Spot Treatment with Laser Resurfacing

Heard that laser resurfacing is a better long-term solution than Botox or Fillers for deep wrinkles and creases. Is this true for the person who has only a small area they want spot treatment on (such as crows feet)?

Doctor Answers 13

Spot Treatment of Crow's Feet Wrinkles with Laser Resurfacing

Laser resurfacing can be a great option for improvement of deep lines and wrinkles in select patients who do not wish to undergo surgery or who are not surgical candidates. By my philosophy, the primary purpose of improving lines and wrinkles is to provide a balanced, more youthful look without looking "done".

Fractional laser resurfacing as performed at our facility uses the CO2 Ultra Pulse Encore to improve deep lines and wrinkles as well as improve skin surface color, tone and texture, for comprehensive, long lasting improvement. For most patients combining TotalFX or MaxFX treatment with Botox, facilitates even better post-treatment results.

Often, deep lines and wrinkles look more prominent as a result of poor texture and color irregularities (dyschromia) in the skin. I  discourage "spot treatment" laser resurfacing because you treat an area and the adjacent region looks starkly different in comparison, lending to an unbalanced look.

Consult with a cosmetic surgeon or dermatologist in your area, who can examine your skin, and determine what the best treatment options for you are, so you can choose what works best for you.

Seattle Otolaryngologist

Laser resurfacing is a more long-term solution for some wrinkles

It depends on the type of wrinkles you have.  If at rest, without smiling, you have crow's feet and lower eyelid lines, then laser resurfacing would be a great option as Botox will not do anything for lines at rest.  Lines at rest  are ingrained in the skin from years of smiling and sundamage.  Botox only paralyzes the muscle under the skin so inhibits dynamic lines which are created when you smile.  Now certainly with time, repeated Botox may soften some of the ingrained lines but will not eliminate them as they are "ironed in" so to speak.  Now, provided that you have taken care of your skin and you have a very even skin tone with no pigmentation issues from years of sun, you can "spot" laser just the lower eyelids and crow's feet and achieve great permanent wrinkle removal/reduction.  If you have photodamaged skin, however,  I wouldn't advise "spot" laser treatment because once that area is lasered you will have beautiful new skin in that area without photodamage or wrinkles and you will see a clear delineation between the lasered area and non-lasered area.  In this case, you should have your entire face lasered.  I often will perform aggressive CO2 fractionated laser resurfacing of the lower eyelids and perform a much milder laser treatment on the rest of the face, aimed at evening up the pigmentation so the 2 areas blend together.  There is no need to be aggressive on the rest of the face unless you are tackling wrinkles as well. What this means is your face will heal very quickly 3-4 days, but your eyelids will take up to 7-10 days to completely heal.  By the way, there is no way to get rid of ingrained wrinkles without at least 7-10 days of downtime.  It doesn't matter what technique you use-laser or chemical peel!  The depth of injury required to get rid of wrinkles will require that long to heal.

Carla R. Retief, MD
Nashville Dermatologic Surgeon
3.7 out of 5 stars 6 reviews

Crows feet treatment

As usual, it depends on what your skin looks like. If the texture and color is good and the only problem that you have is crow's feet I would go for the Botox or Dysport. I do not think that "spot treatment" is a good way to do laser and do not think that it would do well for your problem , as explained. 

Jo Herzog, MD
Birmingham Dermatologist
5.0 out of 5 stars 18 reviews

Laser resurfacing is likely not a better solution

I am not sure what type of laser technology you are considering but, sure, laser resurfacing can be used for periorbital wrinkles/"rhytids" but the results would more likely be underwhelming and carry a higher risk of complication. 

Treatment of crows feet is predictable and safe using Botox +/- fillers.  Laser resurfacing is more predictable for finer lines/ texture and for color irregularities, though any result would certainly be longer lasting.

Connor Patterson, MD
Baton Rouge Dermatologist

Laser resurfacing is not a permanent treatment for lines caused by muscle movement.

Laser resurfacing is not a permanent treatment of lines caused by muscle movement.  I get the best results on by doing both laser resufacing and Botox if the wrinkles are moderately sever and located in areas where there is also sun damage.

Mark Taylor, MD
Salt Lake City Dermatologic Surgeon
4.2 out of 5 stars 18 reviews

Laser a Long-Term Solution

Laser is definitely a better long term solutuon for wrinkles. The problem is spot treatments can leave you looking uneven. I suggest the erbium or CO2 fraxel and always do at least an entire aesthetic unit and not a spot. 

Richard Galitz, MD, FACS
Miami Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Best treatment depends on extent of wrinkling

Maybe, it depends on the extent of the wrinkling and the condition of the skin. Oftentimes, if there is extensive photodamage elsewhere, it is better to resurface the entire face. Non-ablative fractional lasers are another way to improve deep wrinkles and works well in conjunction with a neuromodulator like Botox or Dysport as well as skincare products like TNS from SkinMedica, Tensage from Biopelle, Neocutis or Elastoderm from Obagi Medical Products. 

Mitchel P. Goldman, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 25 reviews

Botox is a bettter treatment for Crow's feet than laser

When wrinkles and photodamaged skin are in static lines, in other words, when the wrinkles are present in skin that doesn't move with underlying muscle action, laser resurfacing can provide a long term improvement.  Mimetic lines are those wrinkles created by the pleating of the skin over the contracting muscle such as the crows feet or the upper lip vertical creases/smokers' lines.  Botox is more effective in these areas because it eliminates the cause of the wrinkle. Unfortunately Botox only lasts about four months and the lines returen when the muscle starts moving.  As muscle movement is not a concern in the cheeks, nose, chin and other areas, laser resurfacing is more practical because the good result is not going to wear off quickly because there is no muscle movement that will start to suddenly occur.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 37 reviews

Botox versus laser

Anything you read in this day and time recommends combination treatment. We really recommend a consultation to look at your skin and specific problems. Botox is going to do great for those dynamic lines used in facial expression. Resurfacing is actually going to help the skin itself and re-build collagen. So they both work in different ways for different problems. Depending on exactly what patients expect...both may be the option!

Tracy Kuykendall, MD
Tulsa Dermatologist
4.3 out of 5 stars 6 reviews

Botox and Laser Resurfacing

Botox addresses the underlying muscle movement that causes the wrinkle, the resurfacing addresses the loss of collagen in the skin.  Thus, both are integral to optimizing your outcome.  Ideally, combining resurfacing of the wrinkle, and Botox provides the best results. 

Sonia Badreshia-Bansal, MD
Bay Area Dermatologist
3.9 out of 5 stars 12 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.