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
