Facial laser resurfacing uses high-energy, pulsed and scanned lasers. Pulsed CO2 and Erbium: YAG lasers have been successful in reducing and removing facial wrinkles, acne scars and sun-damaged skin. High-energy, pulsed, and scanned CO2 laser is generally considered the gold standard against which all other facial rejuvenation systems are compared. Typically a 50% improvement is found in patients receiving CO2 laser treatment. Side effects of treatment include post-operative tenderness, redness, swelling and scarring. The redness and tenderness last several weeks, while new skin grows over the area where the damaged skin has been removed by the laser treatments (ablative laser systems). Secondary skin infection including reactivation of herpes is also a potential problem until healing occurs. Extreme caution is needed when treating darker skinned individuals as permanent loss or variable pigmentation may occur long term.

Erbium: YAG produces similar results and side effects compared to CO2. Despite their side effect profile and long recovery time these ablative laser systems, when used properly, can produce excellent results. Recently non-ablative lasers have been used for dermal modeling; 'non-ablative' refers to heating up the dermal collagen while avoiding damage to the surface skin cells (epidermis) by cooling it. Multiple treatments are required to smooth the skin.

One of the most popular anti-aging remedies is laser skin resurfacing, which improves the appearance of fine lines or wrinkles, scars and hyperpigmentation (discolored areas of the skin), primarily around the eyes and mouth. It can also be used to treat large areas of the face.Dr.Goldman has been called the “Father of Lasers in Medicine and surgery”. Laser skin resurfacing holds advantages over alternative approaches that may cause discomfort, bleeding and bruising, all of which equate to a longer recovery time. What's more, today's lasers are gentler and safer than they have been in the past.

All skin treatments work in a similar manner. They remove a layer of skin so that the new skin can flourish and fill in the wrinkles and crevices. Until recently, the only options to medically treat damaged skin were chemical peels and dermabrasion, which is more invasive and far less gentle than microdermabrasion. During dermabrasion, the surgeon uses a wire brush or a diamond wheel with rough edges to remove the upper layers of the skin. This process wounds the skin and causes it to bleed. As the wound heals, new skin grows to replace the damaged skin. These procedures do offer the anti-aging benefits of glowing skin, reduced wrinkles, decreased areas of skin discoloration and minimal scarring, but they do not produce predictable results. By contrast, laser skin resurfacing uses laser light to target the superficial and deep layers of the skin.

LASER

The word “LASER” is an acronym that stands for Light Amplification by the Stimulated Emission of Radiation. For this reason, a laser is not just an instrument but also a physical process of amplification. All lasers are composed of the same four primary components. These include the laser medium (usually a solid, liquid, or gas), the optical cavity or resonator which surrounds the laser medium and contains the amplification process, the power supply or “pump” that excites the atoms and creates population inversion, and a delivery system (usually a fiber optic or articulating arm with mirrored joints) to precisely deliver the light to the target.

Lasers are usually named for the medium contained within their optical cavity The gas lasers consist of the argon, excimers, copper vapor, helium-neon, krypton, and carbon dioxide devices. One of the most common liquid lasers contain fluid with rhodamine dye and is used in the pulsed dye laser. The solid lasers are represented by the ruby, neodymium: yttrium-aluminum-garnet (Nd: YAG), alexandrite, erbium, and diode lasers. All of these devices are used to clinically treat a wide variety of conditions and disorders based on their wavelength, nature of their pulse, and energy.

The excitation mechanism can be accomplished by direct electrical current, optical stimulation by another laser (argon), radiofrequency excitation, white light from a flash lamp, or even (rarely) chemical reactions that either make or break chemical bonds to release energy, as in the hydrogen-fluoride laser.

Advantages

The main advantage of nonablative wrinkle treatment is the relative lack of patient downtime in contrast to the obligatory 7–10 days of recovery time for ablative resurfacing. The devices that target dermal vasculature will help minimize, if not eliminate, the telangiectases frequently noted in patients with a history of significant sun exposure. Patients with diffuse erythema, resulting either from sun damage orrosacea, also note improvement. Devices which can target melanin as a potential chromophore, such as those with an IPL component, can also treat any concomitant pigmentary changes. Lentigines, melasma, and poikilo dermatous changes can be improved if not completely eradicated.

Disadvantages

The degree of wrinkle reduction is not as significant as that seen with the ablative devices and thus, patient dissatisfaction can be an issue. The improvement is often referred to as skin “toning”or “plumping up of the skin,” in contrast to the “tightening” often seen with ablative resurfacing. Appropriate patient education about the degree and unpredictability of enhancement is the key to success for these procedures. Good quality preoperative photography is helpful to document these changes as they can be subtle and improvement occurs over time, making the change less apparent.

The Future

The field of ablative resurfacing has remained stable with relatively few advances over the past 5 years. A notable exception to this has recently arisen with the advent of both plasma kinetic and fractional resurfacing. Although in their infancy, these novel resurfacing techniques show promise as we await the completion of long-term studies.

No The field of non ablative resurfacing has expanded dramatically over the past 8 years. Studies are underway to elucidate the best treatment intervals, compare the above techniques, and expand the energy potential of the given devices. In addition, a new 900-nm laser in conjunction with RF shows promise.