Our skin is consistently exposed to elements including ultraviolet rays of sun, dust, environmental pollutants, and chemicals in various cosmetics and toiletries.

Moreover, our skin also continues to age alongside our body, sometimes in a more accelerated manner than the rest of body because of the free radical and oxidative damage of highly processed foods we ingest.

The forces of gravity, hormonal imbalances, drug ingestion, smoking, pregnancy and various illnesses also play their role. The end result is premature aging of skin which manifests itself in lines, wrinkles, blotchy skin color and various types of spots.

Various methods have been devised and used for combating these effects and to rejuvenate the skin once again. As expected, face, head and neck are the most common areas for which rejuvenation treatments are sought.

The most commonly used and reliable methods for treating the sun damaged and aging skin are chemical peeling, dermabrasion and laser skin resurfacing. Chemical peels, dermabrasion and laser skin resurfacing all achieve results in basically the same way. Layers of your skin are removed and, as the healing process progresses, a new, healthier-looking skin emerges.

Am I a good candidate for laser skin resurfacing?

You will be a good candidate for laser skin resurfacing if you have any one or more of the following conditions:

• Wrinkles including ‘laughter lines’, ‘frown lines’, skin changes around mouth that cause ‘lipstick bleed’
• Sun-damaged facial skin
• Lines around eyes- ‘crow’s feet’
• Brown spots or blotchy skin coloring
• Skin growths that have potential to become cancerous
• Scars of acne or chicken pox
• Superficial facial scars from a past injury

You will not be a good candidate if you have:

• Collagen Vascular diseases (lupus, scleroderma, keloid)
• Immunologic abnormalities (such as vitiligo)
• Used Isotretinoin in last 1 year
• History of abnormal wound healing
• Skin disorders
• Poor physical, mental or emotional health

What are the different kinds of lasers used for skin resurfacing?

Laser is an acronym for “light amplified by stimulated emission of radiation.” Lasers are unique light sources that were first developed in 1960, based on Einstein’s quantum theory of radiation. Novel laser applications continue to impact on medical and surgical practice, especially in the treatment of skin diseases. Following types of lasers have been used for skin resurfacing.

Pulsed Carbon Dioxide Laser

Carbon dioxide laser resurfacing provides a very predictable result by consistency in the depth of tissue penetrated and affected. There is large amount of data available for this treatment and fine tuning of the method and intensity of laser application as well as good post treatment clinical management can significantly reduce complications and recovery time.

Erbium YAG Laser
This type of laser was introduced after carbon dioxide laser. The use of Erbium: YAG (Er:YAG)laser results in a more superficial peel as compared to carbon dioxide laser. They can be used either as a low energy or high energy treatment.

In low energy treatments there is very rapid recovery but the improvements in lines and wrinkles are also modest. The higher energy Er:YAG lasers produce more thermal injury and a greater improvement in lines and wrinkles, approaching that of carbon dioxide resurfacing.

Non Ablative Lasers
The laser technology which heats the middle layer of skin cells while cooling the superficial layer of skin with a contact cooling device or spray are known as non ablative lasers ( e.g. such as those marketed by names of CoolTouch and Smoothbeam).

The heat treated layer of skin stimulates and jump starts a healing process with the formation of new collagen which has a remodeling effect on lines and wrinkles. This process may be completed in one or more treatments and the results are appreciable after delay of several months.

There is very little loss of superficial layer of skin with this technique and so only a mild redness may be present. There is no downtime and patients are able to return to work and resume normal activities immediately. The demerits of this technique are that clinical improvements are modest as compared to conventional lasers.

The results are also unpredictable, depending on age, skin type, genetics and degree of wrinkling and photo-damage already present.

Broadband High Intensity Light, Nd: YAG and Flashlamp Dye Laser
The relatively new non ablative lasers like frequency modified Nd: YAG laser, the broadband high intensity light, and the flashlamp dye laser act on underlying tissues of skin like collagen without destroying the superficial skin layer.

This allows for a very rapid recovery time, sometimes allowing the patient to return to work within a day. Although these new technologies are not as effective as carbon dioxide or Er:YAG laser, they do diminish wrinkles and photo-damaged areas of skin to varying extent.

Radiofrequency and Pulsed Light
Certain other technologies, although not as popular and mainstream as carbon dioxide and YAG lasers, have also been available. One of these technologies uses radiofrequency system for reducing wrinkles and for skin tightening. Another technology combines radiofrequency with infrared laser and intense pulsed light.

Fraxel Laser
A more recent addition to these technologies is the fractional laser, also known as fractional photothermolysis or Fraxel Laser. This technique instead of coagulating the entire skin layer produces microscopic zones of tissue coagulation that heal over ensuing weeks.

Compared with conventional lasers, it has advantages of less recovery time, few complications and ability to be used in all skin types. The available evidence shows that the improvement is substantial but is not very well documented as compared to other classical lasers.

How laser skin resurfacing treatment reduces wrinkles and aging of skin?

The lasers restructure the skin by applying very high laser power in very short bursts in the areas that have been prepared for treatment. Because of the special design of equipment, there is minimal damage to skin and so the risks of scaring are low.

Laser resurfacing has two components that contribute to clinical improvement. One is the removal of tissue that occurs at the time of treatment. The second is the remodeling effect of the body’s response to wound produced by laser.

How will plastic surgeon assess me for laser skin resurfacing?

You should chose your skin resurfacing treatment in consultation with your plastic surgeon. The plastic surgeon will discuss your medical history with you and determine if you have any contraindications or unacceptable risks related to skin resurfacing procedures.

The type of your skin will be evaluated. This is usually done with reference to a grading system called Fitzpatrick skin type classification. According to this classification, there are 6 different types of skins, skin colors, and their reaction to sun exposure.

• Type I (very white or freckled) – Always burn
• Type II (white) – Usually burn
• Type III (white to olive) – Sometimes burn
• Type IV (brown) – Rarely burn
• Type V (dark brown) – Very rarely burn
• Type VI (black) – Never burn

The higher the type of skin, the greater is the chance of post procedure hyper-pigmentation. Patients who have light skin have prolonged redness of skin after procedure but pigmentation related complications are less likely to occur in them.

Fitzparick skin types I and II respond with fewest side effects. Pigmentation abnormalities are more common in type III individuals. Treatment of more darkly complexioned individuals by laser skin resurfacing is avoided. Glycolic acid peels are an alternative in such individuals.

Other than determining the skin type, your plastic surgeon will also evaluate and document the severity and distribution of sun damaged skin, wrinkles, pigmentation, scarring and other skin imperfections. You should discuss your expectations of the procedure and the type of procedure that you would prefer.

An important determinant in selecting the type and extent of procedure is the amount of time that you will be able to set aside for recovery. All resurfacing treatments can be performed to various depths, allowing you to tailor them to your needs.

A more superficial treatment allows early return to work but may require more repetitions of the procedure to achieve the desired results. Laser skin resurfacing may be combined with other aesthetic procedures like facelift or eyelid surgery.

How is laser skin resurfacing performed?

Your plastic surgeon may place you on a pretreatment regimen of creams, lotions or gels prior to your laser skin resurfacing. The laser skin resurfacing may be carried out in local anesthesia achieved by application of a cream or injection, a field block in which the nerves of the area are freezed by an injection, or sometimes in general anesthesia.

Once the area has been anesthetized, the eyes are protected with moist gauze and special goggles. The procedure of laser skin resurfacing usually lasts anywhere between thirty minutes to two hours depending on the number of passes required to achieve the desired results.

When the treatment is completed your skin may be covered with an ointment, jelly or dressing. You will be given medication to control pain and discomfort.

What will happen after laser skin resurfacing? How long will it take to recover? When will I be able to see the results?

The treated area will look red, sore and swollen. The wound may also leak a watery discharge. The swelling usually subsides in five days but crusting may appear on wound which would require careful cleaning.

The area will remain red from several weeks up to ten months depending on the extent of treatment and response of the individual patient. Gradually the redness will fade. It is extremely important that you use a strong sun block during this phase (at least for initial six months) to minimize the risk of pigmentation.

The results are usually apparent six to ten months after treatment. It is possible to repeat the treatment if the desired improvement has not been achieved but this should be done at least six months after the initial treatment. However, most patients are satisfied with their initial treatment and requests for re-treatment are uncommon.

What are the complications of laser skin resurfacing?

Some complications of laser skin resurfacing are:

• Hyper pigmentation
• Hypo pigmentation
• Scarring
• Skin sensitivity
• Redness
• Infection
• Skin tightening
• Unsatisfactory results

How much will the laser skin resurfacing cost me? Will it be covered by my health insurance?

According to the American Society of Plastic Surgeons, the national average cost for laser skin resurfacing is $2,378. This fee is for one treatment only and doesn’t cover anesthesia fees (if required), antibiotic and pain medications, camouflage make up and hospital fees.

Approximately 570,880 laser skin resurfacing procedures were carried out in 2008 according to statistics released by American Society of Plastic Surgeons.

Skin resurfacing is usually not covered by insurance. Occasionally, however, if the resurfacing is being performed to treat or improve certain types of scars or some skin lesion that can become cancerous, insurance coverage may be available.