Ablative Laser Skin Resurfacing

There are a variety of lasers to choose from for skin rejuvenation.  Laser resurfacing can be divided in to two basic categories, ablative laser resurfacing and non-ablative laser resurfacing.  It is important to understand the difference between the two main forms of laser treatment because the treatment, downtime, and outcomes can vary significantly. 

Ablative Resurfacing - A treatment in which the laser energy is used to ablate (remove or vaporize) the top layers of the skin down to a certain level to directly smooth irregularities and stimulate collagen.

Non-Ablative Resurfacing – This is a non-wounding laser treatment in which the top layers of the skin are not affected by the laser. The laser energy works on the deeper layer in the skin to stimulate collagen and skin tightening without removing the top layers.

HOW ABLATIVE LASERS WORK 

The two main Ablative lasers used in clinical practice for skin resurfacing are CO2 and erbium.  Both of these laser energy targets the water in the cells of the skin and causes it to vaporize the skin cells down to a certain level in the skin. The level penetrated into the skin is determined by settings and type of laser used.  The laser removes the old and damaged top layers of the skin, improving the appearance of brown spots, freckling, fine lines, and dulled appearance that has resulted from sun damage over the years. By removing thin layers of skin, ablative laser resurfacing can also reduce the appearance of skin texture irregularities such as wrinkles and acne scars. 

Once the laser energy ablates the surface of the skin, heat is given off which stimulates collagen and skin tightening. The Erbium laser energy gives off less heat with each pulse of the laser and can be used for more superficial skin resurfacing with less downtime.  The CO2 laser gives off more heat with each pulse of the laser which often results in a deeper treatment, which can result in a longer recovery time, but more skin tightening.  Overall, with both types of ablative lasers, a patient receives some renewal of the skin as well as tightening and stimulation of the collagen in the skin.

Non-ablative laser resurfacing does not remove any layers of the skin and uses varying laser energies to target the middle skin layers to induce new collagen formation with subsequent skin remodeling and tightening. Non-abative laser resurfacing is a less invasive form of laser resurfacing with minimal downtime, however, this is a much less efficient form of skin resurfacing that yields more subtle improvement in skin texture and coloration.  Typically multiple treatments are performed to achieve a significant result.  

SKIN CONDITION TREATMENTS

Ablative laser skin resurfacing can be used to treat a variety of skin conditions including:

• Wrinkles
• Traumatic scars
• Acne scars
• Fine and deep lines
• Pigment irregularities like freckling from sun damage and photoaging of the skin

The treatment stimulates collagen to improve the smoothness of the skin. The coloration of the skin is improved by removing the old and damaged skin, giving the patient a more refreshed and appearance.

LENGTH OF TREATMENT 

The typical non-ablative laser treatment requires multiple treatments, has little downtime, and works slowly to make subtle changes with each treatment. Typically, one treatment with an ablative laser shows a significant improvement in skin quality, but often has significantly more downtime.

Whether a patient has one treatment or multiple treatments depends on the reason they are having the treatment. A person that wants to refresh their skin versus somebody who has deep lines will differ in the number of treatments necessary to get the results they desire. It is possible that some patients need a repeat or additional treatment for really deep lines or acne scars. Acne scars are the most difficult to treat because a lot of the scars are very deep. A doctor cannot go to that depth with the laser and remove everything because of the risk of scarring the skin.

LASER TREATMENT DEPTH 

The non-ablative laser targets the mid-dermis layer of the skin to stimulate collagen in the skin. Changes to the skin surface and appearance of the skin comes from a global skin remodeling that produces overall improvement in skin quality. Non-ablative resurfacing is less efficient than ablative resurfacing which results in a subtle change with each treatment. 

An ablative laser uses the laser energy to remove the damaged surface layer of the skin.  The depth of resurfacing can vary depending on the degree of damage to be corrected and acceptable recovery time. 

LASER RESURFACING VS. BOTOX 

These treatments address completely different skin issues.

• Laser resurfacing addresses the skin texture, skin quality, and skin coloration

• Botox addresses lines that are related to expression movements of the face.  Botox is injected into muscles of facial expression to reduce the movements that cause the lines on the face. 

LIMITATIONS 

The biggest limitation of an ablative laser is that it can only be used on certain skin types. It is not a good option for darker skin tones as the risk of complications increases.   It is best used on lighter skin tones. Darker skin types have a much higher chance of post-inflammatory hyperpigmentation (a darkening of the skin). Many non-ablative lasers can safely be used on darker skin tones.

RECOVERY 

With ablative lasers, the downtime depends on how aggressive the treatment is. Most ablative treatments are performed using fractionated laser resurfacing, also called fractionated ablative resurfacing or fractionated CO2. The laser not only varies the percentage of skin treated with each laser pulse but it also varies with the depth of the treatment. A more aggressive treatment for deep lines can take one to two weeks. A light resurfacing can take four or five days.

Typically, the skin from a fractionated resurfacing will recover after seven to ten days. There will be a residual pink coloration to the skin that can last a couple of weeks until it completely fades. After a week, most people can cover the redness with makeup. If the treatment is an aggressive treatment, the skin may be pink for a couple of weeks up to a month.

RESULTS 

During the initial period after the laser treatment, patients are usually swollen and red. With a deep resurfacing, the skin can even be a little bloody and raw for a couple of days. After that, the new skin starts growing in. After a week, the new skin is present and smoother, refreshed appearance is visible. 

Usually after seven to ten days, the redness might not be completely gone but there are visible results including smoothness, changes in the skin, and decreased discoloration. There can also be some long term effects for several months including additional collagen stimulation, additional tightening, and improvement in the skin quality.

Every patient is not going to respond exactly the same way and receive the same results. A patient with lighter skin can be treated more aggressively with the laser and see a more significant result. If someone has a darker skin tone, they can still be treated but not as aggressively.

FINAL THOUGHTS 

Even though ablative laser skin resurfacing makes changes to the quality of the skin, no treatment lasts forever because people continue to age. Maintenance with sun protection products and general skin care can help keep the skin fresh and young. When the skin begins to change again because of the aging process, a patient can schedule a consultation with an experienced doctor to discuss further treatment options.

Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Jessica Kulak, MD in Chevy Chase, MD