Laser Resurfacing Results Vs. Downtime

Hi Diane,
1) Usually, the least down-time procedures involve minimal results but the arrival of the Fraxel Restore laser, has allowed people to have some redness, mild swelling and peeling with some bronzing for three to five days. Most people though, continue to do their normal routine. Fine lines, acne scars, uneven brown discoloration and texture and pores can improve with this technique. IPL light sources, are not lasers, and they can improve uneven discoloration but do not help scarring.



2) There is the best result in diminishing wrinkles and acne scars with laser ablation. Ablation refers to the removal of the top layer of skin leading into the dermis. Recovery can be 12 days and redness lasts for many months. The new Fraxel Repair uses this technology in a shape of many very fine diameter beams that minimally wound the skin. Healing is more rapid and gentle than the old fashioned laser ablation. Portrait plasma energy source can effectively treat wrinkles and scars and discoloration along with providing tightening.

Resurfacing lasers can
help improve fine lines, shrink your pores, improve skin tone/pigmentation, and
tighten the skin. Depending on the area treated and type of laser used,
the downtime can range from a few days up to a week or 10 days.

These techniques improve fine wrinkles, uneven pigmentation, and general sun damage. They act by stripping away the superficial layers of the skin. New skin cells migrate to the treated areas and produce new, smooth, natural collagen.

Chemical peels such as trichloroacetic acid (TCA) can be applied to the entire face and neck (avoiding the eyelids). Dermabrasion uses a spinning wheel with a rough (diamond encrusted) surface to abrade the skin; this is especially good for the pitting of acne scars and vertical lines around the lips. Lasers can also be used to resurface facial and neck skin. It is effective in treating wrinkles, age spots, acne scars, and uneven pigmentation. The laser also causes a mild tightening effect on the facial skin.

These treatments result in redness and peeling of the skin for 5 to 10 days. There will also be some swelling. Most patients can return to work within 2 weeks. The pink color of the new skin may last for several months.

Dr. Wiener now also offers a new Laser Micro-Peel procedure that reduces post-procedure down-time by nearly 50%. Please contact the office for further information.

Usually “low” downtime results in poor long term results (downtime less than 3 days).  Longer downtime results in a more profound improvement.  The goals and the problem to address must be discussed first.  You may not need to have an aggressive treatment.  If you have lines present without moving your face, then an aggressive treatment is needed.  If your skin is dark, then an aggressive treatment may have a higher risk of pigmentation and scarring.  Lasers have options in settings which can be very mild to very aggressive.  The lasers to use are usually CO2, Erbium, or YSGG-Erbium glass, in the right hands. The involvement of a Board Certified Dermatologist or Plastic Surgeon experienced in lasers is a vital.*

An easy way to consider my response to these questions is that, generally speaking, the degree of effectiveness is proportional to the amount of down time. The more aggressive lasers, when more aggressive results are desired, generally have greater down time associated with them. I think of down time, as it relates to effectiveness, along a continuum. On that continuum, the least aggressive treatment with the least down time would be a series of light chemical peels designed to address minor skin blemishes, improve pore size, skin tone and texture using a “medium strength” peel – such as a trichloroacetic acid (TCA) peel.

Then, moving into lasers with even greater effectiveness and proportional down time, “fractionated” resurfacing techniques generally are at the lower end of the scale for lasers with regard to associated effectiveness and down time. These treatments are fairly aggressive but with less down time than the truly ablative resurfacing laser procedures such as CO2 laser resurfacing or Erbium: YAG laser resurfacing. The treatment you choose has to be very specifically designed to address your unique concerns while allowing your recovery to stay within your available timeframe for down time.
 

Laser skin resurfacing has been very effective at tightening skin and reversing sun damage. The gold standard is traditional resurfacing with a CO2 (carbon dioxide laser by Coherent , now Lumenis). The downtime can be 7-10 days on average. Most patients have rosiness to their skin for another 8-12 weeks. The results are beautiful causing a major improvement in sun damage and diminishment in wrinkles. (Answer to question # 2)
Since many people do not want to have so much downtime, physicians have been searching for an alternative that can give CO2 results with minimal time off. Other modalities have come about like erbium and fraxel but I have found the best results to occur with CO2. Last year I imported from Italy the Mixto laser. It is fractional, meaning a fraction of the energy is placed upon the skin. This allows the skin to heal much faster and with greater patient comfort. The beauty of it ( as well as some other lasers on the market) is that it can be tuned to your skin. I am able to perform a very light fast healing treatment or a more intense treatment which will have even greater benefit. If someone wants very little downtime they can have a series of treatments which can be additive. (Answer to question #1)
You can find out more about the Mixto and laser resurfacing at my website or on Youtube. Other lasers include:Fraxel Re:pair; Affirm, Dot, Active Fx.

Halo is an excellent option for patients seeking laser resurfacing with little downtime. The results are excellent for addressing sun damage and to improve the texture and tone of the skin. For deep wrinkles, a traditional laser resurfacing can provide an excellent result. Consult in person with an experienced and expert treating physician to understand your options.

The Alexandrite Laser is a resurfacing treatment that will work to quickly eliminate deeper brown spots, leaving the skin clear and youthful. Depending on the selected course of treatment, downtime can vary from two to five days—which can be customized to fit your schedule and your needs. This laser can be used on the face, chest, hands, arms and legs.The Sublative Laser is effective on all skin types and tones, Sublative rejuvenation is a deeper treatment that fights fine lines and wrinkles, eradicates acne scars, and improves overall texture. Sublative rejuvenation harnesses the power of energy currents to penetrate the skin and stimulate collagen production (while keeping the outer layer of skin intact). Depending on the selected course of treatment, downtime can vary from two to five days—which can be customized to fit your schedule and your needs.

A general rule of thumb is the better the results the longer the downtime. Microfractional CO2 laser resurfacing alone can smooth and tighten skin up to 60% and dramaticaly reduce pigment. Our patients are able to return to work in 7 days with a minimal powder makeup to cover redness. The neck area takes 2 additional days to be presentable and is usually covered by a silk scarf and the chest/decellotage area is covered by a closed blouse until day 14. If a patient needs deeper resurfacing  (up to 80% tightening)  on the lines aroud the mouth or eyes with Microfractional Plus,  (Sanding down ridges with a Scition Erbium laser first and then using the Microfractional CO2 laser to tighten and snooth), they wil need 8 or 9 days before makeup will cover the red. This make up will need to be used 3 to 12 weeks, but you are back at work durin this time

The results you get from any resurfacing procedure will depend on how aggressive the procedure was done.  This also directly correlates to healing time.  Sadly, this is a very confusing subject for patients becuase there are so many technologies out there along with a lot of mis-information.  The newer non-ablative treatments have minimal down time, but create minimal effects.  This is great for the 40-year-old who wants to liven up their skin.  If your problems are more significant, don't waste your money on non-ablative treatments.  Sadly, the physicians and companies that sell these machines are much better at marketing than they are at getting results.  Before and after photographs cropped down to small areas of the face and  taken with harsh angled lighting in the before and soft straight on lighting in the after should tip you off to phony results.  Absolutely nothing can touch the results of a standard ablative resurfacing in the patient who has signicant age and sun related damage.

The best of the new technologies available today are the fractionated CO2 lasers.  There are many brands and many of these will give the same results when set to similar settings.  These lasers really do open up an in-between world of very nice results with a managable healing course, even for busy people.  Don't expect to wipe away deep wrinkles, but here we have something that in one week of healing will provide very demonstrable results especially with sun spots and fine wrinkles.  This tends to be the best procedure for the typical mid to late 40-year-old, while conventional resurfacing is usually necessary for the person in their 50's and beyond.  The fractionated lasers are also useful on dark skinned people and other parts of the body besides the face.  Of course, everyone is unique and needs to be evaluated as such.