With their ability to reduce discoloration, lessen the appearance of fine lines and wrinkles, and address texture irregularities (among other benefits), lasers offer a host of ways to improve the skin on the face and neck without the invasiveness of surgery. Today’s technologies allow us to better treat damage by stimulating the skin’s collagen and other structural proteins. Yet even as laser technologies continue to evolve, the goal remains the same: to stimulate skin to return to the condition of its youth.
Laser resurfacing targets damaged tissue by addressing multiple layers of the skin; the depth of penetration depends on the level of correction desired. Brown spots, fine lines, and vascular lesions can be treated superficially; conversely, the laser must be fired deeper into the epidermis and dermis when treating scarring or prominent wrinkles.
Ablative lasers can remove the uppermost layers of damaged skin while also treating into the dermis in order to remove damage and stimulate collagen production. Non-ablative lasers heat the epidermal and dermal layers, which stimulates structural proteins like collagen but does not physically ablate any of the damaged skin. These non-ablative procedures tend to work best for less damaged skin, as in most cases they are less invasive and thus require shorter downtime.
In the weeks and months following a laser treatment, the skin builds more collagen, elastin and other structural proteins—all of which help to maintain its structure and integrity. The result: Not only does the skin appear smoother and more luminescent externally; its internal structure actually appears younger under a microscope.
Resurfacing treatments vary in intensity, and adjusting the depth and number of passes in accordance with the area being treated gives us increased control over the results. Typically, we can be more aggressive with skin on the face, whereas the neck—which has thinner skin and fewer oil glands—is more likely to develop side effects with too much heat and may only tolerate one to two passes with the laser device.
One of the most reliable and effective laser options, the CO2 laser, is also one of the oldest. However, there is simply no better laser treatment option to make the skin look younger overall. CO2 resurfacing addresses brown spots, dullness, large pores, fine lines, deep wrinkles, textural problems, and crepiness. In recent years, I have begun to “layer” using old and new technologies. This involves combining traditional CO2 laser, which ablates all of the tissue at a shallow depth, with fractional CO2, which pokes tiny holes into the skin and can go much deeper. Combining these techniques allows me to effectively treat all layers of the skin.
Focused ultrasound procedures such as Ultherapy® are an excellent option for patients concerned about skin laxity. This procedure effectively addresses the skin’s structural layers by stimulating collagen and elastin up to 4 millimeters deep. Ultherapy® is ideal for treating sagging skin on the brow, cheeks, chin, neck, and décolletage, and we are currently seeing good test results on other areas of the body such as the backs of the arms. A single treatment delivers significant skin tightening after a few months and fits seamlessly into the lifestyles of those patients demanding little to no downtime.
Downtime is a major consideration for most patients, and varies based on the treatment performed and the depth of laser administered. Longer healing times are associated with smokers, patients that undergo more aggressive treatments, or those that tend to heal slowly. Following an ablative laser treatment such as CO2 resurfacing, most patients are back to wearing makeup after seven to fourteen days.
Regardless of the laser treatment performed, post-procedural care can make or break the outcome—and can mean the difference between a satisfied patient and one that returns a year later, unhappy with the results.
The primary goals after laser resurfacing are to keep the skin moist and provide the proper healing environment. When the top layer of skin has been removed, the skin loses many of its barrier functions and is very sensitive. The treated area should be protected with regular application of a nonreactive ointment.
Sunscreen, too, is mandatory, as UV light can penetrate freshly treated skin at a much higher level. Sun protection is also crucial to help prevent brown spots, fine lines, and hyperpigmentation from reoccurring.
A patient’s pre-procedural skin care routine also plays a role in the success of any laser treatment. I have patients prime the skin by using topical vitamin C and a retinoid in the weeks before treatment. This not only helps to remove dead skin cells so the laser penetrates more efficiently, but it also feeds skin the nutrients it needs to heal better after trauma.
While there are very few absolute contraindications for lasers, hypopigmentation always remains a possibility and is of particular concern in patients with darker skin types. The risk can be significantly reduced in the hands of a skilled provider who understands how to use patient-appropriate settings. In addition, I am very cautious when treating patients with a family history of vitiligo, as laser treatments can activate this condition.
Finally, it is important for patients to bear in mind that there is not one magic solution for perfect skin. A patient’s own contribution to a successful outcome—good diet, avoidance of sun and smoking, and a consistent skin care routine—is just as important as what we do in the office. We can correct problems and help patients maintain their results, but ultimately what they do at home also makes a huge difference.