Laser facial resurfacing

Laser resurfacing (skin resurfacing) is a procedure to remove the outer layers of skin from your face and encourage new skin to grow. Most people have it to make their skin look and feel better by reducing wrinkles, scars and blotchy patches.

About laser facial resurfacing

If you have laser resurfacing, your doctor will direct an intense laser beam onto your skin. This may be able to:

• reduce or remove fine wrinkles
• tighten your skin
• even out the colour of blotchy patches of skin
• smooth rough skin
• make your scars look better – including shallow acne scars

Your surgeon can direct the laser on particular areas such as wrinkles around your eyes, mouth or nose. Or they can treat your whole face. You can have laser resurfacing treatment on other areas too – for example, on the skin of your neck, arms and hands.

This topic covers laser resurfacing on your face.

Most people of any age can have cosmetic surgery such as laser facial resurfacing (but there are some exceptions).⁷ If you’re under 18, your surgeon will need to understand the reasons why you want it and consider if laser facial resurfacing is the right treatment for you.⁷ Most people who get laser facial resurfacing are over 35.

If you’re considering laser facial resurfacing, choose a surgeon who’s an accredited plastic surgeon trained in laser surgery. You can check if they’re on the General Medical Council's Specialist Register in Plastic Surgery.

Types of laser resurfacing

There are different types of laser treatment for the face.

Ablative and non-ablative lasers

There are two main types of laser resurfacing – ablative and non-ablative. This topic mainly describes ablative laser resurfacing.

Ablative laser resurfacing removes the top layer of your skin (the epidermis). This exposes the deeper layer of your skin (the dermis). The heat from the laser makes your skin tissue tighten, which triggers new collagen fibres to grow. Collagen is a long fibrous protein that gives your skin its structure and strength. As the wound heals, you’ll form new skin that’s softer and less wrinkled or scarred than before.

Non-ablative laser resurfacing doesn’t remove the top layer of your skin. Instead, it heats up the dermis to encourage new skin to grow and trigger collagen growth. Non-ablative laser resurfacing has a gentler effect on your skin than ablative laser resurfacing, but the results aren’t as noticeable.

Types of ablative laser

There are two different types of ablative laser:

• carbon dioxide (CO2) laser
• Erbium:YAG (Er:YAG) laser

Carbon dioxide laser resurfacing goes deeper into your skin than the Er:YAG lasers. Your skin absorbs more of the Er:YAG lasers, which causes fewer side-effects. Your doctor will choose the best laser type for you. Sometimes, they may use both types together or one after the other to get a better effect.

Fractional laser resurfacing ablative lasers remove a small, specific part of your skin rather than all of your skin. These lasers don’t usually damage surrounding skin.

Preparation for laser resurfacing

You’ll meet your surgeon before your procedure. They’ll check your skin type and look at the areas of skin that you would like to be treated. They’ll see where your wrinkles are and how deep they are. This will help them to decide which type of laser resurfacing to use.

Your doctor will tell you if there’s anything you need to do before your surgery – for example, use certain creams on your skin.

Laser resurfacing is usually done as a day-case procedure in a clinic or hospital. This means you’ll have the procedure and go home on the same day. If you’re having a general anaesthetic, your anaesthetist will usually ask you not to eat or drink anything for a time before your procedure. They’ll give you specific advice about how long for.

Your surgeon will discuss with you what will happen before, during and after your surgery. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed and that you are happy to give your consent for the operation to go ahead. Someone in your surgical team will ask you to sign a consent form.

Laser facial resurfacing procedure

You’ll be given an anaesthetic before laser resurfacing to stop you feeling any pain during the procedure. This may be a local or general anaesthetic, depending on how much of your face is being treated and which laser your surgeon uses.

If you’re having small areas of skin treated, you may be given local anaesthetic creams or injections into your skin. The local anaesthetic will numb the skin on your face, so you won’t feel pain or will feel less pain. You’ll stay awake during the procedure. You may also be offered a sedative – this should help you to relax and stop you feeling anxious.

Sometimes, you may have laser resurfacing under general anaesthesia, which means you’ll be asleep during the procedure. You might prefer this if you’re having your whole face treated, for example.

You may need to wear an eye shield if your surgeon is treating the skin near your eyes. Alternatively, a nurse may put a piece of wet surgical material (gauze) over your eyes.

Once the anaesthetic has taken effect, your surgeon will pass the laser beam over the areas of your face to be treated. They’ll carefully control where the laser points and how deep it reaches. They may keep directing the laser onto your skin until they’ve removed enough skin or have gone deep enough.

After laser treatment, your surgeon may cover your face with an ointment or dressing to protect your skin while it heals.

Aftercare following laser facial resurfacing

If you’ve had a local anaesthetic, it could be a couple of hours before you get the feeling back in your face. Your skin may feel raw and you may need painkillers to help with any discomfort. If you’ve had a general anaesthetic, you’ll need to rest until the anaesthetic has worn off.

You’ll usually be able to go home when you feel ready. Your surgeon or nurse should give you some information about how to look after your skin before you go home.

If you’ve had a general anaesthetic or a sedative or if your dressings cover your eyes, make sure someone can take you home. Ask them to stay with you for the first day or so, while you recover from the anaesthetic and get back to normal. General anaesthesia can make it harder to coordinate your movements and to think clearly. Don’t drive, drink alcohol, operate machinery or sign legal documents for 24 hours.

Recovery following laser facial resurfacing

Your skin is likely to be swollen and red for the first few days after the procedure. These are normal side-effects after laser resurfacing so they aren’t be anything to worry about. Your skin should heal after a week or so, and the redness should fade completely after two to six months. This varies from person to person though, and also depends on which type of laser your surgeon used. If the redness or swelling isn’t getting any better after a few days, speak to your surgeon.

Pain relief

You may have some pain after laser facial resurfacing and once your anaesthetic wears off. But if you’re in a lot of pain afterwards, let your surgeon know.

If you need pain relief while your skin is healing, you can take over-the-counter painkillers, such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask a pharmacist for advice.

It may help to keep your head raised on pillows at night and to put some ice on your face. Cover an ice pack or wrap ice in a towel, don’t put ice or an ice pack directly onto your skin.

Caring for your healing skin

Your surgeon may advise you to wash your face gently with a special cleanser, beginning a couple of days after the procedure. You may need to do this two or three times a day and moisturise your skin too. This will keep your skin clean and supple, and stop it drying out. Ask your surgeon which skin products you should use.

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

Sun care

Your surgeon will usually advise you to stay out of the sun until any redness has faded. This is because you may get dark patches, especially if you have olive, brown or black skin. Once your skin has settled down, make sure you apply sunscreen of at least factor 30 and with both ultraviolet A and B protection. It’s important to keep using sunscreen when you go out for at least a year after your laser resurfacing.

Follow your surgeon’s advice to help make sure your skin heals quickly and you get the best results.

Complications of laser resurfacing

Laser resurfacing can cause some complications.

• Redness that lasts a long time. Your skin is likely to be red after laser resurfacing and this should settle down over time. But sometimes redness can last for weeks to months. You may find camouflage make-up helps to make it less noticeable.
• An infection. If your skin suddenly feels very sore a day or so after your procedure or later, you may have an infection. It’s important to let your doctor know.2 An infection can be treated with antibiotics, antiviral or antifungal medicines.⁵
• Changes to your skin colour – this is more likely if you have dark skin. If your skin gets darker, this may go away on its own or your doctor may be able to treat it. Some people notice their skin gets lighter after the procedure.
• Scarring – this is rare but damage from the procedure or an infection can cause scarring. Some things can make you more likely to get scarring after laser resurfacing. These include recent radiotherapy on the same area, being prone to keloid scars (overgrown scar tissue) or recently taking an acne medicine called isotretinoin.
• Cold sores – if you’re prone to cold sores, you may find you get these after the procedure. Your surgeon may suggest you take a medicine called aciclovir to stop this happening.

Alternatives to laser resurfacing

Your doctor may recommend other treatments instead of or before laser resurfacing.

• Chemical peels – these use acid to remove layers of your skin.
• Dermabrasion – in this procedure, your surgeon will remove the top layer of your skin using a rotating surgical instrument.
• Microdermabrasion – abrasive substances such as crystals are directed onto your face to treat wrinkles and sun-damaged skin.
• Fillers – these can bulk up facial tissue to fill and smooth any lines in your face.
• Botulinum toxin (Botox) injections – these work on nerves in your face to relax certain muscles to smooth out lines and wrinkles.
• If you have very deep wrinkles or sagging skin, your doctor may recommend a facelift instead of laser resurfacing.^{2, 3} A plastic surgeon will discuss the different options with you.