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Laser facial resurfacing

Published by Bupa's health information team, July 2005

This factsheet is for people who are considering having laser facial resurfacing.

Laser facial resurfacing is a technique that can remove the upper layers of the skin on your face using a laser. This can improve the look of your skin without having full cosmetic surgery. It can be a very effective treatment for reducing mild scarring, or the effects of sun damage, such as fine wrinkles.¹

What is laser facial resurfacing?

A laser is a beam of light radiation, which delivers intense energy to a specific area of skin. This destroys the surface layer of skin in a carefully controlled manner, exposing the lower layer (the dermis, which is pink). Then, at lower power, the laser heats the dermis, which stimulates the growth of new collagen fibres.¹ As the wound heals, new skin forms that's softer and less wrinkled or scarred.²

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

There are several different types of laser, each with advantages for certain types of treatment.

Pulses of laser light can be used to treat skin lesions such as port wine stains and spider veins. These lasers can also be used to remove the colour from tattoos and do not seriously damage the surrounding skin.³

Carbon dioxide or YAG lasers (YAG is the type of crystal that is used to generate the laser) are often used for resurfacing procedures.^1,3

The structures and layers of the skin

Why have laser facial resurfacing?

Laser facial resurfacing can improve the appearance of your skin and is most effective for:

• removing superficial wrinkles
• tightening your skin
• evening out pigmentation (colouring)
• smoothing rough skin
• improving the look of shallow acne or chicken pox scars

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.

Laser facial resurfacing can cause changes in the pigmentation of your face, which means that doctors do not normally use laser techniques on dark skin. Surgery may be advised instead.

What are the alternatives?

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.¹

Laser facial resurfacing generally isn't suitable for treating the neck, or very deep wrinkles, sagging skin and extra fat. A surgical facelift is a more suitable option.⁴ For more information, please see the separate BUPA factsheet:
Facelift

Excess skin around the eyes can be treated with cosmetic eyelid surgery.⁴ For more information, please see the separate BUPA factsheet:
Cosmetic eyelid surgery

What happens before laser facial resurfacing?

Your surgeon will discuss how to prepare for your operation. For example, you may be asked to give up smoking as this increases your risk of infection and slows the healing of wounds.⁵

Before treatment you will talk to your doctor about the procedure and you will usually be asked 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.

Your doctor can perform laser resurfacing in his or her clinic or in an operating room, depending on the amount of treatment needed and type of anaesthetic. It is often done as a day-case, which means that you can have the operation and go home the same day.

The treatment

Laser facial resurfacing is usually done under a local anaesthetic which numbs the area but you will be awake. If needed, your anaesthetist can also give you an injection of a sedative, which will make you feel relaxed and possibly drowsy.

If you are having your whole face treated or having another cosmetic procedure, such as eyelid surgery, done at the same time, a general anaesthetic may be preferable. This means that you will be asleep throughout the procedure and will feel no pain.

Before treatment begins, your face will be cleaned thoroughly.

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

The procedure lasts from a few minutes to an hour or so, depending on the size of the area being treated.²

After the treatment

After treatment, your face is likely to be covered with antibiotic ointment. A dressing may be put on the treated area too, or it may be left uncovered.⁴

Your operation will usually be a day case and you will usually be able to go home once you have made a full recovery from the anaesthetic. If you have had a general anaesthetic, you will need to arrange for a friend or relative to drive you home and stay with you for 24 hours.

Before discharge, your surgeon will give you advice about how to care for your skin as it heals.

Recovering from laser facial resurfacing

Your will need to wash your face several times a day with a gentle cleanser, and apply antibiotic ointment or cream to aid healing.

To help ensure the skin heals quickly with good cosmetic results, it is important to do the following.

• Stay out of the sun. If you need to go out, apply a sunscreen with a SPF factor of at least 25, and with both ultraviolet A and B protection. You should use sun screen for at least six months after treatment.^2,4
• Avoid making exaggerated facial movements.
• Moisturise your skin frequently with a simple preparation such as aqueous cream.2 This will keep the skin supple and help to prevent it drying out.
• Wash your hair with a mild baby shampoo to avoid irritating your skin.

Deciding on treatment

It is important not to rush into the decision to have any cosmetic treatment. And, it is sensible to discuss the options with your GP, who may be able to recommend reputable surgeons or give advice about how to choose which hospital to be treated in.

Laser facial resurfacing is a commonly performed and generally safe procedure. However, in order to give informed consent, anyone deciding whether or not to have this procedure needs to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For laser resurfacing, side-effects include:

• discomfort from the treated area until it has healed²
• swollen skin that may ooze for the first 7-14 days after treatment¹
• skin redness that may last for 6-12 weeks^1,4
• scabs forming as part of the healing process¹

It can take 10 days or more for the skin to heal, and two to six months for the redness to fade completely.⁴ You can use make-up to disguise the redness.

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. Specific complications of laser facial resurfacing are uncommon but can include those listed below.

• Skin infection.¹
• Reduction or increase of facial pigment.^1,4
• Scarring - this is rare with normal skin but the risk increases for people who have recently had radiotherapy in the same area, who are prone to keloids (overgrown scar tissue at the site of an injury) or have recently had a course of the acne medicine isotretinoin (Roaccutane).^1,4
• Cold sores can be reactivated, but preventive medicine such as acyclovir (eg Zovirax) taken in tablet form can help to stop this happening. Your surgeon will advise you whether this is necessary.⁴

You should bear in mind that although wrinkles or scars may subside after only one laser session, more sessions may be needed to complete the therapy. Also, the effect of laser resurfacing on wrinkles is not permanent, since the ageing process continues as normal after the procedure.

Further information

• British Association of Plastic Reconstructive and Aesthetic Surgeons
  020 7831 5161
  www.bapras.org.uk

References

1. Stratigos AJ, et al, Advances in cutaneous aesthetic surgery. JAMA 1998;280:16.
2. MayoClinic.com, Laser resurfacing: One way to treat wrinkles.
   www.mayoclinic.com
   accessed 31 March 2005
3. Alam A. Aesthetic surgery: coming of age. The Lancet 2000;356:S60.
4. British Association of Plastic Reconstructive and Aesthetic Surgeons, Lasers in plastic surgery.
   www.bapras.org.uk
   accessed 31 March 2005
5. Smoking and wound healing. Am J Med. 1992 Jul 15;93(1A):22S-24S.

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