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Laser facial resurfacing

Published by Bupa's health information team, February 2009.

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

Laser facial resurfacing is a technique that can remove the upper layers of the skin on the face, usually for cosmetic reasons, using a laser.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About laser facial resurfacing
What are the alternatives to laser facial resurfacing?
Preparing for your procedure
About the procedure
What to expect afterwards
Recovering from laser facial resurfacing
What are the risks?
Questions and answers
Related topics
Related Bupa products and services
Further information
Sources

About laser facial resurfacing

A laser is a beam of light radiation, which can be used to deliver intense energy to a specific area of skin.

'Ablative' laser resurfacing destroys the surface layer of skin in a controlled manner, exposing the lower layer (the dermis, which is pink). The laser power is turned down and it's then 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, new skin forms that is softer and less wrinkled or scarred than the original.

'Non-ablative' laser resurfacing doesn't destroy any skin but heats it up to encourage new skin to grow. This factsheet deals with ablative laser resurfacing.

For deeper wrinkles, parts of the dermis can also be removed.

Illustration showing the structures and layers of the skin
The structures and layers of the skin

Laser facial resurfacing can be used for:

removing superficial wrinkles
tightening your skin
evening out pigmentation (colouring)
smoothing rough skin
improving the look of shallow acne scars
treating 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.

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. Chemicals related to vitamin A such as tretinoin (eg Retin A cream) and chemical peels containing alpha-hydroxy acids (eg glycolic and lactic acids) are commonly used for this.

Laser facial resurfacing isn't generally suitable for treating the neck, very deep wrinkles, sagging skin or extra fat. A surgical facelift may be a more appropriate option.

Excess skin around the eyes can be treated with cosmetic eyelid surgery.

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 your procedure

Your surgeon will explain how to prepare for your procedure. For example, if you smoke you will be asked to stop, as smoking increases your risk of getting a wound infection and slows your recovery.

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

The operation is usually done as a day case under local anaesthesia. This completely blocks feeling from the facial area and you will stay awake during the operation. Alternatively, you may prefer to have your laser facial resurfacing under general anaesthesia. This means you will be asleep during the procedure and will feel no pain. You may be offered a sedative with a local anaesthetic to help you relax during the procedure.

Your surgeon will advise which type of anaesthesia is most suitable for you.

If you're having general anaesthesia you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours beforehand. However, some anaesthetists allow occasional sips of water until two hours before a general anaesthetic.

If you go to hospital your nurse will explain how you will be cared for during your stay. Your nurse may check your heart rate and blood pressure, and test your urine.

Your surgeon will usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

About the procedure

Before treatment begins, your nurse or surgeon will clean your face thoroughly.

Your surgeon will pass a laser beam over the treatment area, with precise control over where and how deep the laser penetrates.

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

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. After general anaesthesia you will need to rest until the effects of the general anaesthetic have passed.

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

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. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

Recovering from laser facial resurfacing

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.

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 48 hours afterwards. If you're in any doubt about driving always follow your surgeon's advice and please contact your motor insurer so that you're aware of their recommendations.

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 of this procedure.

Side-effects of laser facial resurfacing

These are the unwanted, but mostly temporary effects of a successful treatment, for example, feeling sick as a result of the general anaesthetic, swelling/pain around a wound or scarring.

For laser facial resurfacing, side-effects include:

a painful wound that may crust, weep or ooze for the first seven to 10 days
skin redness that may last for up to six months
scabs forming as part of the healing process

You can use make-up to disguise the redness.

Complications of laser facial resurfacing

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 or excessive bleeding.

Complications of laser facial resurfacing can include those listed below.

Skin infection.
Reduction or increase of skin pigment - this is more likely if you have dark skin. Your doctor will advise you if an alternative treatment is more appropriate for you.
Scarring - this is rare with normal skin 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 had a course of the acne medicine isotretinoin (Roaccutane).
Cold sores can be reactivated, but preventive medicine such as acyclovir (eg Zovirax) taken in tablet form can help to stop this happening. If you have a cold sore it will be covered with an anti-viral cream or ointment before and after treatment.

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.