Lasers are no longer something we see only in science fiction movies. They have many applications in the medical field, and one of the most exciting has been their use for cosmetic enhancement. Over the last ten years there have been many advancements in this technology, and lasers can now safely and effectively improve our skin in a number of ways. The most popular lasers in the cosmetic world are called resurfacing lasers. These types of lasers work by affecting the collagen in our skin. Collagen is the major protein in our skin, and is responsible for maintaining its volume, structure and tightness. As we age, the collagen content in our skin breaks down through sun exposure and the natural aging process. Our bodies produce less and less new collagen over time, and by middle age, production slows down considerably.
As you can imagine, with less collagen, our skin becomes thinner, more wrinkled and can sag more. Of these three issues, surgical procedures, such as a face lift, only address one: Sagging. Surgery does not improve the quality of the skin, only its tightness. Conditions such as rough texture, brown spots from sun or aging, and issues like acne scarring are not improved by the traditional facelift. Resurfacing lasers can dramatically improve all of these, while also providing some skin tightening. Resurfacing lasers improve our skin through three simultaneous processes. The first is called collagen remodeling. What this means is that the laser beam penetrates down into the dermis (the living deep layer of the skin) and stimulates cells called fibroblasts. Fibroblasts have one job in life, and that is to produce collagen. Dormant fibroblasts can be “awakened” to make new collagen, which is deposited in the skin. This will increase skin smoothness and give it a more youthful look. The second process is skin tightening through collagen contraction. Collagen is shaped like a coil, and when heat is applied to the coil, it shortens. This leads to contraction of the skin surface and a tighter appearing skin. The third effect is that laser energy damages cells in areas of pigmentation, like those brown spots we get from age and sun exposure. Once these cells are damaged, the immune system works to get rid of them. They come to the surface of the skin where they slough off, and the brown spots disappear.
The amazing thing about resurfacing laser procedures is that only one treatment is typically needed to accomplish all of these improvements. I tell patients that, with good sensible skin care and sun protection, they will not likely need another procedure for 3-5 years. There are few better values in the aesthetic world than that. The procedure takes about 20 minutes to perform, and requires only a topical numbing cream and some light sedative medications.
One of the most important features of the modern resurfacing laser is its incredible flexibility. The settings on the device can be fine-tuned to treat whatever feature one wishes to improve. For example, brown pigmentation typically requires very low energy settings, and if that is the only concern, a much lighter resurfacing procedure can be performed, with quicker healing times. Deep lines and wrinkles and acne scars are the most difficult, and may require higher energy settings. Skin tightening settings fall somewhere in the middle. For individuals that have a combination of these issues (and most do), different settings can be used on different parts of the face in the same session, so that all concerns are precisely treated simultaneously.
The most important innovation in laser resurfacing has been fractionation. Rather than using a laser beam that hits 100% of the skin surface, as was the case with older devices, the beam from modern lasers is now broken into many microbeams that lay down a dot pattern on the skin. These beams typically cover about 30% of the skin surface, leaving intact skin between the dots. This allows for much better tolerability, shorter recovery times, and virtually no complications. These lasers are now referred to as fractional lasers.
Resurfacing lasers do produce some down-time, so you will want to choose to have your procedure when you can take some time to heal. Typical recovery consists of 7-10 days of red and sunburn-like appearance with some peeling. The only aftercare is topical hydration creams and sun avoidance. Results are seen immediately upon healing, and may continue for several months as new collagen is deposited.
Laser resurfacing is not for everyone. Individuals with darker skin types such as people of Hispanic, Asian, Indian, or Mediterranean descent should proceed with caution, as hyper pigmentation (darkening of the skin) can occur. This side effect can often be treated effectively with lightening creams, but is nonetheless undesirable.
There are few cosmetic procedures that offer the breadth of improvement that one can achieve with a resurfacing laser. Their versatility, multiple applications, safety and outstanding results make them a valuable tool for the cosmetic physician. I have used these devices with great success for several years, and I have seen incredible results. My patients are absolutely thrilled with the natural-appearing anti-aging effects of these procedures.
With lasers, we can now offer the exciting possibility of total transformation in a single procedure.
*Results may vary from patient to patient
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