About Laser Skin Resurfacing
Dallas, TX board-certified Plastic and Reconstructive Surgeon, Dr. A Jay Burns is regarded as a world expert and innovator of laser skin resurfacing treatments. He speaks around the world on his techniques in treating sun-damaged skin (especially difficult cases). Laser skin resurfacing is a nonsurgical cosmetic procedure that uses pulsating beams of light to remove damaged skin layer by layer.
At Dr. A Jay Burns Cosmetic Surgery, we offer a variety of different types of laser treatments based on your skin type and condition. As with most procedures, there is a trade off with results verses downtime. You must decide your priorities when considering how much improvement you desire in your skin. If you desire dramatic results no matter what the downtime is, then Erbium ablative resurfacing is a wise choice. If you want to insure the lowest possible problems or recovery and can compromise results, then non-ablative Fractional resurfacing (Fraxel Re:store) is a great option with multiple treatments. Many patients are somewhere in between, therefore Fractional ablative (Fraxel Re:pair) is a reasonable choice. We can discuss this in full detail at a consultation in our Dallas office.
Candidates for laser skin resurfacing are very aware of how their skin looks and ages because of gravity, dynamic muscle movements, and how well the skin is cared for on a regular basis (for example: using sunscreen). A great candidate for this procedure has skin with environmental changes caused by sun damage, wind, dryness, or other environmental factors. These changes would appear as dark age spots or sun spots, broken blood vessels, and of course; mild, moderate, and even severe wrinkles. These wrinkles can occur over the entire face, but are often noticed around the mouth. Although these are often termed "smoker’s lines" on the upper lip, many non-smokers unfortunately are troubled by this condition as well.
Not Ideal Candidates:
There are several conditions that Dr. Burns, who has more than 20 years of experience with laser science and clinical practice, believes preclude laser resurfacing with Erbium Laser. Such conditions are, but not limited to:
- Intense, facial electrolysis
If you have had intense electrolysis in the area proposed to be resurfaced (most commonly occurs in the upper lip), you are not a great candidate for laser resurfacing. Most patients, who have had only a "few" electrolysis treatments, are fine. However, there are patients who have multiple intense repeated treatments and now have no hair growth in an area. The hair follicles destroyed would have played a key role in wound healing with ablative resurfacing.
If you have used Accutane in the last year, you are not a great candidate for laser skin resurfacing treatment. Your sebaceous glands are inactivated with Accutane, which greatly interferes with wound healing. You must discontinue Accutane and wait until oil is detected again on the skin in the area to be treated.
- Autoimmune diseases, such as Lupus and Scleroderma
If you have Lupus or scleroderma, you are not a candidate for laser skin resurfacing due to the inherent effects these diseases have on wound healing.
It should be noted that fractional resurfacing (non-ablative) can be used on all these restricted categories. Even ablative fractional resurfacing can be utilized in patients with a history of electrolysis due to its mechanism of action. Again, every patient needs to be managed individually with a personal consult visit with Dr. Burns.
Plan Your Procedure
- Procedure Recovery Location
Types of Laser Treatments
There are several types of laser skin resurfacing treatments that are chosen based on the condition of your skin. Some are performed for milder cases of skin damage, while others are more aggressive.
Here are some terms to better understand the process.
- Ablative Laser Treatments
Ablative lasers remove thin layers of skin, like a deep chemical peel or dermabrasion, with a precision that allows the technician to minimize skin damage. Ablative lasers are best for skin tightening and to remove wrinkles and acne scars. It is known as vaporization; ablative resurfacing is interpreted as vaporizing or eliminating the skin being treated. The vaporization occurs immediately upon contact with the laser. Ablation is caused by heat. Depending on the laser, there is always a non-ablative injury surrounding the ablative injury.
- Non-Ablative Laser Treatments
Non-ablative lasers do not remove any skin; the light simply creates micro-damage to the skin to promote natural healing. Non-ablative treatments are best to remove fine lines and wrinkles on patients who can wait a few months for results. The tissue is heated to various temperatures. High temperatures can kill the tissue in question, but other temperatures can denature protein and damage the tissue, which prompts a healing response. This healing response causes the body to produce new collagen in the area. Lasers therefore can target the obliteration of sun-damaged skin as well as stimulate new collagen. All lasers discussed restore and rejuvenate sun-damage with some mix of these mechanisms.
- Fractional Laser Treatments
Fractional lasers are both ablative and non-ablative that create tiny holes in the deep layers of the skin. The skin's natural healing process creates tighter skin. Fractional lasers may also be used for fine lines, deep wrinkles, acne scarring, sun damage, and uneven pigmentation.
Erbium laser resurfacing (Ablative) – This procedure offers optimal results for rejuvenating the skin. Although no guarantees can be made for any individual, the average improvement on difficult upper lip wrinkles is 80%. This technique is an ablative technique and literally takes off total removal of the upper layers of skin. This procedure has replaced CO2 laser resurfacing which was popular in the late 90’s. The CO2 resurfacing procedure was almost as effective as Erbium resurfacing in my hands but had a much higher complication rate.
Fractional resurfacing (Ablative and non-ablative options) – Dr. Burns was the editor of the first paper produced about fractional resurfacing. This approach is relatively new in the lasts few years. It is a distinct departure from the mechanism of action from standard Erbium or CO2 resurfacing lasers. A fractional approach means that a fraction (usually 20 – 40%) of the skin is treated, but to depths 3 – 5 times deeper than standard techniques. Imagine pixels on your computer and effecting only 20 – 40% of them. In one square cm of skin there is an average of 2000 microscopic columns of injury, yet so small that 60 – 80% of skin remains normal. This sparing of normal skin allows faster healing. Therefore, the advantage of this approach is quicker recovery and fewer potential complications.
There are 2 types of fractional resurfacing approaches.
Ablative fractional resurfacing: this type is usually done with the CO2 Fraxel Re:pair laser as it can be used in combination with Erbium. This is the most aggressive of the fractional approaches. The average improvement is 40 – 50%. Multiple treatments may be advantageous but are not practical at this point due to the need for general anesthesia in almost all cases.
Non-ablative fractional resurfacing – Fraxel Re:store: Our most popular outpatient rejuvenating procedure. This can be done under topical anesthesia. Because there are no open wounds, there is much less downtime. Multiple treatments can be utilized to maximize results yet minimize significant side effects. We recommend 4 – 5 treatments for maximal results. The average result after multiple treatments is 20% improvement in wrinkles.
SPECIAL CIRCUMSTANCES & INDICATIONS
To this point, the discussion has been focused on sun damage and wrinkles. However, there are other conditions, which can be treated with lasers.
- Acne Scarring
Dr. Burns believes that fractional laser treatment has become the state-of-the-art treatment for acne scarring. Non-ablative treatments can be utilized as an outpatient procedure in 4 – 5 treatment sessions or a fractional-ablative treatment can be carried out under general anesthesia.
- "Off Face Treatments"
Many patients have concern with sun damage and wrinkling on their neck, chest (décolleté), arms, and hands. These areas can not be treated with standard resurfacing techniques due to safety issues. These areas have less blood supply, and have less inherent healing capacity than the face. Therefore, the fractional approach is the most viable option for these areas. Fractional laser treatment is extremely useful for patients who have had facial rejuvenation but have previously had no remedy for treating the remaining sun damaged areas below their face. Remember that with fractional treatment only a portion of each area is treated leaving untreated skin to help heal the treated areas. Non-ablative fractional is the safest treatment alternative. Ablative fractional is a treatment choice as well, but must be used judiciously off the face. Individualized treatment plans should be chosen after a detailed consultation.
- All Erbium Lasers Are Not Created The Same
Dr. Burns has worked with many laser systems and can say emphatically that not all Erbium lasers are the same. The best system by far that he has used is the Sciton Profile System, which is what he currently has in his office today. All the results you see shown in our before and after gallery are achieved only with the Sciton.
If you are undergoing a deeper or more intense laser peel, you may be asked to use a topical retinoid for a few weeks prior to your laser treatment. This helps prepare the skin better for the effects of the laser. Medication will be given prior to treatment to help reduce pain and help you relax during your session. If your skin needs mild correction, a topical anesthetic will be used to numb certain areas where the laser will target. However, for full-face or more intense laser treatments, some type of sedation may be necessary. During the procedure, you will relax in our treatment chair, and the laser will glide over the skin, precisely targeting the designated areas for improvement. You will feel heat, followed by coolness from the built-in cooling system of the device. The laser works to destroy damaged skin cells, while also stimulating new collagen growth.
What to Expect
For mild cases, a healing ointment will be applied to the skin and you can return home to recover. The skin will appear red, and there will be some irritation and swelling. This subsides within a couple of days and the peeling process will begin over a 3 – 5 day timeframe. If you are undergoing a more intense laser treatment, your downtime will be longer. The treated areas will most likely be covered by dressings and the swelling, irritation, and burning sensation will be intensified. Medication can be prescribed to help reduce these side effects. The downtime associated with a deeper peel can be 2 – 3 weeks. All patients should limit their sun exposure after their laser treatment and apply sun protection regularly. Regardless of the intensity of the peel, the skin will naturally flake, crust, and peel away. It is important to not assist this process to both avoid scarring and to protect your face at all times from sun exposure. Once the peeling process has been completed, your skin will feel softer, while looking clearer, younger, and rejuvenated.
Results can vary as each person will respond to the treatment based on their own immune system and collagen restorative response. Other complicating factors, such as diabetes and smoking, are known inhibitors to healing and patients must realize that their results can not be expected to achieve average success. Laser skin resurfacing treatments have several risks:
- Prolonged redness
The key word here is "prolonged" as redness occurs as a natural response to heat and is to be expected. The more aggressive treatments, such as Erbium and CO2 resurfacing, have more redness than fractional treatments. If redness lasts significantly longer, it could be considered a complication.
Skin treated with ablative lasers can lose their natural pigment. This is not to be confused with the obliteration of dark age spots/sun spots and the natural sun bronzing that occurs with aging. One needs only to look at the sun protected areas to see the natural color of their skin. However, if true skin pigment is lost, the skin can appear unnaturally light. This was very common with CO2 laser and is the main reason Dr. Burns no longer utilizes it. Although hypopigmentation may occur with aggressive Erbium resurfacing, it is much less common and less severe than with previous methods such as CO2. Fractional ablative resurfacing produces extremely rare hypopigmentation. Such cases to this point are usually found in areas other than the face. The exception is non-ablative fractional laser treatments in which hypopigmentation is virtually non existent.
Scarring may occur with any technology in which heat is produced such as lasers. This is rare overall and very rare in my practice with any laser. It is only logical that scarring is more likely with more aggressive techniques.
Infection is also rare with laser resurfacing and occurs primarily with ablative techniques in which open wounds are created. Again, this is also more common with more aggressive techniques. The most common infection is actually a viral herpes infection. This virus lays dormant in almost everyone and a herpetic outbreak can occur with the stress of laser resurfacing. For this reason, all patients undergoing ablative resurfacing will be given viral prophylaxis medication.
- Post-Inflammatory Hyperpigmentation (PIH)
PIH is a condition in which the melanocytes in the dermis pour out melanin pigment in response to inflammation. This occurs more commonly in darker skin types and is most common in Asian and/or Pacific Rim nationalities. This condition is usually self limiting and fades over time, but can be treated with topical medicines to hasten recovery.
A Softer, Clearer Complexion
Laser skin resurfacing offers outstanding results for patients who want a younger looking complexion. If you are considering a laser peel and would like to learn more about them, as well as the other nonsurgical options we offer, we invite you to call our office today to schedule your consultation.