In laser resurfacing, an intense beam of light radiation is directed on to your skin. Depending on the type of laser used, the laser therapy may be able to:
- remove fine 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 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 just describes laser resurfacing on your face.
There are two main types of laser resurfacing – ablative and non-ablative.
- Ablative laser resurfacing destroys the surface layer of your skin, which is called the epidermis. It does this in a controlled way, and exposes the deeper layer that’s called the dermis. The laser power heats this dermis layer, which stimulates new fibres of collagen to grow. Collagen is a long fibrous protein that supports tissues and cells. 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 epidermis but targets the dermis. It heats up the dermis to encourage new skin to grow, working beneath your epidermis to stimulate collagen growth.
Ablative laser resurfacing works best in people with white skin that doesn’t tan well. The non-ablative type is usually better for people with darker skin.
This topic mainly describes ablative laser resurfacing. See our section belowon non-ablative laser resurfacing to learn more about this type.
Your surgeon will explain how to prepare for laser resurfacing. Your care may not be quite as we describe here as it will be designed to meet your individual needs. But you’ll meet the surgeon carrying out your procedure beforehand to discuss what will be involved. If you smoke, it’s a good idea to quit because smoking can affect how well the procedure works.
Your surgeon can do laser resurfacing in their clinic, or in an operating theatre in a hospital.
Laser resurfacing is usually done as a day-case procedure where you have the procedure and go home the same day. You’ll usually have a local anaesthetic, which completely blocks pain from your face and you stay awake during the procedure. Your surgeon may offer you a sedative too – this helps you to relax and stop feeling anxious. Or you can have laser resurfacing done under general anaesthesia and be asleep during the procedure.
If you have a general anaesthetic, it’s important that you don’t eat or drink anything for several hours before your procedure. Follow your anaesthetist’s advice. If you have any questions, just ask.
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 exactly what will happen. You might find it helpful to prepare some questions to ask about the risks, benefits and alternatives to the procedure. This will help you to inform yourself about the procedure so you can give your consent for it to go ahead. You will be asked to sign a consent form.
Alternative treatments to resurface your skin include the following.
- 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.
If you have very deep wrinkles or sagging skin, surgery such as a facelift may be a better option for you. A plastic surgeon will discuss the different options with you.
How long your procedure takes will depend on how much of your face you’re having treated and the type of laser your surgeon uses.
You may need to wear an eye shield, depending on which areas of your face are to be treated.
During laser resurfacing, your surgeon will pass a laser beam over your face. They will have precise control over where and how deep the laser penetrates. After the laser treatment, your surgeon may cover your face with an ointment or dressing.
After a local anaesthetic, it can sometimes 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 have 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. If you had a general anaesthetic or sedative, or your dressings obstruct your vision, ask a friend or relative to drive you home. And ask them to stay with you for the first 24 hours. Ask your surgeon or nurse for information on how to look after your skin during your recovery.
Having a general anaesthetic can really take it out of you. You might find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important.
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.
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 leaflet that comes with your medicine and, if you have any questions, ask your pharmacist for advice.
You might 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.
Your surgeon may give you a course of antibiotics to take after the procedure to prevent an infection. It’s important to follow your surgeon’s advice to help ensure your skin heals quickly and you get good cosmetic results. They may advise you to do the following.
- 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. If you need to go out, put some sunscreen on that’s at least factor 25 and has both ultraviolet A and B protection. It’s important to keep using sunscreen for a year after your treatment.
- Wash your face gently and then moisturise your skin every day. This will keep your skin supple and help to prevent it drying out. Ask your surgeon what products to use.
As with every procedure, there are some risks associated with laser resurfacing. We haven’t included the chance of these happening as they’re specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of laser resurfacing include:
- swelling, crusting, or weeping of your skin for the first week or so after the procedure
- skin redness that may last for two to six months
Complications are when problems occur during or after the procedure. Complications of laser resurfacing include the following.
- Developing an infection.
- Changes to your skin colour – 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. It’s also more likely to happen if you’re prone to keloid scars (overgrown scar tissue) or have recently taken an acne medicine called isotretinoin.
- Cold sores – your surgeon may suggest you take a preventive medicine called aciclovir to stop this happening.
No, laser resurfacing can’t treat active acne but it can be used to reduce shallow acne scars (not deep acne scars).
If you’re currently taking the acne medicine isotretinoin, or have used it in the past two years you won’t be able to have laser resurfacing. This is because it increases your chances of getting scars after having the procedure.
If you think you have acne, talk to your pharmacist or GP who will give you advice and recommend the best treatment for you. Acne can’t be cured, but there are treatments that can control any infection and prevent new spots forming, and stop scarring.
You will have an anaesthetic 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.
Laser resurfacing works by destroying the top layer of your skin and heating the lower layers. This would, of course, be painful but you’ll 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
- general anaesthesia – if you’re having a very large area of skin treated, for example your whole face
Local anaesthesia completely blocks pain from your face and you’ll 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 surgeon know.
Non-ablative laser resurfacing is similar to ablative laser resurfacing but it doesn’t destroy the top layer of your skin, which is called the epidermis.
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 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.
- Pulsed dye lasers target a beam of light on blood vessels in your skin to lighten red-coloured skin marks, such as birthmarks.
- Infrared lasers can treat wrinkles caused by sun damage by encouraging new skin to grow.
- 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 are less invasive than ablative techniques so have a lower risk of side-effects and people tend to recover faster. They’re usually used for less severe wrinkles and skin tightening and the changes after treatment will be more subtle.
- Skin resurfacing – laser surgery. Medscape. www.emedicine.medscape.com, published 30 October 2015
- Lasers in plastic surgery. British Association of Aesthetic Plastic Surgeons. www.baaps.org.uk, accessed 7 December 2015
- Map of Medicine. Acne. International View. London: Map of Medicine; 2014 (Issue 2)
- Laser resurfacing. Dermnet NZ. www.dermnetnz.org, published 16 June 2014
- Intense pulsed light therapy. Dermnet NZ. www.dermnetnz.org, published 29 December 2013
- Nonablative facial skin tightening. Medscape. www.emedicine.medscape.com, published 2 October 2014
- Nonablative resurfacing. Medscape. www.emedicine.medscape.com, published 13 January 2015
- Personal communication, Mr Anthony Attwood, Consultant Plastic and Reconstructive Surgeon, 23 December 2015
- The British Association of Dermatologists response to the Department of Health’s review of the regulation of cosmetic interventions call for evidence. British Association of Dermatologists. www.bad.org.uk, published October 2012
- Microdermabrasion. Medscape. www.emedicine.medscape.com, published 30 October 2014
- Acne. British Association of Dermatologists. www.bad.org.uk, reviewed August 2013
- Pulsed dye laser treatment. Dermnet NZ. www.dermnetnz.org, published 6 July 2014
- Photodynamic therapy. Dermnet NZ. www.dermnetnz.org, published 23 September 2014
- Photodynamic therapy for the dermatologist. Medscape. www.emedicine.medscape.com, published 3 March 2014
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Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, Bupa Heath Content Team, January 2016.
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