How can I improve my skin issues? (Photos)

Question

Hi I had a mini face lift and core ”laser 2.5 years ago the redness and ongoing fat loss I did have a fat injextion 1.5 years ago and have tried to manage the skin pain with boosters and fat loss with 3ml filler however no treatments for a while now and I’m loosing so much tissue

Anna Chacon, MD, FAAD · Answer

I’m sorry you’ve been dealing with this for so long. It sounds incredibly frustrating to go through a facelift and laser treatment expecting improvement, only to be left with ongoing redness, pain, and the feeling that you’re continuing to lose facial tissue.

Based on what you’ve described, I would think about three separate issues rather than one single problem:

Persistent redness
Skin sensitivity or pain
Progressive facial volume loss

The redness lasting 2.5 years after a CO2-type laser is longer than I would typically expect from normal healing. Some patients develop chronic post-laser erythema, where the superficial blood vessels remain persistently dilated. This can be worsened by sensitive skin, rosacea, over-treatment, or repeated procedures performed while the skin barrier is still compromised.

The skin pain is also important. When patients describe burning, stinging, tenderness, or discomfort long after a laser procedure, I start thinking about neuropathic irritation or a chronically inflamed skin barrier rather than simple redness alone. Treatments marketed as “skin boosters” may provide hydration, but they often do not address the underlying vascular or nerve-related component of the problem.

Regarding the fat loss, true ongoing loss of facial fat 2.5 years later is less likely to be caused by the laser itself continuing to destroy tissue. What often happens is that:

postoperative swelling fully resolves,
collagen remodeling changes the way light reflects on the face,
weight fluctuations occur,
fillers gradually dissolve,
and age-related volume loss becomes more noticeable after surgery because the skin is tighter and less able to camouflage underlying volume deficiency.

A fat transfer performed 1.5 years ago may have only partially survived, which is unfortunately common. The fact that 3 mL of filler improved the appearance temporarily suggests that at least part of what you’re seeing is volume deficiency rather than active tissue destruction.

If this were my patient, I would be cautious about continuing to chase the problem with repeated fillers or boosters alone. When the skin is chronically red and painful, adding more injectable treatments can sometimes create additional inflammation without solving the underlying issue.

A more systematic approach would usually include:

Careful assessment for persistent vascular redness (often treated with vascular lasers such as pulsed dye laser or KTP laser rather than additional resurfacing).
Evaluation of the skin barrier with a very gentle routine focused on barrier repair.
Assessment for rosacea or neurogenic inflammation, which can sometimes appear or worsen after laser procedures.
Determining whether the apparent fat loss is localized, symmetric, progressive, or stable by comparing standardized photographs over time.
Considering structural volume restoration only after the skin has been stabilized.

One thing I would strongly avoid is undergoing another aggressive resurfacing laser in an attempt to fix the redness or texture. In someone with persistent erythema and sensitivity for several years, additional ablative laser treatment could potentially worsen both symptoms.

The encouraging part is that persistent redness and discomfort can often improve even years later when the correct underlying cause is identified, and facial volume loss can usually be addressed in a much more targeted way once the skin is calm. The key is to stop thinking of this as a single cosmetic problem and instead separate the vascular, inflammatory, and structural components, because each of those responds to a very different type of treatment.

Laser Skin Solutions - Portland · Answer

Dealing with persistent redness, chronic skin discomfort, and ongoing tissue or fat loss years after surgical and aggressive laser interventions can be deeply distressing.
As an advanced licensed aesthetician at Laser Skin Solutions - Portland, I frequently consult with clients navigating complex post-procedure complications. When a patient experiences prolonged inflammation, compromised dermal integrity, and volume depletion following procedures like a mini facelift and core laser resurfacing&mdash;especially after attempting management with boosters, fat injections, and dermal fillers&mdash;a cautious, regenerative strategy is required.
Key Considerations for Long-Term Post-Procedure Recovery:Calming Chronic Inflammation: Persistent redness and skin pain indicate that underlying inflammatory pathways or vascular reactivity may still be active. Moving away from aggressive modalities and focusing on barrier repair and gentle, anti-inflammatory protocols is critical.
Addressing Tissue and Volume Deficit: While dermal fillers and prior fat grafts offer temporary volume restoration, structural tissue loss often requires addressing the overall health and vitality of the extracellular matrix. Regenerative aesthetics, such as Platelet-Rich Fibrin (PRF) or specialized microneedling modalities performed with strict parameters, can sometimes help support collagen synthesis without placing undue stress on fragile skin.
A Customized Corrective Plan: Because every healing response is unique&mdash;and aggressive interventions can sometimes exacerbate laxity or sensitivity&mdash;a personalized, step-by-step evaluation is essential to avoid further trauma.
If you are struggling with long-term recovery issues following facial surgery or resurfacing, scheduling a professional consultation with an advanced licensed aesthetician can help provide a safe, structured path forward.

How can I improve my skin issues? (Photos)

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