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Laser facial resurfacing

Laser facial resurfacing is a technique that removes the outer layers of skin on your face and encourages new skin to grow. It’s usually done for cosmetic reasons.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Laser facial resurfacing involves using an intense beam of light radiation to deliver energy to your skin. This energy can affect your skin in different ways depending on the type of laser used.

Laser facial resurfacing can:

  • remove superficial wrinkles
  • tighten your skin
  • even out your pigmentation (colouring)
  • smooth rough skin
  • improve the look of scars, including shallow acne scars
  • treat certain early skin cancers

Your surgeon can direct the laser on problem areas, for example, wrinkles around your eyes, mouth or nose or treat the whole surface of your face.

There are two main types of laser facial resurfacing – ablative and non-ablative.

  • Ablative laser resurfacing destroys the surface layer of your skin (epidermis) in a controlled way, which exposes the deeper layer – the dermis. The laser power is used to heat the dermis, which stimulates the growth of new fibres of collagen (a long fibrous protein that supports tissues and cells). As the wound heals, you will form new skin that is softer and less wrinkled or scarred than before.
  • Non-ablative laser resurfacing doesn't destroy the epidermis but targets the dermis. It heats it up to encourage new skin to grow, working beneath your epidermis to stimulate collagen growth.

This factsheet describes ablative laser facial resurfacing.

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An image showing the structures and layers of the skin

Details

  • Preparation Preparing for laser facial resurfacing

    Your surgeon will explain how to prepare for your laser facial resurfacing. For example, if you smoke you will be asked to stop, because smoking increases your risk of getting a wound infection, which can slow your recovery.

    Your surgeon can perform laser facial resurfacing in his or her clinic, or in an operating room.

    Laser facial resurfacing is routinely done as a day-case procedure (you have the procedure and go home the same day) under local anaesthesia. This completely blocks pain from your face and you will stay awake during the procedure. You may also be offered a sedative – this relieves anxiety and helps you to relax. Alternatively, you can have laser facial resurfacing under general anaesthesia. This means you will be asleep during the procedure. Ask your surgeon for advice on which type of anaesthesia is most suitable for you.

    If you're having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon and anaesthetist’s advice.

    Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

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  • Alternatives What are the alternatives to laser facial resurfacing?

    Alternative treatments to resurface your skin include the following.

    • Chemical peels. These use acid to remove layers of your skin.
    • Dermabrasion. In this procedure a surgeon will remove the outer layer of your skin using a rotating surgical instrument.

    If you have very deep wrinkles or sagging skin, surgery, such as a surgical facelift, may be a more suitable option. A plastic surgeon (a surgeon who specialises in repairing and restoring skin and tissue) will be able to discuss the different options with you.

  • The procedure What happens during laser facial resurfacing?

    Your procedure will last between 30 minutes and a couple of hours, depending on the size of the area you’re having treated and the type of laser your surgeon uses.

    Before treatment begins, your nurse or surgeon will clean your face thoroughly. You may need to wear an eye shield, depending on which areas of your face will be treated.

    Your surgeon will pass a laser beam over the treatment area, with precise control over where and how deep the laser penetrates. There are a number of different types of laser and your surgeon will explain which type he or she will use. After the laser treatment, your surgeon may cover your face with an ointment or dressing.

  • Laser skin rejuvenation

    At our Bupa Health Centres, we offer self-pay health services for a wide range of conditions, including laser skin rejuvenation.

  • Aftercare What to expect afterwards

    After a local anaesthetic, it may take several hours before the feeling comes back into your face. Take special care not to bump or knock the area. If you have a general anaesthetic, you will need to rest until the effects of the anaesthetic have passed.

    Your skin will feel raw and you may need pain relief to help with any discomfort as the anaesthetic wears off.

    You will usually be able to go home when you feel ready. If you had a general anaesthetic or sedative, or your dressings obstruct your vision, you will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.

    General anaesthesia and sedation temporarily affect your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

  • Recovery Recovering from laser facial resurfacing

    It usually takes about seven to 10 days for your skin to heal, and two to six months for the redness to fade completely, but this varies between individuals and type of laser your surgeon used so it’s important to follow your surgeon’s advice.

    Your skin may be swollen for the first few days after the procedure. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen but your surgeon will often give you medicines for pain to take home with you. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your doctor or pharmacist for advice. You might also find it helpful to keep your head raised at night and to apply ice to your face – use an ice pack or wrap ice in a towel. Don’t apply ice or an ice pack directly to your skin as it can damage it.

    Your surgeon may give you a course of antibiotics to take after the procedure to prevent infection.

    It's important to follow your surgeon’s advice to help ensure your skin heals quickly and you get good cosmetic results. This advice may include the following.

    • Stay out of the sun until any redness has faded. If you need to go out, apply a sunscreen with a protection factor of at least 25, which has both ultraviolet A and B protection. It’s important to continue to use sunscreen for at least a year after your treatment.
    • Don't make any exaggerated facial movements that will stretch your skin in the first three weeks.
    • Wash your face gently and then moisturise your skin every day. This will keep your skin supple and help to prevent it drying out.
    • Wash your hair with a mild baby shampoo to avoid irritating your skin until it’s fully healed.
  • Risks What are the risks?

    As with every procedure, there are some risks associated with laser facial resurfacing. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.

    Side-effects

    Side-effects are the unwanted but mostly temporary effects you may get after having the procedure.

    Side-effects of laser facial resurfacing include:

    • swelling, crusting, or weeping of your skin for the first one to two weeks after the procedure
    • skin redness that may last for two to six months

    Complications

    Complications are when problems occur during or after the procedure. The possible complications of any procedure include an unexpected reaction to the anaesthetic.

    Complications of laser facial resurfacing are listed below.

    • Infection.
    • Changes to your skin pigment. This is more likely if you have dark skin.
    • Scarring. This is rare but your risk increases if you have recently had radiotherapy in the same area, are prone to keloid scars (overgrown scar tissue at the site of an injury) or have recently taken the acne medicine, isotretinoin.
    • Cold sores. These may be reactivated but your surgeon may suggest you take a preventive medicine such as aciclovir to stop this happening.
  • FAQs FAQs

    Can laser resurfacing treat my acne?

    Answer

    No, laser facial resurfacing can't be used to treat active acne. If your acne isn’t active, it can be used to reduce shallow acne scars, but it isn't appropriate if you have deep acne scars. It's also unsuitable if you're taking the acne medicine isotretinoin, or have used it in the past two years.

    Explanation

    Acne is a common skin condition that causes spots and scarring, usually on your face, back or chest, and this often gets infected. Laser treatment shouldn’t be done if your skin is infected.

    If you think you have acne, talk to your GP who will give you advice and can recommend the best treatment for you. Acne can't be cured, but there are treatments available that aim to control infection and prevent new spots forming and stop scarring. Your GP may prescribe you a medicine that you apply to your skin or one that you take as tablets.

    Will laser facial resurfacing hurt?

    Answer

    Your surgeon will give you an anaesthetic to stop you feeling any pain during the procedure. This may be a local or general anaesthetic, depending on a number of things including the size of the area of skin that you’re having treated and the type of laser your surgeon will use.

    Explanation

    Laser facial resurfacing works by destroying the top layer of your skin and heating the lower layers, which would be painful. However, you will be given an anaesthetic to stop you feeling pain during the procedure. There are a number of options available, including:

    • local anaesthetic cream – if you're only having the procedure on a small area of skin
    • local anaesthetic injection – also for small areas of your face (you may have both a local anaesthetic injection and cream applied)
    • regional anaesthesia – if you're having a larger area treated
    • general anaesthesia – if you’re having a very large area of skin treated, for example your whole face

    Local and regional anaesthesia completely block pain from your face and you will stay awake during the procedure. General anaesthesia means you will be asleep during the procedure.

    You may have some pain after laser facial resurfacing. Over-the-counter painkillers can help with this. If you’re in a lot of pain afterwards, let your GP or surgeon know.

    What is the difference between ablative and non-ablative laser resurfacing?

    Answer

    Ablative techniques destroy the top layer of your skin (epidermis), whereas non-ablative techniques don't destroy your epidermis.

    Explanation

    Ablative laser resurfacing techniques destroy the top layer of your skin to expose the lower layers and encourage new growth. Non-ablative techniques encourage new growth without removing the top layer of your skin.

    Ablative laser facial resurfacing most commonly uses either a carbon dioxide or an Erbium:YAG (a type of metal-enriched crystal) laser.

    Non-ablative facial resurfacing uses a variety of techniques.

    • Intense pulsed light targets the pigment in your skin to remove areas of discolouration.
    • Infrared lasers can treat wrinkles caused by sun damage by encouraging new skin to grow.
    • Radiofrequency treatment tightens your skin to reduce the appearance of wrinkles.
    • Photodynamic therapy is a technique used to treat some skin cancers but can also be used to reduce the signs of ageing.
    • Fractional resurfacing is a technique in which a laser is used in conjunction with other treatments in certain parts of the treatment area, rather than all of it. The treatment is done over several sessions.

    Non-ablative techniques aren't as effective as ablative techniques but have a lower risk of side-effects and faster recovery time.

  • Resources Resources

    Further information

    Sources

    • Cosmetic dermatology. American Academy of Dermatology. www.aad.org, accessed 23 January 2013
    • Lasers in plastic surgery. British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 23 January 2013
    • Skin resurfacing – laser surgery. eMedicine. www.emedicine.medscape.com, published 16 April 2012
    • Nonablative resurfacing. eMedicine. www.emedicine.medscape.com, published 27 June 2012
    • Laser resurfacing. Dermnet NZ. www.dermnetnz.org, published 1 July 2011
    • Microdermabrasion treatment and management. eMedicine. www.emedicine.medscape.com, published 11 October 2012
    • Skin resurfacing – laser surgery treatment and management. eMedicine. www.emedicine.medscape.com, published 16 April 2012
    • Acne. British Association of Dermatologists. www.bad.org.uk, published July 2010
    • Intense pulsed light therapy. Dermnet NZ. www.dermnetnz.org, published 15 June 2009
    • Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: nonablative, fractional, and ablative laser resurfacing. J Am Acad Dermatol 2008; 58(5):719–37. doi:10.1016/j.jaad.2008.01.003
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    Produced by Rachael Mayfield-Blake, Bupa Heath Information Team, January 2013.

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