What Is Laser Skin Resurfacing?

What Is Laser Skin Resurfacing?

Laser skin resurfacing, also known as a laser peel, laser vaporization, and lasabrasion, is one of the most popular skin care procedures that depend on lasers to smooth out wrinkles, get rid of skin problems, and improve skin texture and appearance.

The word laser stands for Light Amplification by Stimulated Emission of Radiation. When used for cosmetic purposes, the laser technique depends on releasing direct, short, concentrated, pulsating light beams at the targeted areas to remove the skin, layer-by-layer, in a very precise way, by vaporizing it.

The outer skin layer, also known as the epidermis, will be removed, and the underlying skin layer, also known as the dermis, will be heated. This will lead to the stimulation of the growth and formation of new collagen fibers in the targeted area, leading to the formation of new skin cells that are firmer and smoother. As we age, the production of collagen in our skin decreases, which leads to the formation of fine lines and wrinkles. With the new collagen formation, the skin will start looking young again.

In other words, skin laser resurfacing creates an injury area in the targeted tissues. This injury is controlled completely, and it is the main goal is to stimulate the body to develop a healing response in a certain way that resolves the skin problem and makes it look better after the procedure.

According to the American Society of Plastic Surgeons report in 2018, the percentage of laser resurfacing skin procedures increased significantly by about 248%. The number of procedures done in 2000 was 170,951 while in 2018, it was more than 600,000 in the United States alone. (1)

Types of Lasers and What You Can Expect from Each One

There are many lasers on the market nowadays and if it is your first time undergoing a skin laser resurfacing procedure, you may get overwhelmed and confused about the best type for you. (2, 3, 4, 5, 6)

First things first, you need to be aware of these laser terms.

• Ablative Lasers

Ablative lasers depend on wounding your outer skin layer, the epidermis, while delivering heat to the inner skin layer, the dermis. This approach aims to stimulate the growth and formation of new collagen. While the epidermal cells regenerate, the wrinkles and fine lines in the targeted areas will be smoothed out, which makes the skin younger and look better.
Ablative laser procedures are more invasive than non-ablative lasers. Therefore, these procedures require more recovery time and subsequently, the results will be better and more dramatic.

• Non-Ablative Lasers

Non-ablative lasers do not depend on wounding the epidermis, but still, they stimulate the growth and formation of new collagen in the dermis.

Non-ablative laser procedures are non-invasive. Therefore, they need less recovery time and subsequently, the results will take more time to appear. These types of lasers are safer for all skin types than all other laser types.

• Fractionated / Fractional Lasers

These types of lasers allow leaving certain microscopic skin columns untreated, which allows for shorter recovery time while providing the skin with great results.

Here are the best and most recommended lasers available and what they can do for you.

• IPL or Intense Pulsed Light

IPL is highly recommended for getting rid of skin pigmentations to create the perfect skin tone. Therefore, if your main goal is to get rid of skin issues such as aging spots, dark scars, and sun discoloration, the IPL laser may be the right solution for you. It is a non-ablative laser that can be used for various body parts such as the face and arms.

• Fractional Laser

Fractional lasers are highly recommended for people who want to improve their skin texture. Therefore, it is great for skin problems such as wrinkles, fine lines, and depressed acne scars.
It depends on selective photo-thermolysis and can treat scars and skin discolorations without causing any harm to the surrounding skin.

• Clear + Brilliant

This type of laser is non-ablative. It is gentle on the skin and safe for all skin types. The procedure is less harsh than other types of lasers. The sessions do not require recovery time and the results appear after a few sessions.
It is highly recommended for skin problems such as mild scars, superficial wrinkles and fine lines, and sunspots. Besides, it can increase skin permeability, which enhances the effectiveness of skincare products allowing them to reach the deeper layers of the skin.

• Picosure

This type of laser is non-ablative. It is mild but highly recommended for pigmentation problems such as sunspots, wrinkles, and acne scars.
This treatment does not cause any pain or discomfort and does not need any recovery time.

• Erbium YAG Laser 

This laser is effective in treating superficial wrinkles, fine lines, acne scars, and pigmentation problems such as age spots and sunspots. Since it is an ablative laser, patients can feel some pain during the procedure, but the results are great and can be noticed after the first session.

Laser Skin Resurfacing Uses

People who suffer from acne problems, aging signs, sunspots, and other skin problems that cannot be treated using over-the-counter (OTC) products may benefit from laser skin resurfacing.

The procedure is used to treat one or more of these skin problems:

• Aging spots.
• Mild to moderate scars and acne scars.
• Wrinkles and fine lines.
• Crow’s feet wrinkles.
• Uneven skin tone or texture.
• Sagging skin.
• Enlarged oil glands.
• Sun-damaged skin.

The natural tone of the skin plays a role in determining whether skin laser resurfacing will be good for you or not.

The procedure is recommended for people with lighter skin tones since the risk of hyperpigmentation is low. On the other hand, the American Board of Cosmetic Surgeons (ABCS) says that the procedure is not exclusive for people with lighter skin tones. The procedure can work for any skin tone as long as the dermatologist or physician has enough experience and can determine the best type of laser for the patient’s skin tone. (7)

Furthermore, ABCS recommends getting skin laser resurfacing during winter or fall to decrease sun exposure, which can lead to damages to your delicate skin. Finally, the procedure is not recommended for people who have active acne breakouts or excessive sagging skin.

Figure 1 – Fractional resurfacing. Patient before (A) and after (B) treatment with 1550-nm erbium-doped mid-infrared fractional laser resurfacing. 

The Risks and Side Effects of Laser Skin Resurfacing

1. Ablative Lasers

Ablative laser skin resurfacing can cause many side effects including:

• Itching, and Swelling: The treated skin can become itchy, swollen, and red. Redness can be severe and lasts for several months after the procedure. If there is a previous skin condition such as rosacea, its severity can increase the redness.
• Acne: If you applied thick creams, lotions, or bandages to your face after the procedure, your acne may get worse. Temporary tiny white bumps, also known as milia, can develop on the treated areas.
• Infection: A viral, bacterial, or fungal infection can develop after ablative laser resurfacing. The flare-up of the herpes virus is the most common infection occurring after laser skin resurfacing. The herpes virus is what causes cold sores. In these cases, the virus exists in the skin, but it is dormant.
• Skin Discolorations: Ablative laser skin resurfacing can cause skin discolorations. It can either make your skin darker than it was before the procedure (hyperpigmentation) or lighter (hypopigmentation). Skin discoloration can start weeks after the procedure. People with darker skin tones are at risk of developing permanent skin discoloration.
• Scarring: Ablative laser skin resurfacing can cause permanent scarring in some cases.
• Ectropion or Turning of the Eyelid: In some rare cases, ablative laser skin resurfacing procedures done near the lower eyelid can lead to ectropion, which is the turning out of the eyelid and exposure of its inner surface.

2. Non-Ablative Lasers

Non-ablative laser skin resurfacing can cause many side effects including:

• Infection: Non-ablative laser skin resurfacing can lead to the flare-up of the herpes virus. Bacterial and fungal infections are not common in non-ablative laser skin resurfacing.
• Skin Discolorations: People with darker skin tones are at risk of developing darker skin tones (hyperpigmentation) temporarily after the procedure.
• Mild Redness and Swelling: Redness and swelling last between several hours to a few days after the procedure.

Talk to your doctor about the possible risks and side effects and the best ways to manage or prevent them. (8, 9, 10)

Who Should Not Undergo Laser Skin Resurfacing?

Laser skin resurfacing is not recommended for everyone. Your doctor may recommend against in the following cases.

• If you have taken a certain acne medication called isotretinoin, also known as Claravis, Myorisan, and Zenatane, during the previous year since it may increase the risk of scars.
• People with weak immunities or who have an autoimmune disease should not undergo this procedure.
• People who tend to form scars, prone to cold sores, or have suffered from a recent cold sores outbreak or herpes virus infection.
• People with darker skin tones.
• Pregnant or breastfeeding women.
• People who have had facial radiation therapy.

You can reduce the risks and potential side effects of laser skin resurfacing by following your doctor’s pre-care and post-care instructions. Your doctor can prescribe antibiotics or antiviral medications as part of the precautions before the procedure according to your medical history.

You should talk to your doctor about any medical conditions you have or any medications you take including any over-the-counter medications. Even aspirin should be mentioned since it can increase the recovery time and may increase the risk of bleeding.

It is recommended to quit smoking for at least 2 weeks before the procedure and another 2 weeks after. Smoking after laser resurfacing can enhance the risk of side effects.

How to Get Prepared for Laser Skin Resurfacing?

Before the laser skin resurfacing procedure, your doctor will do the following.

• Get a Full Medical History: Your doctor will ask you about your current and previous medical conditions, any medications you took or are taking, and any procedures, including dental and cosmetic procedures, you have had in the past.
• Do a Physical Examination: Your doctor will check your overall skin as well as the treated area to determine how the procedure will be done, the exact changes that will be made, and how your skin features such as tone and thickness will affect the results of the procedure.
• Discuss Your Needs and Expectations: Your doctor will discuss everything with you including your needs, expectations, and the potential risks and side effects. Make sure to understand all the information given to you including how long the healing process will last and what the results may be.

Furthermore, before the laser skin resurfacing, you may need to:

• Take Certain Medications to Prevent Complications: Whether you are going to have an ablative or non-ablative laser skin resurfacing and depending on your medical history of herpes virus infection and cold sores around your mouth, your doctor may prescribe an antiviral medication before and after the procedure to prevent viral infections.
• Avoid Sun Exposure before the Procedure: Excessive unprotected exposure to the Sun for up to 2 months before the procedure can cause skin damage and permanent irregular pigmentation, especially in the areas that will be treated. Besides, this sun exposure can make the herpes virus active again in some people. Therefore, you may need to discuss how much sun exposure is acceptable and the best sun protection ways with your doctor.
• Quit Smoking for a While: Smoking before and after the procedure can inhibit the healing process. It is necessary to stop smoking for at least 2 weeks before and after the procedure to avoid side effects and help your body to heal properly.
• Prepare Your Ride Home: You may need to arrange a ride home after the procedure if you will be sedated during the skin laser resurfacing treatment.

Laser Skin Resurfacing Procedure

Laser skin resurfacing’s main goal is to increase collagen production by targeting the outer skin layer, the epidermis, while heating the inner skin layer, the dermis.

The perfect procedure will create new collagen fibers that will create new skin cells. Your skin texture is supposed to be smoother and firmer after the procedure. (11)

The procedure is easier than you might expect and formed of the following steps:

• Before the procedure, your skin must be prepared correctly. Your doctor will provide you with several treatments to be applied several weeks before the procedure. The main purpose of these treatments is to enhance the tolerance of your skin to laser skin resurfacing procedures. Besides, it can lower the risks of side effects significantly.
• On the procedure day, your face needs to be washed to remove any makeup and pollutants. Some doctors use mild antiseptics on the treated area to make sure it is free of any irritants or pollutants.
• Your doctor can apply a numbing cream on the treated area if the laser causes mild to moderate pain. If the laser does not cause significant pain such as Clear + Bright or Picosure, this step may be skipped. While waiting for the procedure, a plastic wrap may be put over the cream to make sure that it makes the treated area totally numb. The topical anesthesia will reduce the pain and make you comfortable during the procedure.
• If the treated area is large, your doctor may recommend using a sedative or a pain killer.
• The waiting period ranges between 30 to 45 minutes until the cream makes the treated area totally numb. It is recommended to have a friend or family member to talk to during this time to soothe any worries and make you more comfortable.
• Once the treated area becomes completely numb, your doctor will start the laser treatment. No matter the type of laser, your doctor should provide you with an opaque eye protection device such as silver or black goggles.
• The laser will be moved slowly around the targeted area. Depending on your needs, the treatment can either focus on a specific part or an entire skin stretch.
• After the procedure is done, the treated area will be dressed in wraps to keep it protected.
• Ablative laser skin resurfacing can take up to 2 hours according to the type of laser, the technique, and the size of the treated area.

Non-ablative laser skin resurfacing requires a series of treatment sessions that will be scheduled over the next few weeks or months depending on the condition.

Laser Skin Resurfacing Aftercare and Recovery

Despite the fact that some cosmetic and dermatologic surgeons perform laser skin resurfacing procedures, they are not surgeries. Once the procedure is done, you can leave immediately and get back to your daily routine. (12, 13)

However, the recovery period is necessary to help the treated area heal properly.

• The Duration of Side Effects

Healing after Laser skin resurfacing takes between 3 and 10 days. Generally, the larger the treated area is and/or the deeper the laser treatment goes, the longer the recovery period will be. Recovery after treating the area with an ablative laser can take up to 3 weeks.

During the healing process, your skin may be red and slight peeling may occur. If there is swelling, ice packs can help you to reduce it.

However, you do not have to stay at home until your skin heals completely. Just try to follow your doctor’s instructions and stay away from the highly infectious areas such as the gym since they can increase the risk of getting an infection.

• Cleansing the Treated Area

You must modify your daily skincare routine to enhance the healing process. The treated area must be cleaned 2 to 5 times per day. Besides, you should avoid using regular cleansers no matter how good the brands you use are. Instead, your doctor will recommend saline or vinegar-based solution.

Furthermore, airtight and watertight dressings must be used regularly to ensure that the treated area stays clean and protected.

Moisturizers can also enhance the healing process, but you need to get approval for using them first.

• Protection

After the laser skin resurfacing procedure, your skin may remain sensitive to sun exposure for up to a year. It is necessary to wear sunscreen all the time with an SPF of at least 30 to prevent sunburn and sun damage to your skin.

Before leaving, apply sunscreen every morning, even if the weather is cloudy, to protect your skin and treated area. Throughout the day, reapply the sunscreen as needed.

• Other Precautions

Try to avoid activities that may increase the risk of infection such as going to the gym or swimming.
Besides, if there is discomfort, redness, or swelling after non-ablative laser resurfacing, you can use cool compresses as required. Non-ablative procedures do not require recovery time and you can get back to your normal activities and skincare routine immediately, but it is always better to consult your doctor first.

Laser Skin Resurfacing Results

Non-ablative laser skin resurfacing does not have as many risks or side effects, but a series of treatments may be required to achieve the optimal results. The results are usually gradual and progressive, and you will notice improvements in skin texture, tone, pigmentation, and wrinkles over time.

On the other hand, ablative laser skin resurfacing results appear immediately after the treatment session. However, the risk of side effects is high. Your skin may remain red and swollen for months. But once the healing process starts, you will notice great improvements in the quality of your skin texture and appearance.

It is worth mentioning that the results vary from one person to another depending on the treated concern and the type of procedure. Once the treatment sessions are over, the results can last for years. However, the results are not permanent. As you age, your face will keep developing fine lines and wrinkles as you squint, frown, smile, and get exposed to the sun. Therefore, you may need to repeat the treatment at a certain point. (14, 15, 16, 17)

Laser Skin Resurfacing Cost

According to the American Society of Plastic Surgeons, the average cost of laser skin resurfacing in 2020 was about $2500 for ablative procedures and $1440 for non-ablative procedures. However, the cost can vary according to many factors such as the severity of the condition and your geographic location.

Most laser skin resurfacing procedures are not covered by medical insurance since they are done for cosmetic purposes. However, some cases are covered such as scars and removal of precancerous skin growths.

Before the procedure, it is essential to discuss the costs with your doctor and insurance company. Try to find out if it is possible to get covered by insurance. Also, your doctor will provide you with many financing options.

FAQ about Laser Skin Resurfacing

1. Can I Combine Laser Skin Resurfacing Be Combined with Other Procedures?

Yes, it is possible to combine laser skin resurfacing with other cosmetic procedures to help you to reach your skin rejuvenation goals faster. Topical retinoids are highly recommended after laser skin resurfacing to maintain the results. Besides, Botox and dermal fillers can be used to enhance laser skin resurfacing when it is used to remove wrinkles and restore facial volume. Depending on your goals, your doctor will design the perfect treatment plan for your unique needs.

2. How Long Does the Healing Process Take?

After the treatment, your skin will be red and swollen for a while and you may feel a degree of tightness in the treated areas. Immediately after the procedure, you should put ice on the treated area for 30 minutes. For the next 2 to 3 days, you should avoid glycolic, salicylic acid, and vitamin A derivative creams and lotions. After 3 days, your skin may become dry. It is recommended to use a hydrating moisturizer that will not cause any irritations to your skin. In 1 to 2 weeks, the treated areas will be healed completely.

3. Is Laser Skin Resurfacing Procedure Painful?

Most patients report that the procedure is well-tolerated, and it feels like warm pinpricks on the treated areas. The face becomes warm during the procedure.   

4. Am I a Good Candidate for Laser Skin Resurfacing?

If you are about to get laser skin resurfacing, make sure that you are a good candidate first.

Here are some criteria you should meet:

• Not pregnant.
• Not tanned recently.
• You do not have a medical history of seizures, especially light-induced seizures.
• No recent cold sores or skin infections.
• You do not have any medical implants in your skin.
• No photosensitivity.

Laser skin resurfacing is not just for aging signs and wrinkles but also acne scars, surgical scars, and other lesions such as enlarged pores.
The procedure is safe for patients who may not be good candidates for other treatments.

5. How Is Laser Skin Resurfacing Different from Similar Treatments Such as Chemical Peels?

Laser skin resurfacing has many advantages over similar treatments such as chemical peels. First of all, the procedure is precise and with no or little bleeding. Besides, the post-operative discomfort is less than other treatments.