Aging skin undergoes a series of predictable changes, including the loss of elasticity due to a decline in collagen and elastin integrity, the development of wrinkles (fine and coarse), the appearance of pigmentary disturbances like sunspots and lentigines, telangiectasia formation (visible small blood vessels), and actinic keratoses (precancerous lesions). Volume loss in the facial fat pads also contributes to an aged appearance, resulting in malar depressions, furrows, and skin excess. Laser resurfacing has emerged as a significant tool in addressing these signs of aging, offering various benefits depending on the technology used.
The primary benefits of laser resurfacing for aging skin include the reduction of wrinkles, improvement in skin texture and tone, and the treatment of pigmentary abnormalities and vascular lesions. Ablative laser resurfacing is particularly effective in treating deeper wrinkles, especially perioral rhytids (lines around the mouth), acne scars, and significant photo damage. By removing the outer layers of damaged skin, ablative lasers stimulate the production of new collagen, leading to a smoother and more youthful appearance. Nonablative lasers and light-based therapies, while gentler, can still provide noticeable improvements in fine lines, mild to moderate wrinkles, uneven skin tone, and skin laxity by heating the dermis and promoting collagen remodelling. Fractional laser resurfacing, in both ablative and nonablative modes, offers a balance by treating microscopic columns of skin, leading to effective rejuvenation with potentially less downtime and risk compared to traditional fully ablative methods.
Despite the benefits, laser resurfacing carries several risks and potential complications. Common immediate side effects of ablative lasers include redness, swelling, pain, and oozing, which can last for several days to weeks. There is also a risk of infection, which may require antiviral or antibacterial treatment, especially if the patient has a history of herpes simplex virus. Post-inflammatory hyperpigmentation (darkening of the skin) is a significant concern, particularly in individuals with darker skin types, and may require topical treatments like hydroquinone to resolve. Hypopigmentation (lightening of the skin) can also occur, especially after ablative resurfacing, and may be more challenging to treat. Other potential risks include prolonged redness, persistent itching, milia formation (small white bumps), and, in rare cases, scarring. Nonablative lasers generally have a lower risk profile, with the most common side effects being transient redness and mild swelling. However, pigmentary changes and textural irregularities can still occur in some individuals.
Understanding what to expect during the entire laser resurfacing process is crucial for patient satisfaction. The process typically begins with a consultation where the patient’s skin is evaluated, their concerns and goals are discussed, and the appropriate laser treatment is recommended. Preoperative care for ablative lasers often involves using topical retinoids or hydroquinone for several weeks to prepare the skin and potentially reduce the risk of post-inflammatory hyperpigmentation. Antiviral medication may be prescribed prophylactically for those with a history of herpes.
On the day of the procedure, topical or local anaesthesia is usually administered to minimise discomfort. For ablative resurfacing, the laser is systematically passed over the treatment areas, vaporising the outer layers of the skin. The procedure can take anywhere from a few minutes to over an hour depending on the extent of the treatment. Nonablative laser treatments are generally quicker, and patients may feel a warming sensation or mild pricking during the procedure. Cooling devices are often used in conjunction with nonablative lasers to protect the epidermis and enhance comfort.
The postoperative period varies significantly between ablative and nonablative resurfacing. After ablative laser resurfacing, the treated skin will be raw and may weep. Patients need to follow a strict skincare regimen, which typically includes frequent application of emollients, avoiding sun exposure completely, and potentially using vinegar soaks to prevent infection. Redness and swelling will gradually subside over several weeks to months, and the new skin will be more sensitive to the sun for an extended period. For nonablative treatments, the recovery is much easier. Patients may experience mild redness and swelling that typically resolves within a few days, and they need to use gentle skincare products and sun protection. It is essential for patients to have realistic expectations about the outcomes of laser resurfacing. While ablative lasers can produce significant improvements, they may not completely eliminate deep wrinkles or scars. Nonablative lasers offer more subtle and gradual results, and multiple sessions are usually required to achieve the desired level of improvement. The long-term results of laser resurfacing depend on factors such as the type of laser used, the severity of the initial skin condition, and the patient’s adherence to a proper skincare and sun protection routine. Proper patient selection is key to successful laser resurfacing, ensuring that individuals have realistic expectations and understand the commitment involved in the recovery process.