Laser Rejuvenation

By Stephen M. Schleicher, MD, Director, DermDOX Center for Dermatology

Laser resurfacing is characterized as either ablative or nonablative. Ablative resurfacing entails wounding of the skin surface. Lasers for this purpose are the CO2 and erbium:YAG varieties. During the ablative process the epidermis and parts of the dermis are removed resulting in improvement of skin texture, uneven pigmentation, and some correction of wrinkles. Downtime is significant, with marked redness and crusting lasting at least ten days. Scarring is possible, and the procedure is best not performed on more darkly pigmented individuals. Fractional ablative lasers break light into thousands of microbeams that bore tiny holes in the epidermis. The result is skin tightening of variable degree with less downtime. Healing occurs within six to ten days.

With nonablative resurfacing, the beam of laser light passes through the epidermis and stimulates new collagen production in the dermis. Downtime is nil with minimal redness. The results are often subtle and may not become apparent for weeks to months. A series of treatments are required approximately four to eight weeks apart. Periodic touch-ups are recommended.

Intense pulsed light (IPL) uses non-laser light to improve pigmentation, reduce unsightly blood vessels, and even smooth texture. This too is a nonablative technique.

With the latest technique, nonablative fractional resurfacing, the laser creates so-called micro-thermal zones of controlled skin damage. Mildly photodamaged skin usually improves with this technique, but deeper wrinkles do not.