Laser for Moderate Under Eye Laxity/lines, Cancer Scar and Slight Marionette Lines for the Most Dramatic and Longlasting Result?

I had been considering a mid to deep peel, but decided I am not comfortable with the toxic chemical aspect. I'd like a fairly extensive re-surfacing of face (maybe neck/chest) for under eye lines and laxity, a 2"+ skin cancer scar/asymmetry by nose, minor marionette lines and sun damage/spots. Botox glabella/forehead 3-4 mos, and Radiesse every 1.5-2 years in naso-labial folds. I am less concerned with downtime and recovery as I want a long-lasting outcome. I am 50 with fair skin. Thanks!

Doctor Answers 8

Laser resurfacing offers a very well controlled, precise modality for addressing any wrinkles, post-operative scars and even imp

A mid to deep chemical peel would be an excellent treatment to correct uneven skin pigmentation and fine lines. However, it is unlikely to improve your appearance of any noticeable wrinkles or post-operative scarring.

Your choice to consider laser resurfacing is a good one, given your goals. Laser resurfacing offers a very well controlled, precise modality for addressing any wrinkles, post-operative scars and even improving under eye laxity. Physical improvement you enjoy will often be proportional to the aggressiveness of the treatment and consequently to the amount of recovery time and care.

Excellent results in rejuvenation of the face and improved post-operative scars can be accomplished with both CO2 laser resurfacing and Erbium:YAG laser resurfacing. My preferred technique is to use a Sciton Erbium:YAG tunable resurfacing laser that allows me to carefully adjust the depth of treatment in the various areas of the face, depending on need due to sun damage or scarring.

Because the skin of the face behaves and heals much differently than that in the neck and chest, a different type of laser treatment should be considered for these areas--such as a series of ProFractional treatments.

You would need to be prepared for a up to a week of true downtime following an aggressive laser resurfacing treatment of the face, with post treatment redness gradually resolving over several weeks following the treatment (easily covered by makeup). This downtime would be worth it though since the results are remarkable. 

Bay Area Facial Plastic Surgeon
4.6 out of 5 stars 18 reviews

Laser Resurfacing Results are Optimized When Combined with Fillers

I have extensive experieince with the Fraxel Repair (CO2) laser which causes skin tightening, especially in the thin skin areas under the eyes. I have also seen many cancer removal scars and Mohs'  flaps improve with the Fraxel, avoiding the need for scar revision.

The best rejuvenation results in my practice are achieved when the patient has Fraxel combined with volume enhancement, such as Sculptra. The combination is synergistic, adding volume below the skin layer to compensate for facial fat and bone loss with age.

Edward Szachowicz, MD, PhD
Minneapolis Facial Plastic Surgeon
4.5 out of 5 stars 13 reviews

Laser Resurfacing

Most authorities agree that CO2 laser will provide more tightening and collagen deposition than erbium laser.  Portrait plasma is another good option which I have used but in my hands I prefer CO2 laser.  I currently use the SmartXide DOT CO2 laser with excellent results.  There is about 5 days of recovery time after a moderately aggressive treatment.  DOT laser is great for reduction of fine lines, general tightening of the skin, and elimination of surface pigment.  It is great in combination with Botox and fillers.

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 25 reviews

Resurfacing with fraxel laser or portrait plasma, botox, fillers, eyelid wrinkles and Mohs scar

When considering what is best to rejuvenate the facial skin and evaluate scar revision, one needs to see a physician in consultation to have the skin examined for elasticity, skin texture and coloration.  Some resurfacing techniques have greater risks than others. Lower eyelid skin can be resurfaced using medium depth chemical peels but we tend to get better results with either the Fraxel Repair (carbon dioxide fractional ablative) laser or the Portrait Plasma resufacing (recently acquired by Energist). The latter provides similar resurfacing results to the Fraxel Repair but I find it to be more gentle on the skin, providing equal if not better tightening, and a more natural skin texture and color post operatively.  All these techniques have risks, including scarring, so the consultation needs to be thorough for you to understand the procedure and post operative treatment regimen and restrictions / downtime and follow-up course.  Scar revision can be done by similar techniques, dermabrasion or surgical revision, but again, the skin must be examined in person to determine the laxity, lack of symmetry, three dimensionality of the contour change, etc. Asymemtric corners of the mouth can be improved with using Botox in the DAO muscle and fillers such as Restylane, Juvederm and others in the skin near the corner of the lips.  RAdiesse can be used in deeper marionette lines and smile creases.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Laser resurfacing

Laser resurfacing with an erbium or CO2 or fraxel may be helpful. This can be done with the botox, and the fillers.  I prefer an erbium.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

Laser Resurfacing instead of Mid to Deep Chemical Peeling

Since you do not wish to undergo the peel resurfacing your alternate option for a long lasting result is laser resurfacing.

Specifically, Ultra Pulse CO2 fractional resurfacing (Total FX). This will help with laxity, deeper lines, scars, sun damage, age spots and collagen stimulation for plumping the skin. This treatment may be performed in combination with Botox or Dysport treatment just prior to resurfacing for optimal results.

You will more than likely need on-going Botox or Dysport and Radiesse for maintenance.

Anifat Balogun, MD
Seattle Otolaryngologist

Best Laser for Long-Lasting Results

Until recently, aggressive laser resurfacing of the face (ablative laser treatment) was the only way to achieve superior cosmetic results in rejuvenating significantly aged or sun-damaged skin. Unfortunately, this treatment is associated with open healing, with prolonged recovery time and redness. With the advent of fractionated laser resurfacing (non-ablative laser), specifically the Fraxel laser, significant results can be achieved through a series of “fractional” treatments whereby multiple tiny columns of skin are aggressively treated, with surrounding areas of skin untouched. This enables faster healing than if the entire area were treated at once, and since there is no skin surface disruption, healing times are very short. This treatment eliminates irregular skin discoloration, and stimulates new collagen production, tightening the skin without prolonged recovery. After a series of 2 to 4 Fraxel treatments, the cumulative cosmetic improvement is near more aggressive lasers, but unlike more aggressive lasers, redness and swelling eliminated within 2 to 4 days after each treatment. Fraxel is outstanding for fine wrinkles, mild skin laxity, irregular pigmentation, acne scars, surgical scars, enlarged pores, stretch marks, age spots and Rosacea. It can be used safely on the face, neck, hands, arms, and chest.

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
4.8 out of 5 stars 107 reviews

Laser resurfacing in a 50 year old

  I'm sorry but I didn't really see a question here.  Yes, I think you are a candidate for deep laser or chemical peel resurfacing.  But you should know in advance what this technique can and cannot do for you.  It really does not take the place of eyelid surgery and it will not lessen the need for fillers to the nasolabial folds, and possibly not for Botox either.  Hope this helps.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.8 out of 5 stars 131 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.