CO2 Laser Resurfacing
The biggest consideration for potential laser patients is to decide what is the best laser for their specific condition. Although the CO2 laser is the gold standard for skin tightening and wrinkle reduction, it has the longest recovery time of up to 2 weeks. The CO2 laser causes redness for about one week and then the skin is pink in color for another several weeks. At 10-12 days make up may be applied. Our office uses special make up products that are blended to mask the pinkness. If the patient can return to work with a pink (looks like sunburn) face then most patients only need a week for recovery. If the patient is in a job situation where a pink face is not an option, then two weeks off may be necessary. This type of laser has a long recovery, but reversing decades of wrinkles and sun damage with a two week recovery is possible. In laser resurfacing, you get what you pay for; not in money but recovery. Lasers treatments with short recoveries have minor results, those with longer recoveries have maximum results.
Dr. Niamtu is very active with laser academics and has published the first human research study on a method to treat laser patients with less pain and faster recovery.
Traditional CO2 laser skin resurfacing remains the “gold standard” for wrinkle, pigment improvement, skin tightening and acne scars.
Don’t be fooled by pumped up and sensational claims that “new” lasers provide the same results with only several days of down time. This is impossible. Many patients have new or fractional laser procedures, spend thousands of dollars and require 3-5 treatments of painful treatment only to see little results. Before having this type of laser, ask the surgeon to see 20 cases that he or she has done (not laser company pictures). You probably won’t see the type of improvement you are seeking. Always demand to see other patients results before having any cosmetic procedures.
Having a shorter downtime is no benefit if you have to have 4-5 procedures. Do the math! A single traditional CO2 laser treatment takes about 12 days of downtime. That is not a bad deal to erase decades of aging.
The pictures below show patients treated with a single session of traditional CO2 laser skin resurfacing.
The above patient is shown before her laser, 10 days after the procedure and 3 months after the procedure.
The Image below show shows sun damage made visible by UV photography. The black dots are brown spots and in some cases premalignant lesions. Note the improvement in the picture of the same patient taken after traditional CO2 laser resurfacing.
How CO2 Laser Resurfacing Works
The CO2 laser is a concentrated beam of light that creates a precision burn on the outer layers of the skin. A single pass with the laser will remove a very thin amount of skin, about the thickness of a human hair. Patients with minimal sun damage or wrinkles may only need a single pass. Patients with advanced sun damage, wrinkles or deep acne scars will need multiple passes. Every patient is different and there is no cookbook formula for the number of passes.
Since the outer layer of skin will be removed, several medications will be necessary to prevent infection and assist healing. The patient is prescribed an anti-herpes medication, antibiotics, as well as medication for swelling and discomfort.
The actual laser procedure takes about 45 minutes and the patient is sedated. Immediately after the laser surgery, the patient’s face will be covered with Vaseline and cold packs.
Beginning the third day a gentle cleanser is used several times per day to wash the face and Vaniply ointment is applied. The face is very red for the first week and fades to pink for the next week. At 10 to 12 days, the patient can wear makeup to cover the pinkness. Generally, by the third or forth week, the majority of the pinkness is gone and the positive effects of the laser resurfacing can be appreciated. Some patients may stay a very light pink for several months, but this can be covered by make up. Research has shown that the improvement of wrinkles will continue to be seen as the skin continues to heal over the course of 18 months. So, for most patients, if they look good at several weeks, they will look better at several months.
Like any surgical procedure, complications are possible, but are rare with experienced doctors. Dr. Niamtu has performed thousands of laser procedures with multiple types of lasers. In addition he has written textbook chapters and numerous articles on laser therapy. A list of Dr. Niamtu‘s scientific publications.
After the laser treatment the skin is pink. This can be covered by makeup at about 10-12 days and generally resolves in most patients by 4-6 weeks. Some patients may remain a very light pink for several months but it is always a temporary situation. Our office has special types of make up to hide redness to return to work or play faster.
It is not uncommon to have increased pigmentation which happens about a month after the procedure and can occur in 30-40% of patients. This manifests as blotchy tan areas on the face and is temporary. This happens more frequently to patients that are exposed to sunlight or other forms of irritation such as wind, car defrost, hair dryers, etc. This is always a temporary condition and is usually easily treated with bleaching creams.
Scarring is extremely rare and prudent practitioners are conservative with laser treatment. It is always safe to under treat a patient and perform a touch up later. In fact, patients with significant wrinkling or acne scars may need multiple procedures. Dr. Niamtu recommends waiting 12 weeks before retreating an area with the laser.
Touch Up Surgery
Many patients are completely treated with a single laser procedure, but for extreme wrinkles or acne scars touch up treatment may be required. Frequently we will treat the entire face on the first laser treatment and then for touch up procedures only certain areas of the face need to be treated.
Face and Neck Demarcation
Damages skin is darker than undamaged skin. Look at the outer surface of your forearm and it is darker than the under surface because of sun exposure over the years. The underside of the forearm is lighter. When the face is lasered, the new skin will be lighter because it is healther. There is a demarcation between the lasered skin and the non lasered skin of the neck. It is not safe to laser the neck. The neck can be treated with chemical peel at the time of the laser to blend the demarcation. The transition area where the laser stops is intentionally hidden in the jaw line. Although the transition line may be apparent at first, it usually blends in well. In cases of extreme neck aging, the neck will always look more aged than the rejuvenated face, but the trade off of a younger face is usually well worth it.