Is my skin ruined forever from co2 laser?

Thank you for your question. I understand you underwent erbium and CO2 laser about four weeks ago, and now you’re concerned your skin is ruined because it is now leathery, shiny and bumpy.

To first give you a bit about my background — I’m a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have used the CO2 laser, erbium laser and fractional CO2 laser in my practice over this time as well.

Now, when it comes to wound healing, there are four phases: the hemostatic phase, inflammatory phase, proliferative phase and wound-remodeling phase. At the time that you submitted your question, which is four weeks or one month after the procedure, you’re at the proliferative phase. The proliferative phase is the phase where a lot of blood supply and collagen are being formed.

In the mid-90s, when the CO2 laser was first introduced, it was not unusual for someone to have fairly intense redness that lasted for months. In your case, it is possible that the indication for you had to be aggressive, which is why you’re seeing these symptoms.

In some cases, it might seem like there is excess redness or excess bumpiness, and this is the art of medicine - what may seem excessive to one doctor, may seem expected to a more experienced doctor. There is also often a challenge when it comes to reviewing photos because the situation can sometimes look worse in photos than they do in person, perhaps because the reds tend to be more intense and look more vivid than they do in real life.

You can modulate some of that inflammation with the help of topical steroids or other modalities such as platelet-rich plasma (PRP), which can really diminish a lot of the initial redness. But in the absence of a proper physical exam, it’s hard to say whether or not you are suited for it.

I recommend that you meet again with the doctor who performed this procedure and tell them your concerns about your results. Your doctor should be able to tell you if this is normal healing or not, and if there is unusual inflammation, then they should be able to recommend a topical steroid to help. In rare cases, redness can also be a sign of infection, but that is not necessarily the case, especially if someone is watching over your progress. Keep in mind however that based on these photos, you will get a lot of conflicting opinions from different doctors, should you seek their advice, so you have to be sure that you aren’t being over treated.

I hope that was helpful and I wish you the best of luck!

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Your skin will continue to improve. I would suggest Plato's Scar Serum twice daily followed by Vbeam laser, Clear and Brilliant laser, and massage. 

Best, 
Dr. Karamanoukian
#Realself100 Surgeon

I performed this procedure 6 weeks ago. Erbium laser using Scition 20 microns dialled in 10 hz, no coag. Very quick passes to the area, down to mild pin point bleeding- upper dermis. Then swapped to CO2 5% 80 mj, 3 passes, moved quickly and revisited the area 3 times. Very conservative IMO. No pulse stacking. Blended surrounding area with erbium only. No coag. Just another walk in the park procedure. 

Aborted Co2 Fractional to other areas as had evidence of melasma during procedure, swapped to 1927, conservative 10 mj 6 passes, followed by HQ 5% 8 days later to prevent rebound. 

Patient loss to follow up apart from photos. Ideally I see all my patients until COMPLETE healing is achieved. Completely agree with Dr Emer's comment. I performed the procedure, and I should be responsible for follow ups including methods to reduce scarring (if evident on clinical examination). Ideally patients should be followed up by their treating Specialist- this is how we ensure best patient care. 

Catrealo9, If you could come back for an examination, I am sure a treatment plan can be initiated for best outcomes. All I have are emails and low res. photos. 

I appreciate your postings online, but remember, I fix other patients problems, including mine- however a visit will be appreciated. 

Door is open for you... just need to open it. 

Warmest regards

Dr Davin Lim 
Laser and aesthetic dermatologist 
( to date with an excellent reputation for patient care and satisfaction - bar one!)

It looks as if you may have hypertrophic scarring or hyperpigmentation caused by the laser, I would suggest a formal consultation with an expert to begin wound healing treatment. Best, Dr. Emer