Ablative laser resurfacing: The promise, dangers and reality

Most research studies agree that properly performed laser resurfacing can visibly reduce the appearance of fine lines and, in some cases, deeper wrinkles. It is used either on the entire face, or, more commonly, in the areas around the eyes and mouth. Some surgeons combine laser resurfacing with a facelift or other procedures to produce maximal effect. The advantages of laser over other resurfacing methods (deeps chemical peels and dermabrasion) include greater precision, less bleeding and discomfort and, possibly, shorter recovery time.

The results of laser resurfacing are particularly noticeable after the initial healing and for about a year thereafter. According to different sources, the results generally last from one to five years. (The results of lower eyelid resurfacing tend to be less lasting - one to two years). Maintenance treatment with topical agents may prolong beneficial effects of laser resurfacing on the skin appearance. Generally, the wrinkles solely due to skin aging respond better than those due to facial movement, such as smiling, frowning or squinting. Even if successfully removed, movement wrinkles tend to recur relatively quickly.

It appears that the results of laser resurfacing vary greately, depending on the technique, skill of the surgeon and patients unique physiology. Some people experience results exceeding their expectations, while others see little benefit, or even have negative reactions.

Risk

Whether you call it a laser peel or resurfacing, it is still an invasive surgical procedure where top layers of your skin are vaporized by a laser-generated energy burst. In most cases the damage is well controlled and the recovery is smooth. Possible adverse reactions include excessive scarring, infection, loss of normal skin pigmentation, skin redness and dryness, and others. When the procedure is performed skillfully and the patient and technique are properly selected, side effects are relatively infrequent. If you opt to undergo a laser peel, it is critical to find a board-certified physician with extensive hands-on experience in this procedure.

Keep in mind that due to variations in individual physiology, adverse reactions can occur even if you are treated by a highly skilled professional. In particular, people with darker skin are more likely to develop uneven pigmentation whereas people who were on accutane (a common acne treatment) or those with certain connective tissue disorders are more prone to scarring. Various inflammatory skin conditions also increase the risk of adverse reactions. Also, laser peels can activate herpes virus and possibly other dormant pathogens. In most cases, a patient is given an oral antiviral drug and sometimes antibiotics before and after the procedure.

It may be prudent to perform a test patch (a small test treatment), particularly in people with darker skin pigmentation to assess the risk of skin discoloration and other side effects.

Laser techniques

There is a considerable variety in the equipment and treatment techniques user for laser resurfacing. The two most common lasers for wrinkle removal are carbon dioxide and erbium:YAG lasers. Carbon dioxide laser appears to be somewhat more effective for treating deep wrinkles but has longer recovery time and tends to cause greater adverse reactions. Some surgeons use both carbon dioxide and erbium:YAG lasers in the same procedure: erbium laser for fine lines and small wrinkles and carbon dioxide laser for deeper wrinkles. Such an approach may provide the best risk-to-benefit ratio.

Another important technical aspect is the number of passes the surgeon makes when treateing skin with a laser. Multiple passes, particularly with carbon dioxide laser, produce greater thermal injury and lead to greater side effects and longer recovery. Some surgeons assume that more passes results in a greater wrinkle reduction. However, research indicates that the benefit from additional passes may be small whereas additional risk is substantial. Some surgeons use a combination protocal where problem areas (around eyes, mouth and on the foreehad) are first treated with one pass of carbon dioxide laser and then with one or more passes of less injurious erbium laser. The rest of the face may be treated with one pass of erbium laser.

Limitations

No mater what equipment or techniques is used, laser resurfacing rarely removes or markedly reduces deep wrinkles or facial sag. If wrinkles are movement related, Botox (botulinum toxin) injections are likely to be both safer and more effective. Another alternative for deep wrinkles, whether related to movement or not, are wrinkle fillers, such as Restylane. Facelift remains the procedure of choice to correct marked facial sag.