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Laser Skin Resurfacing:

Author: Letty's Staff Writer

Many of us have heard of laser treatments and are curious to see if it is as miraculous in treating wrinkles, lines, and sagging skin as the commercials and news releases suggest that it might be.

After all, who wouldn't want all of their imperfections to magically be "zapped away"!...

However, in doing the research to bring this article to you – I discovered some very interesting information about laser skin therapies that suggests that it may not be for everyone. At the very least, different treatments have to be prescribed for different individuals based on their particular skin attributes.

Find out what those attributes are and other great information about laser skin resurfacing – as we delve more into this very popular cosmetic therapy.

What is laser skin resurfacing?

To begin - laser skin resurfacing is a non-invasive, cosmetic laser treatment used to improve the skin after years of abuse and neglect, or simply due to the effects of aging.

The goal of laser skin resurfacing is to remove imperfections, boost collagen production, and tighten sagging skin with the use of lasers or light-based technologies.

Laser therapies essentially developed in response to the question: "What can be done to encourage aging, photo-damaged skin to rejuvenate?"

In fact - the search for safer, more effective, and less-invasive ways to treat skin is never-ending. As a result laser skin resurfacing technologies are constantly evolving and improving.

So next, let's talk about how laser therapy works.

So exactly how does it work?

Lasers work by emitting a narrowly-focused, high-energy beam of light which produces significant (yet targeted) heat - essentially vaporizing wrinkles, fine lines, and scars. The water contained in the interior of the target skin cells – heats to 2 times the boiling point.

The tissues - in which those super-heated cells reside - vaporize without burning the patient.

But it's the body's response to this "orchestrated damage" that is so remarkable. The microscopically burned tissues slough off over several days. The production of collagen and fibrin kicks into overdrive - rebuilding and replacing tissues as healing takes place.

The final result is newer, younger-looking, more elastic skin – which in essence replaces the old, collagen-depleted, tired-looking skin.

What conditions does it treat?

Laser resurfacing is a non-invasive, cosmetic treatment used to achieve a number of positive outcomes:

1. To improve sun-damaged skin
2. To soften scars
3. To remove discolorations from the skin
4. To diminish fine-lines, and wrinkles
5. To improve skin elasticity
6. To firm and lift sagging skin

Skin imperfections happen for an unlimited number of reasons. However, laser skin resurfacing is particularly helpful with improving the look of photo-damaged, aging skin. But can also be used to diminish scars from accidents, or acne.

Additionally, lasers have been used to effectively treat underlying laxity (sagging) that occurs over time.

Different lasers used in skin resurfacing:

Many different laser treatments have been developed to treat a variety of conditions and patients. The following table lists a few of the more commonly used laser treatments.

Table: Laser Types and Uses
Ablative Lasers [removes the surface of skin]:
Carbon Dioxide	Resurfaces photo damaged epidermis by removing the epidermal layer and part of the upper dermis; reduces rhytides
Erbium (Er:YAG)	Resurfaces the epidermis and tightens underlying tissue by stimulating collagen growth; diminishes rhytides, scarring, discolorations
Non-ablative Lasers [does not remove outer layers of skin]:
Neodymium (ND:YAG)	Improves skin elasticity and firmness; can remove dark pigment and hair.
Yellow light	Removes rosacea, port-wine stains, and enlarged blood vessels; can remove some scarring and, tattoos (of red, orange, and yellow pigments).
Alexandrite	Removes hair on dark-skinned people. It is also used to remove tattoos (of black, purple, violet and other dark pigments).
Ruby	Removes dark hair on pale-skinned people. It is also used to remove tattoos (of black, purple, violet and other dark pigments).
Diode	Removes dark hair on pale-skinned people. It is also used to remove spider veins and liver spots.

What are the side effects?

Since its inception in the late 80's and early 90's – laser skin resurfacing has evolved from high-strength ablative systems to gentler non-ablative systems that help minimize risk and shorten recovery times.

However even non-ablative lasers have potential side-effects. The following is a list of some of the complications that laser therapy can cause. Most of the complications we are going to talk about can be transient or permanent consequences of laser therapy.

Laser Skin Resurfacing Potential Side-Effects:

1. Scarring. Instead of the skin return to a soft and supple texture – the texture of laser-treated skin may become hard, or rubbery.
2. Swelling. Is a normal response that can occur whenever the body sustains trauma of any sort. Swelling is actually one of the mechanisms the body uses to "call in" healing resources. It usually resolves soon after healing.
3. Burning. Although laser therapy is controlled burning of the layers of skin. More extensive burn injuries can occur due to lack of skill or experience of the doctor, from improper settings on the laser, or from unexpected sensitivity of the patient.
4. Keloid formation. These are raised, hyperpigmented and often aggressive scars that extend beyond the treated areas. Usually occurring in dark-skinned individuals – keloids can form in reaction to laser treatment.
5. Post-inflammatory hyperpigmentation. These are dark marks that can occur as healing takes place. Instead of the treated skin healing to match the color and tone of surrounding skin – it heals visibly darker. This can result in a splotched, "calico" appearance. This is usually seen immediately upon healing.
6. Hypopigmentation. This is opposite of hyperpigmentation. Instead of treated skin healing to match the color and tone of surrounding skin – it heals visibly lighter. This actually can be the more difficult of the two to treat. And can occur as a delayed reaction months after healing.
7. Local or systemic infection. Laser therapy compromises the skin which is a defense against bacteria and fungi. Laser therapy patient are susceptible to infection during the healing process.
8. Herpes simplex virus reactivation. Cold sores and lesions can become active when patients are treated with laser therapy.
9. Redness and Inflammation. The laser-treated area can remain red and "raw-looking" or sunburned-looking for month after surgery.
10. Long period of recovery. Unlike other cosmetic procedures, laser skin resurfacing requires an extended period of time to regrow skin. AND during this time – individuals will have very visible signs of healing. So, the downtime is significant.

Although not a complete list, these are some of the potential negative consequences of laser skin resurfacing that you must consider before deciding to have the procedure.

Who are the ideal patients for this procedure?

In general healthy individuals are preferred for any elective cosmetic surgery procedure. However, there are certain conditions that are not conducive to laser skin resurfacing. Among those NOT suited for this procedure are:

1. Pregnant or lactating women.
2. Immune compromised individuals.
3. Individuals with connective tissue disorders.
4. Individuals with a history of keloid formation.
5. Those who are currently using vitamin A, or retinoid creams.
6. Those who are using topical steroids.

This isn't an exhaustive or complete list of individuals who are excluded from laser skin resurfacing. The only way to find out for sure whether or not you are an ideal patient is to have a consultation with your physician.

What about dark skin?

In the past, dark-skinned individuals were counseled to avoid laser skin resurfacing and light-based skin therapies because the risk of skin discoloration and scarring was significant.

Nowadays, great strides in understanding the interaction between skin tissue and laser light have resulted in the development of a new and improved generation of treatments that are friendly to Black and ethnic skin.

Many gentler, non-ablative lasers and techniques help to minimize the risks of scarring and discoloration that made the harsh lasers of the past inadvisable for dark skin. Fractional lasers, Light-emitting diode (LED), Radiofrequency (RF) are a few of the gentler innovations that researchers have developed and used successfully to treat photo-aging in dark-skinned individuals.

In addition to this, doctors have developed a set recovery protocols for preventing an overactive immune response in Black skin particularly – that can lead to disfigurement. Among those improved protocols are: skin cooling techniques, and hydrocortisone ointment to prevent inflammatory responses.

Laser treatment for dark-skinned individuals is more difficult than that for light-skinned folks. BUT those treatments are continually improving.

What is the take-home here?

Laser skin resurfacing is an evolving procedure with terrific potential to treat signs of aging, and imprudent sun-worshipping during youth. However, there are some real risks that have to be understood, and considered seriously.

So, before you decide – be sure to consult a qualified doctor. As always your health is more important than your looks. Be sure to keep that in mind when moving forward.

Laser Skin Resurfacing References:

• Gotkin, Robert H., et al. "Ablative skin resurfacing with a novel microablative [CO.sub.2] laser." Journal of Drugs in Dermatology 8.2 (2009): 138+. Expanded Academic ASAP. Web 17 Mar. 2010.

• Foster, K. Wade, et al. "Early improvement in rhytides and skin laxity following treatment with a combination fractional laser emitting two wavelengths sequentially." Journal of Drugs in Dermatology 7.2 (2008): 108+. Expanded Academic ASAP. Web 17 Mar. 2010.

• Elsaie, Mohamed, and Heather Lloyd. "Latest laser and light-based advances for ethnic skin rejuvenation." Indian Journal of Dermatology 53.2 (2008): 49. Expanded Academic ASAP. Web 17 Mar. 2010.

• Buren, Nicole Van, and Tina S. Alster. "Laser treatment of dark skin: a review and update." Journal of Drugs in Dermatology 8.2 (2009): 821+. Expanded Academic ASAP. Web 17 Mar. 2010.

• Rendon, Marta, Lina Cardona, and Adolfo Benitez. "The safety and efficacy of trolamine/sodium alginate topical emulsion in postlaserresurfacing wounds." Journal of Drugs in Dermatology 7.5 (2008): s23+. Expanded Academic ASAP. Web 17 Mar. 2010.