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Patient Brochure
The Laser Resurfacing is an ablative fractionated laser procedure. A laser resurfacing could be
described either as superficial or a deep ablative. The term ablative is indicating that the laser
beam penetrates into skin layers, breaking its entirety while punching it in multiple micro-holes.
Depending on the energy density the ablation depth can range from affecting upper epidermal
layers only to deep to the layers of the dermis. The meaning of ‘fractionated’ presumes so that
the laser radiation is delivered in portions and with the help of a scanning attachment (the head)
the ablative micro perforating holes in which skin layers evaporate, are applied to the skin. These
micro-holes are applied with a certain density, consistency, and intensity.
The superficial resurfacing (ActiveFX *) removes epidermal pigmentation resulted from sun and
photo damage. It is often; as such resurfacing is being described as a laser peeling with an
emphasized effect on the skin surface. Performed, it effectively removes epidermal melasma,
sun-induced pigmentation, brightens the skin as overall, and could also smooth out any fine lines
around the eye area. As with the superficial resurfacing the laser ablation is done over a
relatively large focal spots (up to 1.3 mm) yet, remaining within the epidermal level. The
recovery process hence is shortened, unlike as with the deep ablative laser resurfacing.
As with the deep CO2 laser resurfacing (DeepFX*) effectively and durably are being removed
and corrected any fine lines, medium to deep wrinkles, acne scars, as well as stretch marks and
scars resulted from coarse correction burns, surgical intervention or any other causes. The laser
operator works within higher power densities while treating smaller (less than 0.150 mm) focal
spots unlike the superficial resurfacing. At the time of vaporization the surrounding healthy
tissue shrinks due to a thermal coagulation retraction of the dermal extracellular matrix formed
around and each ablative channel. All cellular and extracellular structures evaporate at the center
of each ablative channel, while the formed cavity is being immediately filled with exudation
plasma. While in the process of epithelization new connective tissue (collagen and elastin)
structures are being synthesized and stimulated to correct and restore surface structure and
volume of all treated skin area. Deep lines, wrinkles, any acne scars, as well as stretch marks
appear visibly smoothed and narrowed with just the very first procedure. In cases of deeper scars
and persistent wrinkles the procedure is being repeated with the applied working ablative dose
adjusted at the discretion of the physician.
Patients generally feel a burning discomfort during and after the procedure yet, it is usually well
tolerated as no anesthesia is being required. The feeling straight after the procedure resembles
sunburn like sensation and subsides within two hours. This particular method gives a low rate of
complications, although, since a violation of the skin integrity (ablation) is present there is some
risk of subsequent infection (impetiginisation). However, risks of side effects are thoroughly
minimized as with the new laser systems operating now on smaller focal spots and short pulses.
When using RF CO2 laser aroused sources deep ablation is being achieved through lower energy
densities in narrowed ablative channels, thus allowing greater density of perforation, and
respectively one more efficient resurfacing with a shortened recovery time. A rejuvenation effect
of a deep laser resurfacing occurs immediately after the very first session - skin wrinkles, fine
lines and other imperfections are visibly smoothed. It is reported skin tightening and largely
eliminated superficial pigmentation, dishromia, as well as most of the visible capillaries. The
rejuvenation results post a well-performed resurfacing could be defined as rejuvenation for the
following at least 5 to 15 years. Once a deep resurfacing is being administered, afterwards a
superficial laser resurfacing could be also performed, in order to permanently remove any
leftover pigmentation or any slight residual pigmentation hues resulting from the selected deep
resurfacing ablative micro-holes. The effect of the procedure is permanent and largely reduces
the appearance of new wrinkles. After a few years another procedure can be performed to
enhance the rejuvenating effect. Upon removal of severe acne scars several procedures are
usually held every other month. A laser resurfacing procedure is done during late fall and winter
season (pls., note: at the end of month of March the procedure is no longer recommended until
next fall season).
* ActiveFX, DeepFX са запазени марки на фирмата Lumenis Inc.
Conduct of Recovery and Care for the Treated Area:
Conduct of Recovery and Care for the Treated Area: Immediately after treatment the scanned
area fades due to vasoconstriction and vascular obliteration in partial areas around the zones of
ablation. Subsequently, there is a pinkish coloration or redness of the treated area noted, with
mild to moderate plasma exudation, as well as some punctate bleeding on the spots where an
ablative channel has punched a large capillary vessel. There is, at this early stage, some
uncomfortable burning sensation and tension due to some moderate edema, which can be
reduced by locally applying cold compress in the first few hours after the procedure, is done.
Prevent the area from getting wet. It is possible, so a more expressed swollen reaction would also
arise further - usually after the first few days. It is desirable at that time to limit intake of any
salty foods as well as alcohol, in order to reduce the edematous response in areas with loose
connective tissue - around the eyes and upper cheeks. The treated area tends to form crusts
(scabs) after the first day. During the first week it is recommendable using epilotonic and
hydrating fluids, physician prescribed. Crucial are first three days post procedure. At the end of
the first week formed crusts start to peel off. After the second day post procedure moisturizing
emulsions (i.e.Eudermol 0) can be applied if appointed by the doctor to soften the formed crusts
yet, skin should not be scrubbed but lightly tapped with a gauze pad. Self- attempts to
mechanically remove the crusts shouldn’t be made. When at the end of the first week crusts start
to peel off by themselves the area can be splashed with lukewarm water then, gently tap-dry.
Again, an epilotonic and/or a hydrating cream is applied gently; once all crusts are permanently
off the area can be washed with lukewarm water as with no soap and afterwards must be treated
with moisturizing cosmetics. After crust removal the reconstructed area is appearing smooth and
slightly pink in color with a subtle ablative perforation pattern which usually resolves within two
to three weeks disappearing gradually and completely after a month. The residual laser ablation
pattern clears off and smoothens. During this period treated area could be easily masked by
slightly adjusting light makeup. After the procedure is done, the overall treatment effect keeps
increasing during the following four months due to the organization of newly synthesized
collagen. During that period, the treated area should be kept replenished with medical cosmetic
products, applying rigorously appropriate topical photo protection with SPF50. It is suitable
using a silicone-based facial cream for at least six weeks..
Worldwide dermatology practice recognizes the CO2 fractionated laser resurfacing as the ‘gold
standard’ as being the most effective therapeutic and cosmetic treatment. Disadvantages of the
method are associated with the need of a one-week recovery period post ablation, and the
possible complications. The widely promoted recently developed methods for non-ablative laser
rejuvenation where the patient can be carried out without any interruption from the social
environment are considerably less effective - even though after performing multiple sessions.
The tension (lifting) of the skin, as well as the polishing (resurfacing) of the skin after a deep
ablative laser resurfacing is due to two reasons:
- The coagulation shrinkage of dermal extracellular matrix in the area surrounding the ablative
channels- which is easily seen by the visual skin tightening during the actual scanning process, as
well as straight immediately post the laser procedure;
- A formation of new collagen in the already shrunk dermal mariks; stimulation of collagen
synthesis in the ablative holes during the first weeks as well as organizing and modifying the
collagen in the following four months.
A visible rejuvenating and smoothing skin pattern is established straight after the very first
procedure and has a profound and lasting effect. Since after undergoing treatment skin shrinks,
there shows a manifested tightening (facelift) effect which boosts the overall remodeling and
rejuvenating look as a whole. Unlike surgical face lift which pulls skin wrinkles away, a
resurfacing procedure tightens the skin and renews its entire volume. The numerous connective
tissue ablative holes serve as one reinforcing skeleton that keeps skin tight while ensuring a
lasting rejuvenating effect from a CO2 laser resurfacing procedure. Such laser resurfacing could
be combined with other aesthetic surgical procedures such as for example: a facelift, hyaluronic
fillers or Botox. It is desirable so such supplementary procedures be performed after the
resurfacing procedure to help in correcting deep expression frown lines. Also, it is not
recommended combining a deep laser resurfacing with a dermoabrazio procedure because of the
adverse effects arising from improper dermoabrassion, and may actually distort the real laser
resurfacing outcome.
Early and Late Reactions. Limitations and Risks Associated with the Procedure:
A laser resurfacing with a CO2 laser is an ablative procedure, and thus emergence of any
temporary swelling and crust formation tend into leading to patients’ discomfort in their
appearance, hence, it is better for the patient being away from work and their social environment
for up to two weeks. This is especially true when performing the resurfacing over the entire face.
When only limited areas of the face are treated and then appeared to be swollen, the formed
crusts in the treated area can be masked with makeup thus adjusting the patient of not being
detached from their social environment, if necessary. Usually on the drier skin types edema is
somehow slighter.
Unsatisfactory result: The procedure may turn out to be ineffective enough, and should be
repeated with different parameters - depth and density of ablative channels. .
Hyperpigmentation: it may show up to two months after epithelisation. It occurs more
frequently among patients with darker skin (types III and IV by Fitzpatrick) when the treated
area is being exposed to sun during the recovery period, and/ or when administered topical
retinol products. Before administering a resurfacing it is required so any use of vitamin A /
retinol / in facial cosmetics to be stopped completely in order to prevent further appearance of
unwanted pigmentation. Any aroma fragrances, perfumes, cosmetic products and facial
cosmetics containing perfumes should also be avoided during the whole recovery period for at
least two months after the laser procedure, since those may induce photosensitivity reaction
hence inducing pigmentation of the skin treated. Hyperpigmentation occurs rather compulsory
after visiting a tanning bed during first few months after the procedure. Strictly avoid exposure to
direct sunlight for at least three months after the procedure. It is especially risky visiting ski
resorts. During this period any outdoors stay requires applying sunscreen with a high SPF 30/50.
Depigmentation (bleaching): Such adverse reaction is more common to IPL photorejuvenation
procedures or photoepilation where an overdose destroys epidermal melanocytes in a large
degree. Usually such side reaction occurs when an IPL treatment area has been additionally
damaged after increased sun-tanning pigmentation. Rare and temporary condition after a deep
laser resurfacing. Physical fractionated equipment damage melanocytes in very small areas - in
the spots of ablative wholes (0.1 to 0.15 mm) as the surrounding epidermis remains intact.
Depigmentation may rather occur in an overdosed superficial laser peeling which generally
works with large-diameter focal spots (0.3-1mm). In very few instances, this kind of side effect
may occur if followed a more pronounced diffused infectious process (impetiginization).
Edema: Prevention and reduction of swelling immediately after the procedure requires applying
cooling packs. It is desirable to redo those at home few hours after the session. Prevent the
treated area to remain dry. Swelling is common especially around the eyelids, upper cheeks, and
forehead. It goes away for a few days. Most often, a significant swelling may occur during the
first three days post procedure. The swelling is less if in those days the patient sleeps with a body
position reclined. Avoid use of salty foods and alcohol!
Herpes: This manipulation may induce an appearance of herpes simplex eruption, especially
when treating the perioral (around the mouth) area in patients with underlying infection. For
prevention purposes, various anti-herpes products (i.e. Acyclovir, Izoprenozin) can be assigned
several days before the manipulation..
Impetiginization: While in some rare cases it may be a considerably severe inflammatory
reaction, it needs to be managed promptly. Listed above side effects are typically related to an
infection of the treated skin area. Prophylactically, topical antibiotic ointments and/or powders
are to be applied, and in case of a suspected or present infection an orally taken antibiotic with
marked skin accumulation (Azithromycin) can be assigned.