Almost no improvement in fine lines after laser resurfacing after 4.5 months

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

"I suggest reaching out to an expert for a formal consultation. I like to recommend my patients start a combination of facial rejuvenation treatments.

1) Skincare with products and microneedling/PRP
2) PDT Light Therapy a few times per month with growth factors
3) Laser treatments like Clear + Brilliant regularly and others (Fraxel, Moxi, Viva, CO2, Erbium, Halo) a few times per year
4) Sculptra injections a few times per year for collagen production with fillers like Juvederm, Restylane, Belotero, Radiesse, and/or Bellafill
5) Thermage/Ultherapy for yearly skin tightening with or without PDO or cone-based Instalift threads for lifting
6) Botox every 2 to 3 months to stop movement lines and prevent lines at rest

Best, Dr. Emer."

At 4.5 months,  you should be close to your final result. With a combination treatment, there should be significant improvement in lines and wrinkles. I would recommend returning to see your board-certified plastic surgeon or dermatologist to assess your results, and determine whether a repeat treatment, or additional modality is necessary.  Best wishes. 

I'm sorry that you're not happy with your results. Often times these fractionated/combined therapies take multiple rounds of treatment to see significant benefits. 

In my practice, I use ablative lasers more because the results are more substantial. The recovery can be more protracted but none can argue with the results. 

I would recommend returning to the plastic surgeon who performed these to make sure everything was performed as discussed. Communication is key and you have to be realistic with the expectations of the treatment. 

Hope this helps and God Bless!



Dr. Robb

In order to achieve full correction of fine lines and wrinkles, in my experience, full ablative erbium laser is needed. While the temporary deformity can be more severe with fractional laser the healing time is similar. if you are looking for a really dramatic change, and have skin type 1-3, I'd recommend you take a deep breath and consider ablative rather than fractional erbium resurfacing.
Full ablative erbium differs from fractional in that the entire surface of the skin is treated as opposed to a small fraction of the surface area. While the power you were treated with may have been high, if the percentage of surface area treated was low, it is unlikely that you will see much difference. 

Laser resurfacing treatments generally help with tone /texture, brown discoloration ( dyschromia)  , acne scars and wrinkles (many lasers are FDA approved for the latter 3 reasons) . At 33 years old, ( without pictures provided)  I can not imagine you have much sagging skin. Sagging skin is a condition that laser resurfacing will not help, since it does not penetrate into the deeper layers of the dermis..   The resurfacing process helps soften wrinkles but can never eliminate them . The power /settings used on the laser is usually a direct correlation with the outcome . Lip lines (smokers lines) improve minimally with even very high laser settings , so it is best to keep expectations low for peri oral improvement. In general , laser resurfacing will reveal much more dramatic effects on individuals who have more pre existing needs. Your condition of fine lines, young age and possibly highier expectations of what the laser can provide may have been a recipe for a disappointing outcome. 

Fractional ablative laser at appropriately high settings should reduce fine wrinkles and sun damage. Deeper wrinkles may require more than session. Folds of skin can not be eliminated with laser resurfacing. CO2 fractional ablative resurfacing at moderate or aggressive settings (according to skin type and other factors) is extremely gratifying for patients after just one session. Photographs are important to check progress with wrinkles and sun damage. Collagen neo-genesis and remodeling continues for 6-12 months. It is important to follow up with your doctor so that he/she may be aware of your results at particular settings with the particular laser used. Your doctor can give you explanations that are most accurate for your situation.
Lasers can "turn back the clock" to some extent, but they will not stop the clock from ticking. It is important to have healthy habits with regard to eating, sleeping, and skin care. For example, if you have a laser treatment and then return to smoking, sun-bathing, or other not-so-healthy habits, your skin will deterioration to pre-laser status rather quickly.
Best wishes.

I agree that fully ablative laser resurfacing will give the most predictable results. Results from your combination treatment will depend on the settings of the laser, importantly power and density from your erbium. If there are significant lines, sun damage and laxity, I often also combine erbium and a fractional CO2 laser. The explanation will lie in how the procedure was performed, and the severity of your sun damage. Additionally if mild to moderate settings are used, a series of 2-3 treatments are needed if fractional lasers are used.  All the best, Dr Davin Lim. Brisbane. Australia.