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Laser skin resurfacing

Introduction to skin resurfacing with lasers

Laser skin resurfacing is one of the new age mantras of getting back your youthful looks. For no one wants to look old and technological advancements have now come up with surer means of hindering the skin’s ageing process compared to the age-old herbals extracts and masks.

Laser resurfacing is certainly a luxury to indulge in and also has its side effects. Nonetheless it is a fast and effective skin rejuvenation technique that many are opting for now-a-days.

Laser skin resurfacing is a biphasic process, which involves the substitution of the fine layers of old, damaged skin with fresh, healthy skin. Carbon dioxide (C02) laser skin resurfacing for skin restoration came to light in the 1980s. Since then technical advancements have made it an effective and safer means of correcting the following conditions:

  • Epidermal lesions
  • Skin tumors
  • Dermal lesions
  • Inflammatory dermatoses

The advent of the more advanced scanning systems such as the computer pattern generator (CPG) further modernized the laser skin surfacing process. CPG is applicable for many laser systems and has the following advantages:

  • It can correct skin of various sizes and distribution
  • It is a speedy process
  • It is highly precise
  • Full-face resurfacing can be done quickly
  • It ensures uniform results

Comparison with other skin rejuvenation procedures

Laser resurfacing is now preferred over the two conventional therapies for cutaneous photo damage namely chemical exfoliation and dermabrasion, due to procedural drawbacks, inconsistencies and side effects like scarring and de-pigmentation associated with the latter. It is also the better choice in the correction of superficial skin lesions since surgery often causes scarring. This apart, pulsed C02 lasers is also the favored choice over cold-steel surgery in case of invasive techniques such as rhytidectomy and blepharoplasty.

A comparative analysis between pulsed C02 laser, medium-strength trichloroacetic acid peel and dermabrasion has come up with almost similar results. However, Baker’s phenol peel has reported deeper thermal damage. Medium-strength trichloroacetic acid peel and dermabrasion had the same restorative period as in case of one to three applications of pulsed laser. In case of phenol treatment there was greater injury and longer restoration time.

Er:YAG Laser is the latest laser procedure which is also being researched for skin resurfacing.

Types of CO2 lasers used for skin resurfacing

There are two major types of CO2 lasers used for skin resurfacing:

1. The continuous-wave CO2 laser: This is the earlier type of laser first used for skin resurfacing. It has greater chances of associated thermal damage of the surrounding skin tissues. This is known as nonselective thermal damage that can result in scarring and discoloration.

2. Rapid pulse lasers and flashscan CO2 lasers: These are more current and advanced laser techniques that ensured lesser thermal damage of surrounding skin tissues other than the targeted ones. It technologically targets tissue ablation more specifically and hence minimizes chances of leaving behind scars. This is achieved by decrease in the period of time the target tissue is exposed to laser radiation. The ultrapulsed carbon dioxide (UPC02) laser is one of most beneficial in adding the glow of youth to old, haggard facial skin.

Lasers can also be categorized according to first generation lasers and the more modern ones produced by different companies. Two top first-generation lasers are ultrapulse laser and Sharplan Surgilase 150 XJ. Among more recent lasers we have Novapulse laser, Clearpulse laser, Tru-Pulse, The Sharplan SilkTouch laser and FeatherTouch.

The laser resurfacing procedure

There are certain factors associated with the laser resurfacing procedure. They are:

Fluence: Fleunce is the energy density necessary to thermally damage the target issue. In case of laser resurfacing it should ideally be 4.5 to 5.0 J/cm2. A fluence greater than that and a pulse duration less than 1 msec, can target tissues up to a greater depth but causes thermal damage as well.

Preoperative and post-operative steps: It is vital to undertake certain pre-operative measures for ensuring best results from the treatment, especially important in patients with darker complexions. The pretreatment steps involve the use of broad-spectrum sunscreens, application of bleaching agents and tretinoin cream or glycolic acid cream, therapy with oral antibiotics and antiherpes medications. Post-operative care involves use of petroleum ointment, hydrogel surgical dressings, diluted acetic acid soaks, soap-free wash, use of sunscreen, bleaching and a tretinoin cream routine.

Anesthesia: The right kind of anesthesia is necessary according to the type of laser exposure. Generally, topical anesthesia is effective for up to two laser applications for a full-face therapy. For patients intolerant to the discomfort associated with the procedure, sedational anesthesia is necessary. Often sedation is chosen over topical anesthesia to minimize pain involved in large surface laser passes.

Complications from laser skin resurfacing treatments

You should also watch out for complications that may occur during a laser resurfacing procedure. Some of the more common complications are:

  • Infection
  • Contact Dermatitis
  • Swelling
  • Erythema
  • Depigmentation
  • Scarring

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