Laser resurfacing

Expert reviewer Anton Alexandroff, Consultant Dermatologist
Next review due July 2021

Laser resurfacing is a procedure to remove the outer layers of the skin from your face and encourage new skin to grow. People usually have it done for cosmetic reasons – it may be able to remove wrinkles, scars and areas of discolouration, and tighten your skin.

An image showing the structures and layers of the skin

In laser resurfacing, your doctor will direct an intense laser beam onto your skin. Depending on the type of laser used, the laser therapy may be able to:

  • remove fine wrinkles
  • tighten your skin
  • even out areas of discolouration
  • smooth rough skin
  • improve the look of scars, including shallow acne scars

Your surgeon can direct the laser on particular problem areas, such as wrinkles around your eyes, mouth or nose. Or they can treat the whole surface of your face. You can have laser resurfacing treatment on other areas too, such as on the skin on your neck, chest, and hands. This topic only describes laser resurfacing on your face.

Types of laser resurfacing

Ablative and non-ablative lasers

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

  • Ablative laser resurfacing removes the surface layer of your skin, called the epidermis, by vaporising the skin tissue. It does this in a controlled way, exposing the deeper layer of skin below, called the dermis. The heat from the laser causes your skin tissue to tighten and stimulates new fibres of collagen 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 destroy the upper layer of your skin (the epidermis) but targets the dermis. It heats up the dermis to encourage new skin to grow and to stimulate collagen growth.

Ablative laser resurfacing produces the most dramatic results, but the recovery period can be up to a couple of weeks. There is also a greater risk of side-effects. Non-ablative laser resurfacing has a gentler effect on the skin with milder results. You may have redness of your skin for only a few hours after this therapy.

Non-ablative lasers may be a better option if you have a darker skin type because the ablative lasers can cause discolouration of darker skin. This topic mainly describes ablative laser resurfacing. See our FAQ on non-ablative laser resurfacing to learn more about this type.

Types of ablative laser

There are two different types of ablative laser that your doctor may use – the carbon dioxide (CO2) laser and the Erbium:YAG (Er:YAG) laser. Carbon dioxide lasers go deeper into the skin, whereas Er:YAG lasers are absorbed more by the skin and are associated with fewer side-effects. Your doctor will usually have a preference for which one they use. Some doctors also use the two types in combination or one after the other to get a better effect.

You may also hear the terms fractionated and nonfractionated used to describe laser therapies. Nonfractionated lasers act on the whole surface area of your skin, whereas fractionated ones only act on a portion of your skin. Fractionated lasers are newer and tend to be safer.

What are the alternatives to laser resurfacing?

There are other treatments that act in a similar way to destroy the surface of your skin and encourage newer skin to grow.

  • Chemical peels – these use acid to remove layers of your skin.
  • Dermabrasion – in this procedure, your surgeon will remove the outer layer of your skin using a rotating surgical instrument.
  • Microdermabrasion – this is when abrasive substances such as crystals are directed onto your face, with the aim of treating wrinkles and sun-damaged skin.

If you have very deep wrinkles or sagging skin, surgery such as a facelift may be a better option for you than resurfacing. A plastic surgeon will discuss the different options with you.

Preparing for laser resurfacing

You’ll meet your surgeon before the day of your procedure. They’ll want to examine your skin to check your skin type and the areas that you want treated. They’ll also discuss what will happen before, during and after your procedure, and any pain or possible complications you might have.

This is your opportunity to ask questions so that you understand what will happen. You might find it helpful to prepare some questions to ask about the risks, benefits and alternatives to the procedure. If you decide to go ahead with the treatment, you’ll be asked to sign a consent form.

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 the same day. If you’re having a general anaesthetic, you’ll usually be asked not to eat or drink anything, typically for six hours before your procedure. You may be able to drink water for up to a couple of hours beforehand, but follow any advice given to you by your doctor.

On the day of your procedure, your surgeon will check that you've given your consent, and that you're still happy to go ahead.

What happens during laser resurfacing?

If you’re having small areas of skin treated, you’ll usually 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 – but you will stay awake during the procedure. You may be offered a sedative too – this helps you to relax and stop feeling anxious. Sometimes, you may have laser resurfacing done under general anaesthesia, which means you’ll be asleep during the procedure. This will usually be the case if you’re having your whole face treated. You may also need to wear an eye shield, depending on which areas of your face are to be treated.

Once the anaesthetic has taken effect, your surgeon will pass the laser beam over the specified area of your face. Your surgeon will be able to control the area of skin that’s treated, and how deep the laser penetrates. They may carry on directing the laser onto your skin until either the affected area of skin has been removed or a particular depth into the skin is reached.

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

What to expect afterwards

If you’ve had a local anaesthetic, it might take several hours before the feeling comes back into your face. Your skin will feel raw and you may need pain relief to help with any discomfort as the anaesthetic wears off.

If you’ve had a general anaesthetic, you’ll need to rest until the effects of the anaesthetic have passed.

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 healing skin before you go home.

If you’ve had a general anaesthetic or sedative or if your dressings obstruct your vision, make sure you have someone who 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.

You might find that you’re not so coordinated or that it’s difficult to think clearly after a general anaesthetic. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important.

Recovering from laser resurfacing

Your skin is likely to be swollen and red for the first few days after the procedure. These are expected side-effects of the procedure. It usually takes about a week to 10 days for your skin to heal, and two to six months for the redness to fade completely. This varies between people and also depends on the type of laser your surgeon uses, so they can tell you more.

Pain relief

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 your pharmacist for advice. You might also find it helpful to keep your head raised at night, and to apply ice to your face. Use a covered ice pack or wrap ice in a towel. Don’t apply ice or an ice pack directly to your skin.

Caring for your healing skin

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

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

Sun care

You’ll usually be advised to stay out of the sun until any redness has faded. This is because you may develop dark patches, particularly if you have olive, brown or black skin. Once your skin has settled down, make sure you apply sunscreen of at least factor 25 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 treatment.

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

Complications of laser resurfacing

All medical procedures come with a certain amount of risk. But the chance of these happening is different for everyone. Ask your surgeon to explain how these risks apply to you. Possible complications of laser resurfacing include the following.

  • Persistent red skin. Some reddening of your skin is expected after laser resurfacing, but it may be more severe or last for longer than you were expecting. You may find it bothers you more than your original problem (for example, wrinkles). Reddening should settle down with time. In the meantime, you may find camouflage make-up helps.
  • Developing an infection. Sudden, increased pain is a sign that you may have an infection. Let your doctor know if this happens. An infection can be treated with antibiotics or antifungal medicines.
  • Changes to your skin colour – this is more likely if you have dark skin. Darkening of your skin may resolve by itself or your doctor may be able to treat this. Some people experience a lightening of their skin.
  • Scarring – this is rare but damage from the procedure or an infection can cause scarring. Certain things can increase your risk of scarring. These include recently having had radiotherapy in 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 these, you may find that the procedure reactivates them. Your surgeon may suggest you take a preventive medicine called aciclovir to stop this happening.

Frequently asked questions

  • Ablative laser resurfacing can’t treat active acne but it can be used to reduce shallow acne scars. It won’t help with deeper acne scars. Non-ablative laser techniques may be able to help in the treatment of acne.

    More information

    There are many treatments available for acne, including creams, lotions and antibiotics that can control any infection and prevent new spots forming. Ablative laser resurfacing won’t help to stop acne but if you’ve been left with acne scars, it may help to reduce them.

    If you’re taking the medicine isotretinoin for acne or have used it in the past two years, you won’t be able to have laser resurfacing. This is because isotretinoin increases your chances of getting scars after having the procedure.

    If you have acne, your pharmacist or GP will be able to give you advice and recommend the best treatment for you.

  • You’ll have 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 you’re having treated and the laser your surgeon uses.

    More information

    There are a number of options available for anaesthesia in laser resurfacing, including:

    • local anaesthetic cream – if you’re having the procedure on a small area of skin
    • local anaesthetic injection – also for small areas of your face
    • sedative – sometimes used in combination with a local anaesthetic, to help you relax
    • general anaesthetic – if you’re having a very large area of skin treated such as your whole face

    If you have a local anaesthetic, you’ll be awake during the procedure but the anaesthetic will completely block pain from your face. With a general anaesthetic, you’ll be asleep during the procedure.

    Different types of laser are associated with different amounts of pain. This will also depend on how much of your skin you’re having treated. Your doctor will recommend which type of anaesthetic is best for you, based on exactly what you’re having done.

    You may have some pain following laser facial resurfacing and after your anaesthetic wears off. Over-the-counter painkillers such as paracetamol and ibuprofen can help with this. If you’re in a lot of pain afterwards, let your surgeon know.

  • Non-ablative laser resurfacing is similar to ablative laser resurfacing but it doesn’t destroy the top layer of your skin (the epidermis).

    More information

    Ablative laser resurfacing destroys 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 resurfacing most commonly uses either a carbon dioxide (CO2) or an Erbium:YAG (a type of metal-enriched crystal) laser. Non-ablative facial resurfacing uses a variety of different techniques and types of laser.>/p>

    Non-ablative techniques are less invasive than ablative techniques so have a lower risk of side-effects, and people tend to recover faster. You might experience redness of your skin for only a few hours after this therapy, without the scaling and peeling that you’d have with ablative laser resurfacing. These techniques are usually used for less severe wrinkles, discolouration and scarring, and the changes after treatment will be subtler.

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Related information

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    • Wrinkles. BMJ Best Practice., last reviewed March 2018
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    • Good surgical practice. The Royal College of Surgeons, September 2014.
    • Acne. British Association of Dermatologists., updated January 2017
  • Reviewed by Pippa Coulter, Freelance Health Editor, July 2018
    Expert reviewer, Anton Alexandroff, Consultant Dermatologist
    Next review due July 2021