Does laser resurfacing hurt? Are you under anesthesia? Which is best for tightening?

In my opinion, the co2 laser is good for removing wrinkles. People who have wrinkles from a significant amount of sun damage do very well with the co2 laser. The Laser is painful as it ablates the skin. That means it vaporizes the tissue. Some physicians perform this procedure with intravenous sedation. Others use nerve blocks and oral and intramuscular sedation. I believe that there are other devices that work as well or better for skin tightening. These are radio frequency devices. Some are bipolar and some are mono polar. Lately we have had good results with microneedle radio frequency of the skin (infini) for tightening.Tightening of the midface is difficult with any device. Fillers are often used in this location. I hope this helps. Good luck.

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Ice pick scars DO NOT improve with laser resurfacing, they require lasers with TCA cross or surgery to improve them.  Yes resurfacing hurts but can be painless (see my videos) with the proper numbing, oral medications, cool air/ice packs, and nerve blocks.  Best, Dr. Emer.

Over the years, the experience gained with laser resurfacing has provided me with a comfortable technique.  Certainly under general anesthesia there would be no discomfort during the procedure, however I prefer a local anesthesia technique which when done expertly provides a comfortable patient experience.  Mild oral sedatives combined with local tumescent anesthesia and field block can do the trick.  The experience of the laser surgeon is important.Fractionated CO2 laser is excellent for acne scars, but expectations need to be tapered.  Some over 45 years of aged patients can also benefit from facelift in addition to the laser to further smooth out the deformities. 

In our office, we use compounded high-strength topical numbing cream applied under plastic for two hours before the procedure. With rare exceptions, this is well tolerated. We use the DEKA Smartxide DOT laser and have used it with just topical numbing, even at the highest fractional settings.

When it comes to tightening facial skin, i have often used
either the co2 laser or the modified phenol peel of the facial skin (hetter
peel). Both modalities yield excellent results. We have the pixel CO2 laser, by
Alma lasers, and I have been very pleased with our outcomes.