I had CO2 ablative laser around my mouth and Chin 2 times in one year, why isn't it working? (Photos)

Dear RSmember:

It’s all about understanding what you are treating and the doctor and patient being on the same page. In your photos at least, I see multiple issues which would require different modalities of treatment, depending upon what you were trying to improve. CO2 is excellent for fine lines and sun damage and brown spots as well as scars, but it cannot tighten or lift the skin, get rid of deep upper lip lines, nor increase volume that has been lost. If you can have a frank discussion with your doctor, trying to understand exactly what it is you were trying to improve, you may be able to have a different modality of treatment to address your issue or issues.

You should be careful about repeating CO2 in the same area, because if the skin is not fully healed under the surface, you can get much more ablation and downtime. It may be better to wait at least three months before having another CO2. Having said that if it’s the upper lip lines that you were trying to improve, I have found that two sessions with Ultherapy works much better than CO2. Also, if they are due to an overactive muscle around the mouth, relaxing a portion of that muscle with a tiny bit of Botox near the lip line can really help a lot. Lastly, a little bit of filler to the lips would actually help to soften the lip lines that approach the pink portion of the lip itself.

If you were concerned about what you see going on at the corners of the mouth and on the chin, I do believe that fillers would help your problems a lot. I believe I also see dimpling of the chin, with attachments of the underlined the mentalis muscle to the skin of the chin, which could be relaxed with a tiny bit of Botox to that muscle.

If you are concerned about some skin laxity that is adding to the droop of the corner of the mouth and a tiny bit of jowling, a full face microneedling with radiofrequency could be very helpful, for example, with Secret RF/Fraxis Duo.

I hope this helps!

Sheryl Clark MD FAAD

Thank you for your question. It is hard to determine why the laser did not work. There are many different depths that the laser can penetrate too and the deeper the depth the better at removing deep wrinkles. Typically the deeper depth has about a 2-3 week recovery period and then it does take several months to start building collagen which will smooth and soften the lines out even more. Hope this helps!