Cosmetic Laser Surgery for Skincare Resurfacing, Wrinkles and Scar Removal | CO2, Pulse-Dye, Visible Light (VLLs) and Fraxel repair

Cosmetic Laser Surgery

Cosmetic laser surgery is becoming a more common procedure. In the hands of a skilled cosmetic surgeon, laser surgery is a very controlled procedure that can be used to remove wrinkles and scars and tighten skin. Lasers are basically a concentrated form of energy. A laser's advantage as a surgical tool is that it can cut through tissue without causing as much bleeding as a scalpel. Also, there are different wavelengths of the laser light, so surgeons can use different types of lasers on very specific types of tissues, without affecting nearby tissue.

Laser skin resurfacing and rejuvenation

There are many different types of lasers and cosmetic laser surgery which can be used on for skin rejuvenation. During ablative laser resurfacing - examples include carbon dioxide laser (CO2 lasers) and erbium (YAG) laser - a laser vaporizes superficial layers of facial skin. The carbon dioxide laser (CO2 laser) was one of the earliest lasers. In cosmetic surgery, it is still useful for scars and cosmetic skin resurfacing. The downtime after rejuvenation with these types of lasers can last two weeks or more, while the skin heals.

There are also non-ablative lasers, which are said to help skin look better with less surface damage. These are the types that are often used for skin rejuvenation. Although not typical surgery, these procedures are sometimes referred to as laser facelifts. Examples of lasers for these so-called laser facelifts include

• pulse-dye lasers
• visible light lasers (VLLs)
• NLite lasers

Other examples used for laser facelifts include the Genesis laser and the Titan laser. The Coolglide XEO uses a combination of pulsed light and long-pulsed technology called Nd: YAG. The Smoothbeam diode laser is used for acne scars as well as wrinkles.

Fractional laser surgery (photothermolysis) is another form of laser treatment. Examples include:

• Fraxel laser and Fraxel repair
• Pixel laser
• Palomar Lux 1540 fractional laser
• Affirm laser

Active FX / Deep FX CO 2 laser is a combination laser. The Active FX / Deep FX CO 2 laser both tightens and resurfaces skin, according to its proponents. This laser surgery can have less healing time than other CO lasers.

There are also lasers that can be used for pigmented areas of the skin. These types of lasers emit short pulses of intense light which is absorbed by melanin or tattoo ink. They can be used for age spots, birth marks, skin discolorations and tattoo removal. They include:

• Q-Switched Ruby Laser (QSRL)
• Q-switched Nd:YAG
• Q-switched Alexandrite Laser

Portrait plasma skin resurfacing uses plasma energy for resurfacing and skin rejuvenation. Proponents say portrait plasma surgery can tighten skin and improve appearance.

Other lasers used in cosmetic surgery include the Gentlelase APOGEE lasers, which are used for hair removal as well as wrinkles. The Medlite peel is another type of laser used in skin resurfacing. Proponents say it non-ablative lasers such as these produce results with less risk of scarring and less downtime.

For aging skin, fractional laser resurfacing may help improve damaged skin. They can be very precisely targeted to remove lesions on the skin such as moles and age spots. They can also be targeted to improve the appearance of wrinkles and lines. Lasers can cut through tissue without causing excessive bleeding. Their use as a cosmetic tool was discovered somewhat by accident. In the course of treating acne scars with a laser, surgeons noticed that after resurfacing the skin around the scar to make the scar less visible, small adjacent wrinkles were greatly diminished.

For skin with acne scars, lasers can help to remove the scars or make them less noticeable.

Cosmetic lasers can also be used for:

• wrinkles and lines caused by sun damage
• laser tattoo removal
• wrinkles due to age and facial expressions
• acne scars
• some folds and creases around the nose and mouth
• precancerous and benign superficial growths
• age spots
• spider veins and varicose leg veins

In addition to removing the top layers of skin, proponents say laser resurfacing can also lead to more collagen production. Collagen is a key fibrous protein in the skin's connective tissue, and it helps give the skin its texture. Natural aging and such factors as sun damage and smoking help break down the collagen layer so that the skin's once smooth surface develops wrinkles. When you increase collagen production, the skin looks fuller and better.

Lasers can not rejuvenate skin on large areas of the body nor can laser treatment lift or remove sagging jowls or smooth out crepe-like or sagging neck skin. These conditions only respond to traditional plastic or cosmetic cut-and-stitch surgical methods, such as a facelift or other types of facial plastic surgery or body sculpting.

Cost of cosmetic laser surgery

If laser surgery is done for cosmetic reasons, cost is to be considered, because it will not be covered by insurance. Costs can range from the high hundreds to several thousand dollars. Some types of laser surgery, for example for scar removal, may be covered, so the out-of-pocket cost would be less. You should discuss cost with your plastic surgeon. But do not choose a clinic or surgeon on cost or price alone.

It is essential that you use a qualified surgeon for any cosmetic laser procedures. You ideally want a doctor who owns his or her own laser equipment, and who has done the procedure for years. After a laser resurfacing procedure, there will be bruising and swelling for over a week, with the skin looking scabbed and crusty. After the procedure, plan on at least 10 days of healing before applying any makeup. For satisfactory healing, that means following rigorous after-care treatment, including proper skin cleansing, the application of a skin lubricant, and the frequent changing of dressings.

It's important to remember that after any kind of laser resurfacing surgery, patients must avoid sunbathing which will accelerate the aging process and increase your risk of skin cancer. Anyone who's had a laser procedure on their skin should make sure they use sun protection.

Laser resurfacing is not for everyone. Some people with very sensitive skin cannot tolerate the medications and lubricants used on the skin during healing. People with darker skin can also have problems due to uneven coloration.

As with any medical procedure, patients may experience certain complications including:

• prolonged redness of skin
• tenderness
• easy flushing
• hyperpigmentation, when the skin appears darker than normal
• hypopigmentation, or lightening of the skin

It is essential that anyone considering this procedure see a doctor who is qualified to do the procedure, since laser resurfacing that goes too deep can result in bad scarring.

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Updated June 2009

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