around eyes only) a SPF 50 sunscreen and stay in the shade. Even after you have healed from your resurfacing procedure we advise avoiding the sun in order to obtain maximum longevity of your results.
Can I bathe and wash my face after CO2 laser resurfacing?
You may bathe normally, but be cautious of getting soap on your healing face. Always apply the post-recovery ointment immediately after showering. Your skin should be washed frequently the first few days with only cool tap water and soft cotton balls. DO NOT USE ANY CLEANSERS; SOAPS OR TONERS while the skin is still raw. Once the skin starts to heal you will start to use a prescribed skincare regiment that will optimize healing which includes a face wash, recovery crème and sunscreen with SPF 50.
When is the best time to do laser resurfacing?
Most physicians would agree that fall and winter are the seasons to perform laser resurfacing. A big part of that has to do with sun avoidance both before and after the CO2 laser resurfacing procedure. If you show up for your procedure with sunburn, the procedure will be cancelled. Sunburned skin does not heal well. Additionally, during the colder months most people are indoors and the daylight hours are less, minimizing sun exposure. However, if you live in parts of the country like Miami, FL where avoiding the sun any time of the year is nearly impossible then there is not perfrect time of the year to have laser resurfacing done. No matter what time of the year you have laser resurfacing performed, it is important that you continue to take care of your skin by always wearing sunscreen with a minimum of SPF 30 and avoiding direct sun exposure.
I am prone to getting cold sores, is there anything that I need to do to prevent a break out after my laser treatment?
Prior to laser resurfacing your doctor will want to know if you have a history of cold sores. Any type of injury or insult to the skin can reactivate the herpes virus, which is responsible for cold sores. Laser resurfacing can definitely prompt a cold sore break out and that is why we place patients with a history of cold sores on anti-viral medication prior to their procedure and a few days after. The medication will significantly minimize the risk of a cold sore break out.
Does the actual laser resurfacing procedure hurt?
Yes, laser resurfacing done with a CO2 laser is uncomfortable. Laser resurfacing is ideally done under general anesthesia to ensure maximum patient comfort or if performed with oral or IV sedation the surgeon applies numbing crème as well as often times combined with injections of local anesthesia to the face.
I was told that I am not a candidate for CO2 laser resurfacing because of my Fitz Patrick skin type. What options for resurfacing do I have?
Just because you are not a CO2 laser resurfacing candidate does not mean that you can not perform any type of resurfacing procedures. Patients of all skin types are candidates for resurfacing procedures such as microneedling, chemical peels (VI peel), micro-laser peels and medical skincare regiments, which induce, skin resurfacing.
Do my medical conditions and medications I take on a regular basis affect whether I can have laser resurfacing done?
Absolutely! Certain medications and medical conditions may make laser resurfacing unsafe to perform. That is why it is crucial that you inform your doctor of all medical conditions, medications and supplements that you are taking. A few of these medications and conditions include the following:
- Isotretinoin (Accutane) taken for treatment of acne impairs wound healing
- Blood thinners and medications which increase risk of bleeding (motrin, aspirin, ibuprofen, naproxen)
- Smoking can impact healing
- Certain antibiotics and other medications can induce hyperpigmentation post-laser treatment
- Diabetes can slow down healing and recovery
- Active Acne
- Autoimmune disease or weak immune system
Is laser resurfacing expensive?
Depending on the area you are looking to treat laser resurfacing can cost anywhere from $1200 for around the eyes to $3500 for the entire face. At The Naderi Center in order to ensure full patient comfort and safety we perform our procedures in a hospital operating room setting, thus there are facility and anesthesia fees that are associated with the procedure.
Is it important what kind of CO2 laser device my doctor uses?
In the last decade the laser technology has advanced tremendously and there are lots of options when it comes to purchasing lasers. At The Naderi Center we do the research and scrutinize the competition before deciding what is the best device to use for our patients. Lumenis® is a global leader in developing Laser technologies and their CO2 lasers are recognized for being safe, effective and reliable. Dr. Jessica Kulak is expert at working with Lumenis® Ultrapulse and knows how to operate the laser to achieve the fantastic results safely for her patients.