Can I Get Laser Resurfacing w/o Sedation?

the old fashioned-CO2 laser was too painful in my experience, for patients to have it done with the use of topical anesthetic cream and local anesthetic injecitons. intravenous sedation was very helpful to make them comfortable. i find the same with fractional ablative CO2 Fraxel Repair.  Fraxel Restore, however, only needs numbing cream.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Laser resurfacing can certainly be done without sedation if you want. The amount of pain that a laser treatment causes depends on the type of laser/planned depth of resurfacing. Topical numbing creams and/or injection of numbing medicine can be done in many cases.

I commonly perform deep fractional CO2 laser treatments without any sedation in the office.  I prefer to first place a topical anesthetic on the face for 45 minutes and follow this with nerve block injections to numb the entire face.  Lighter treatments can be performed under topical anesthetic only (a skin cream) but the results of the lighter treatment are not as good for fines lines and wrinkles as the deeper treatments.

Deeply penetrating skin lasers - such as the fractional C02 ( ex. smartskin)  can provide excellent rejuvenating skin resurfacing. They are most often performed after a topical anesthetic cream has been applied for 45 to 60 minutes.

Not all numbing creams are equal. Besides the active ingredients, the emollient  aids in the absorption.

With a good topical numbing cream, applied for the appropriate time - it would be exceedingly rare to need sedation. 

Depending on what laser is being used, and the patient's mindset, many resurfacing procedures can be done with local anesthetic.  Both oral and IV sedation can be used as well, but in my office, with the use of the Fraxel re:pair CO2 laser, we most often use topical sedation, nerve blocks and oral medications.

You can definitely get laser resurfacing without sedation. The local anesthesia used for laser resurfacing should be 100% effective so that there is no pain during the actual treatment.

The type of local anesthesia varies with the type of laser that is used for the resurfacing. In most of my cases resurfacing with the erbium laser, which is most often used to treat specific regions of the face, can be done using only a topically applied anesthetic. After each "pass" of the laser, additional anesthetic solution is applied, so that the numbness persists even into deeper layers of the skin. The carbon dioxide (CO2 ) laser, on the other hand, requires an injected anesthetic. This is true for both conventional and fractional CO2 laser resurfacing. In most cases the CO2 laser is used for resurfacing the entire face. Even for full-face CO2 laser resurfacing, most of the anesthetic injection is nearly painless (this is because tumescent local anesthesia is used). Most patients require no sedation with either type of laser.

Please keep in mind that I developed my methods of anesthesia over the past 16 years of performing laser resurfacing, with the goal of maximizing patient comfort during this procedure. Not all laser surgeons use similar methods of local anesthesia.

Absolutely !
We do several cases of fractional C02 per week on aggressive settings with proper blocks and tumescent anesthesia, and all patients tolerate well

The pain of laser resurfacing depends on the type of laser and the depth of the resurfacing.  I use a fractional erbium laser and microlaserpeels without sedation. We use a topical anesthetic applied for an hour before the procedure.

The deeper the penetration of the laser the better the results of the procedure, but the more painful it is.  If I need to use more depth, I do local blocks with lidocaine.

The pain involved in Laser Skin Resurfacing truly depends on the type of laser being used and the depth of the procedure. With the fractional Co2 Laser I typically use some type of anesthetic either topical, or via blocks, or intravenous. This is a decision discussed per each patient's wants and desires at their consultation appointment and
reviewed in the preoperative process. There are many options available for every patient. Pain tolerance differentiates from patient to patient and this is well discussed to meet each patients needs.