Can CO2 laser help with skin tightening? (Photo)

Question

I've been noticing very mild skin laxity (a fallen brow and deeper creasing around my mouth/dynamic lines/a). I'm 37. I think eventually I would need a face lift since it seems to be the gold standard, and I use Dysport to address the lower brow. However, I'm interested in laser to tighten up my jaw. Could C02 laser tighten skin? I tend to hypertrophic scars so I can't do micro needling.

Jason Emer, MD · Answer

In our practice, we use the CO2 laser for many different applications such as skin rejuvenation or to treat acne scars. It helps tighten the skin, reducing the appearance of wrinkles. We also employ treatments such as microneedling RF to tighten the skin as well.

Raffy Karamanoukian, MD, FACS · Answer

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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

A full-face photo would have been additionally helpful. However, from the photo provided, these appear to what have been called  parallel laugh lines or lower facial "accordion" lines--i.e. lines that typically are located parallel to the mouth in the lower face and become more pronounced with smiling. Even if microneedling were possible, there is little chance that it would have been successful at all, since its primary value is for treating superficial, surface color and textural irregularities and is of little value for deeper lines or for lines that arise from the dynamic motion of the underlying muscles of facial expression. (As an aside, and for the benefit of other readers of this response, there is especially little benefit from RF microneedling, since the RF, due to the heating of the skin, primarily adds to the expense and to the risks for adverse reactions). Ablative lasering  is an aggressive for skin ablation and is akin in its effects and risks to old-style dermabrasion and, ill-advised in a person with a tendency to hypertrophic scar formation.   
The use of an appropriately low viscosity, cohesive, malleable filler fanned properly and in the correct directions beneath the accordion lines can work quite well for this condition. I have been using this approach with satisfying results for quite a few years already. You would be wise to make sure to consult an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

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