Used for many years to treat a variety of benign and malignant skin conditions, carbon dioxide lasers have undergone rapid and dramatic improvements and now give us the ability to rejuvenate sun-damaged, wrinkled skin. These revolutionary carbon dioxide resurfacing lasers use very short-pulsed light energy or continuous light beams, delivered in a scanning pattern, to very precisely remove thin layers of skin with minimal heat damage to the surrounding structures. These lasers have been successfully used to treat wrinkles and scars as well as other benign skin growths such as warts, linear epidermal nevi (birthmarks), rhinophyma (enlarged oil glands on the nose) and other skin conditions.
In general, carbon dioxide laser resurfacing is performed on an outpatient basis, using local anesthesia in combination with orally or intravenously administered sedative medications. Wrinkles around the eyes, mouth or forehead may be treated individually, or a full-face laserabrasion may be performed. The areas to be treated are numbed with a local anesthetic. General anesthesia may be used when the entire face is treated. A partial-face laserabrasion takes 30 to 45 minutes and the full-face treatment takes 1½ to 2 hours.
Following the laser resurfacing procedure, a Telfa dressing is applied to the treatment sites for 24 hours. The patient then cleans the treated areas two to five times a day with saline or a dilute vinegar solution and applies an ointment such as Vaseline, Eucerin or Aquaphor. This wound care is intended to prevent any scab formation. Scabs increase the chances of scarring. In general, the areas heal in ten to 21 days, depending on the nature of the condition that was treated.
Once the areas have healed, makeup may be worn to camouflage the pink-to-red color that is generally seen after laser resurfacing. Green-based makeups are particularly suitable for this camouflage. Oil-free makeup is recommended. The redness in the laser-treated sites generally fades in two to three months but may take as long as six months to disappear. The redness generally persists longer in blondes and redheads.
Patients with darker skin tones have a greater risk of healing with darker pigmentation (hyperpigmentation). This may be minimized by preoperative use of a bleaching agent as well as continued use of this agent after healing.
- Milia, which are small white bumps, may appear in the laser-treated areas during healing. These may be removed by gentle cleansing with a washcloth.
- Hyperpigmentation (darker skin color) and more rarely hypopigmentation (lighter skin color), may result in the laser-treated areas. In general, the hyperpigmented areas may be treated with bleaching cream to facilitate fading of the pigment. Reactivation of a herpes simplex cold sore may occur, especially after laser resurfacing around the mouth. This can be prevented by giving an antiviral medicine prior to the surgery and continuing it for seven to ten days afterward.
- Bacterial infections are also prevented by taking an antibiotic prior to the surgery and continuing for seven to ten days afterward. Postoperative swelling is to be expected and is lessened by administration of intramuscular steroids.
- Scarring, although very rare, may occur in laser-treated areas.
How is the skin cared for afterwards?
Daily sunscreen application is necessary after healing to protect the newly laser-resurfaced skin. A broad-spectrum sunscreen, which screens both ultraviolet B and ultraviolet A rays, is recommended. A sunscreen with a sun protection factor (SPF) of at least 15 and specifically formulated for use on the face should be chosen.
Liberal moisturizer application is also recommended after healing. Patients may resume application of Retin-A and / or glycolic acid products around six weeks after the procedure or as directed by their physician.