All about laser skin peeling (laser resurfacing)

When talking about laser skin peeling or laser skin resurfacing, there are two different uses for it. One is to remove, and thereby renew the skin surface. The other is to stimulate the skin’s deeper layer to tightening.

However, in order to not get confused, we have divided these two treatments in two different pages. This page is about laser skin peeling/laser skin resurfacing, which remains as the method that removes and rejuvenates the skin’s surface.

If you want to know more about the other method, where the laser is used to tighten the skin, you should visit our page about laser skin tightening (shortly.)

Removing the outer skin layer

There are three established methods for skin removal. The first two are dermabrasion and chemical peels. Laser skin resurfacing is the third and last method, and has basically replaced the other two.

A laser skin resurfacing treatment involves the creation of a controlled burn. To do this with great precision, the laser that is used adds the right amount of heat energy in the right place. It basically works like this:

  1. During treatment, a nozzle is used which set offs laser pulses. When a laser pulse hits the skin, a rapid heat development occurs. The heat heaths the water in the skin so it is vaporizes along with the tissue.
  2. For each laser pulse that is set off, a thin layer of the skin is removed. Therefore, by passing the same area several times, the practitioner may decide how deeply he/she wants to go
  3. The body will perceive the treated area as burns and therefore will activate the healing process. A new healthy skin is built up and replaces the old one.

Renews and rejuvenates the skin’s surface

Laser skin peeling is used the same way as other methods such as peeling and skin resurfacing in order to remove defects, renew aging and sun damaged skin. The warmth and healing stimulates also the skin’s deeper layers and gives a certain skin tightening.

Laser skin peeling can be performed on both the body and face. Examples of popular treatments areas are:

  • Full face for a comprehensive rejuvenation of facial skin
  • Around the eyes to remove age-related wrinkles
  • On the cheeks and chin to reduce acne scars (fractional laser)
  • Around the mouth to get rid of smoking wrinkles
  • On stretch marks to improve the skin colour and texture of the surface (fractional laser)
  • The décolletage to rejuvenate sun-damaged skin (only fractional due to risk of scarring

Laser skin resurfacing is often performed as an option to surgical face lift where the light tightens the sagging skin while laser skin peel rejuvenates the surface

Ablative laser skin resurfacing removes all skin, fractional leaves

Laser treatments that remove skin are called ablative laser treatments. An ablative laser treatment can in turn be fully ablative or fractional which is known as Fraxel.

A fully ablative laser skin resurfacing, just like dermabrasion and deep chemical peels removes 100% of the skin surface on treated area. Fractional laser treats the skin with micro-point sized dots, leaving untreated skin left between the channels for a faster recovery.

For more information on laser technology and function, please visit our page about cosmetic lasers.

There are two different laser techniques used for laser skin peeling. The oldest of these methods is carbon dioxide laser (CO2) and the newer Erbium YAG laser (Er: YAG). Both of these works at a wavelength (colour) seeking water molecules in the skin’s surface.

Fully ablative laser skin resurfacing – a powerful one time treatment

A fully ablative laser skin resurfacing of the skin removes all skin in the treated area to a depth of 0.2 to 1 mm. The treatment is powerful and provides after healing a whole new layer of skin.

The ideal patient for a fully ablative laser skin resurfacing is a person with relatively light skin that wants to remove superficial wrinkles on the face.

Here are some key facts in point form:

  • Ablative skin resurfacing is a good option for removal of superficial wrinkles. It is also often offered as a treatment to smooth out uneven pigmentation, which it also does. However, it is common that uneven pigmentation come back after being treated.
  • The difference between the older CO2-technique and the newer ER:YAG is that the heat from CO2 has a tendency to overheat the tissue. This damages the pigment cells, which in turn leads to hyperpigmentation. ER:YAH is therefore preferable for ablative skin resurfacing.
  • The benefits of ablative ER:Yag skin resurfacing compared to deep chemical peels are primarily the reduced risk of pigment loss.
  • The benefits of ablative laser skin resurfacing compared with demrabrasion is that the laser is easier to use, which reduces the risk of going too deep into the skin.
  • Normally, you get good results after only one treatment with fully ablative laser.

The increased risk of damage to the pigment cells of the skin and to some extend the risk of scarring followed by overheating are strong arguments for choosing Er:YAG instead of CO2 for a fully ablative laser resurfacing.

Fractional laser resurfacing – a softer option that requires multiple treatments

The fractional laser technique was developed by the company Solta Medical and appears under the name Fraxel-laser.

The purpose of this technique is to keep the results from the fully ablative laser while minimizing the discomfort associated with it. Therefore, parts of the skin in the treated area are removed. Also, here from 0.2 to 1mm in depth.

The fractional laser can treat just as effective as the fully ablative, but sice it only removes some parts of the skin (20-30%) it requires (3-5) fractional laser resurfacing treatments to achieve the same results as in one fully ablative treatment.

A suitable patient for a fractional laser resurfacing is someone who wants to reduce superficial wrinkles or acne scars and who accepts longer wait for the results against a milder recovery with a shorter absence.

Here are some key facts in point form:

  • The risk of overheating with fractional laser peel is relatively small whether using CO2 laser or Er:YAG. Both techniques are therefore a good option.
  • It is only with the help of fractional laser you can leave some of the skin surface in the treated area unaffected. Chemical peels and dermabrasion always remove all of the skin.
  • The benefits of fractional laser resurfacing compared to fully ablative laser resurfacing are much milder and less “down-time”.
  • Normally, you can expect to do 3-4 fractional laser resurfacing every 3-6 months before achieving the desired results.

How laser skin peeling is performed

Before performing laser skin resurfacing, you will first visit the clinic for an assessment of your skin and discuss what expectations you have of the treatment. Then you can make an appointment.

Effective treatment can cause inconvenience

A laser skin peeling is performed with the use of a cosmetic laser. The laser machine has a nozzle that fires the laser pulses that removes the skin. The more skin you remove, the more impact and more difficult recovery can be expected. In the end, it is about burns that your body heals on its own.

However, a laser skin peeling is a powerful treatment. It heats up the skin by the use of a laser with great effect. When it’s used correctly, it provides nice results. Incorrect use can give bad results and in worse cases physical damage.

Larger areas are performed under general anesthesia, small in local anesthesia

How “large” a laser skin resurfacing is, depends on how much skin is removed. This in turn depends on how big the treated area is, how deep it goes and if you remove all skin in the area or if you leave some parts with the so called fractional technique.

A deep fully ablative laser skin resurfacing of a larger area can be treated with a surgical procedure. This is performed under general anesthesia. Less fully ablative or fractional laser skin resurfacing are performed under local anesthesia combined with sedative medication.

Skin resurfacing is performed in three steps:

  1. In the first step preparations are performed. You “check in” at the clinic where you get examined and meet your doctor. Prior to the surgery, you skin is cleaned and then you get anesthesia.
  2. In the second step, the laser skin resurfacing is performed. It takes between 15 to 120 minutes and during that time, the doctor shoots laser pulses into the skin while he constantly cleans, controls and evaluates the effect. The treatment is finished when the right amount of skin is removed. If you are wake, each laser pulse feels like a snapping a large rubber band against the skin.
  3. When the treatment is finished, you will rest at the clinic until you feel better. Then you will get a review of restrictions and information about aftercare and afterwards you may leave the clinic.

Time away from work

Since laser skin peeling basically adds controlled burns to the body, the healing process have several similarities. It is about traditional burn wound healing. Both open and closed wound healing is used.

The first week after laser skin resurfacing is difficult. It is not uncommon for the patient to call the clinic or doctor on several occasions just to talk and get assurance that everything is as it should be.

You may go back to work 4-6 days after a fractional laser resurfacing. A fully ablative laser resurfacing requires however almost 2 weeks off work.

The first day after treatment is usually the hardest. When larger areas being treated, you should expect comprehensive swelling, fluids, itching and irritated skin.

A less fully ablative or fractional skin resurfacing similar problems may be experienced but to a lesser extent and for a shorter time.

After the first week, skin peeling and sometimes itching occurs that you may endure without touching and scratching. After two weeks, a new outer layer of the skin has been built up. Treated skin will be read but you feel better and be ready to wear make-up.

A big part of the recovery is about self-care in the form of cleansing, lubrication, patience and resting when it comes to deeper skin resurfacing. How this is managed has a major effect on the final outcome.

Risks and complications with laser skin resurfacing

When laser skin resurfacing is performed by a person with the right skills and equipment on a patient with the right conditions, the risk of complications are reduced. However, you should be aware and discuss the most common ones with your doctor.

  • Ablative laser skin resurfacing with Er:YAG laser can in rare cases develop darker patches on the skin, which is also called hyperpigmentation. This is usually temporary.
  • Ablative laser skin resurfacing with Co2 laser may lead to skin bleaching of the treated area, a so called hypopigmentation. Unfortunately, the skin whitening may remain permanently.
  • Scarring may occur for two reasons: bacterial infection in the wound surface or going to deep so burns occur. Burns occur almost solely in the use of cO2 laser for ablative resurfacing.
  • You can expect redness in the treated area which can last from a few weeks to six months. In some cases, longer than that.

Prices for laser skin peeling

For a safe and successful laser skin resurfacing of the skin, it requires several things. Two of the most important is skills and good equipment. In this case, a practitioner with at least postgraduate qualification and a good laser. This costs money.

We have previously stated that ablative laser resurfacing is best performed with an Er:YAG laser, but that fractional laser resurfacing can either be performed with Er:YAG or CO2-laser. Below you will find treatment costs.

  • The cost for a fully ablative laser resurfacing of the entire face with Er:YAG laser is about £3500-4000. For medium to large skin areas such as cheeks, around the eyes and mouth cost about £1400. For smaller areas such as chin, under or lower and upper lip cost about £1000
  • Fractional laser peel with fractional Er:YAG or CO2 laser cost about £1400 for the entire face and from £600 to £900 for specific areas. Since only parts of the skin are affected, a series of 3-5 treatments are needed for desired results.

Basically, you can say that the treatment outcome of laser skin resurfacing cost about the same regardless of technology. It’s the journey that differs.

More alternatives and information about laser skin peeling

The information about laser skin peeling is examined by dermatologist Tore Nilsen at Vaxjo Medical Centre. It provides only a general guidance to laser skin resurfacing and cannot replace a consultation with a doctor.

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