Laser facial resurfacing

Published by Bupa's Health Information Team, January 2011.

This factsheet is for people who are having laser facial resurfacing, or who would like information about it.

Laser facial resurfacing is a technique that can remove the outer layers of skin on the face and encourage new skin to grow, usually 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.

About laser facial resurfacing

Laser facial resurfacing involves using an intense beam of light radiation to deliver energy to your skin.

Laser facial resurfacing can be used to:

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

The laser can be directed on problem areas, for example, wrinkles around your eyes, mouth or nose, or the whole surface of your face can be treated.

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 manner, exposing the deeper layer – the dermis. The laser power is used to heat your dermis, which stimulates the growth of new fibres of collagen (a long fibrous protein that supports tissues and cells). As the wound heals, new skin forms that is softer and less wrinkled or scarred than before.

Non-ablative laser resurfacing doesn't destroy any skin but heats it up to encourage new skin to grow. It works beneath your epidermis to stimulate collagen growth.

This factsheet deals with ablative laser facial resurfacing.

What are the alternatives to laser facial resurfacing?

Fine wrinkles and some of the milder signs of ageing skin can be improved with creams and gels.

Chemical peels and dermabrasion can also be used to resurface your skin. Dermabrasion is a surgical procedure in which a surgeon removes the outer layer of your skin using a rotating surgical instrument.

If you have very deep wrinkles or sagging skin, 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.

Preparing for laser facial resurfacing

Your surgeon will explain how to prepare for your procedure. 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.

The procedure is usually done as a day case under local anaesthesia. This completely blocks feeling in your facial area and you will stay awake during the procedure. You may be offered a sedative to help you relax. Alternatively, you may have laser facial resurfacing under general anaesthesia. This means you will be asleep during the procedure. Your surgeon will advise you on which type of anaesthesia is most suitable for you.

If you're having general anaesthesia, 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’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.

What happens during laser facial resurfacing

Before treatment begins, your nurse or surgeon will clean your face thoroughly. You may be asked to wear an eye shield, depending on which areas of your face are being 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 of laser he or she will use.

Your procedure will last from a few minutes to an hour or so, depending on the size of the area being treated and the type of laser used.

What to expect afterwards

After a local anaesthetic, it may take several hours before the feeling comes back into the treated area. Take special care not to bump or knock the area. If you have general anaesthesia, 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.

After treatment, your face is likely to be covered with antibiotic ointment. Your surgeon may also cover your face with a dressing.

You will usually be able to go home when you feel ready. 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.

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 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. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your doctor may give you a course of antibiotics, such as the medicine ciprofloxacin, to take after the procedure to prevent infection.

It's important to do the following to help ensure your skin heals quickly with good cosmetic results.

• 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. You should use sunscreen for at least six months after treatment.
• Don't make any exaggerated facial movements.
• 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.

It can take 10 days or more for your skin to heal, and two to six months for the redness to fade completely.

What are the risks?

Laser facial resurfacing is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

For laser facial resurfacing, side-effects include:

• swelling, crusting, or weeping of your skin for the first seven to fourteen days after the procedure
• skin redness that may last for up to three months or more

Complications

This is when problems occur during or after the procedure. Most people aren't affected. The possible complications of any procedure include an unexpected reaction to the anaesthetic.

Complications of laser facial resurfacing include those listed below.

• Skin 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 can be reactivated, but preventive medicine such as aciclovir taken in tablet form can help to stop this happening.

The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.