Laser Skin Resurfacing

Laser resurfacing is a non-surgical treatment used to remove wrinkled, scarred, or damaged layers of skin and improve the appearance and functional aspects of the skin such as elasticity.

Your skin is made up of three layers, epidermis, dermis, and subcutaneous fat layer. The epidermis is the thin outer layer, while the dermis is the middle layer that contains the touch and pain receptors. The dermis contains a special protein called collagen that gives strength and flexibility to the skin. Factors such as sun exposure, ageing, smoking, alcohol consumption, burns, trauma, heredity, and various skin diseases may cause wrinkles, scars, and other changes in your skin. 

Laser resurfacing works by sending short, concentrated pulses of high-energy light through a laser into the damaged skin. The water molecules and chromophores (the substance that contributes to skin colour) in the skin absorbs this light and transforms it into heat that vaporises the damaged layer of the skin, one layer at a time. During the days following the treatment, new skin will replace the damaged skin removed during the treatment.

Carbon dioxide (CO2) and erbium laser are commonly used for laser resurfacing. Fractionated CO2 is a new method used for laser resurfacing that allows faster regeneration of cells than traditional lasers. A fractional laser consists of several narrow columns of light that enable small islands of undamaged skin to remain in place. These islands serve as a cell reservoir to promote quick restoration of cells in the laser-treated area.

Laser resurfacing is mostly performed on the face, but the skin in the neck, chest, and hands can also be treated.

This treatment is recommended to improve the appearance of skin in individuals with:

• Moles
• Facial lines and wrinkles
• Sun-damaged skin
• Scars from chickenpox, smallpox, acne or herpes simplex
• Raised birthmarks
• Viral warts
• Stretch marks
• Age spots (black patches or dark spots on the skin)
• Enlarged oil glands on the nose
• Freckles
• Melasma (grey-brown or brown patches on the face)
• Actinic keratosis (coloured, small, dry patches of skin)
• Rhinophyma (to reduce and reshape the nose)
• Vascular birthmarks
• Non-cancerous skin growths
• Seborrhoeic keratosis
• Superficial skin cancer (non-melanoma)

Laser resurfacing may not be performed in people with:

• Viral infections or bacterial infections of the skin
• History of hypertrophic or keloid scars
• Scarring from earlier treatment
• Sagging skin
• Deep wrinkles
• Active acne
• Human immunodeficiency virus (HIV) or hepatitis C infection
• Connective tissue disease
• History of radiation therapy to the skin on which laser resurfacing is to be done
• History of ionising radiation to the skin
• Burn scars, scleroderma, and other conditions that reduce the number of sweat glands and hair follicles in the skin
• Unrealistic expectations from the surgery

The treatment is not performed in individuals who have used isotretinoin (medicine to treat severe acne) in the last six months. People with very dark skin tone are also not considered for laser resurfacing as there is a high probability that the new skin will have darker pigmentation.

You will need to meet a plastic surgeon if you are considering this treatment. The surgeon may ask you to share the following information:

• Your medical history containing details of your previous surgeries and co-existing conditions
• List of your medications, including vitamins and supplements that you take
• List of topical skin preparations that you use or have used in the past
• History of having a chemical peeling procedure or X-ray treatments on the facial skin

During the preoperative consultation, the surgeon will also conduct a physical examination and closely examine your skin type, the severity of sun damage (if present), depth of irregular skin, and presence of uneven skin colour. He/she will share the details of the procedure with you and try to understand your expectations from the treatment. If you choose to undergo the procedure, you will be asked to sign an approval form. A preparation period of four to six weeks is required before the procedure.

You will be asked to follow the following instructions during this period:

• Avoid sun exposure as it increases the risk of skin pigmentation changes after treatment.
• Stop taking certain medications.
• Do not use a fake tan for at least seven days before the scheduled day of treatment.
• Stop smoking.

Before coming for the treatment, you should:

• Remove all moisturising creams and make-up from your skin.
• Shave the hair over the skin to be operated.
• Buy a sunscreen of SPF 30 or above to apply after the treatment.
• Arrange for someone to drive you home and help with your daily chores for one to two days after the procedure.
• Fast from midnight before the procedure (this depends on the type of anaesthesia used).

The treatment can be performed either with local anaesthesia (to numb the area of the procedure) or general anaesthesia (to make you fall asleep) based on the size of the treatment area.

Once you reach the hospital, a nurse will provide you with a hospital gown. If the procedure is performed under local anaesthesia, a numbing cream will be applied to the skin to be operated. You will then be moved to the skin theatre to perform the procedure. If general anaesthesia is used, it will be administered in the skin theatre. The procedure will be done as follows:

• The surgeon will cleanse your skin and mark the region to be operated with a pen.
• You will be given goggles to prevent laser damage to your eyes. In addition, the surgeon will place wet towels around the marked area to absorb excess laser pulses.
• He/she will pass the laser over your skin a few times.
• The surgeon will clean the area to be operated with saltwater or sterile water in between passes of the laser. This helps to remove the skin destroyed by laser and cool the remaining skin.
• Depending on the type of skin and size of the area covered during treatment, the number of passes differs.
• Once the procedure is done, the surgeon will apply an ointment on the area and cover your skin with a clean dressing.

The procedure may take 30 minutes to an hour to complete. You may experience a burning, stinging, or snapping sensation during the treatment. The treated skin will be swollen, red, and hot to the touch for a while.

Once the effects of anaesthesia fade away, the area of the procedure may feel sore and painful. A nurse will give you painkillers to provide relief from the pain. You will be discharged from the hospital on the same day of the surgery.

The risks associated with the surgery include:

• Infection of the skin
• Changes in the skin colour
• Cold sores
• Recurrence of acne (if you have had it before)
• Scarring
• Ectropion (a condition in which the eyelid rolls outwards)
• Contact dermatitis
• Prolonged redness

You will be asked to revisit the surgeon eight weeks after the treatment to monitor your healing process and discuss additional treatment if required.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.