Ablative Laser Resurfacing

With advances in laser technology, it is now possible to significantly improve aged or sun-damaged skin. Ablative laser skin resurfacing is one of the most effective cosmetic procedures for improving aging skin.

The procedure works by delivering an intense wavelength of light to the skin, which removes the outer layers of aged or sun damaged skin. In addition, the laser stimulates the underlying skin, resulting in collagen formation and an improvement in wrinkles. As the lasered skin heals following the procedure, new skin forms that is smoother and tighter.

Ablative lasers are used to treat:

  • Fine to moderate wrinkles
  • Liver spots or age spots
  • Uneven skin tone
  • Sun-damaged skin
  • Acne or chickenpox scars

It is important to note that laser resurfacing cannot remove deep wrinkles or excessive or sagging skin. In addition, the effects aren't permanent because as you age, you continue to develop wrinkles. Repeated treatments may be necessary.


If you are considering ablative laser resurfacing, you will first meet with a dermatologic surgeon to discuss your cosmetic goals. You will also discuss your medical history, including previous surgeries, present and past health problems, medications, as well as nutritional and herbal supplements you are taking or have taken at some time. Your dermatologic surgeon will examine your skin to determine if ablative laser resurfacing is the right treatment for you.

Your dermatologic surgeon will give you specific instructions to follow before the procedure. These may include:

  • Take an antiviral medication to prevent a herpes virus infection (common virus that causes cold sores).
  • Minimize excessive sun exposure both before and after laser resurfacing. Too much sun may cause permanent irregular coloration in your facial skin.
  • Depending on the extent of the procedure, make arrangements for the day of surgery. For the first 24 hours after sedation, you may not feel like your usual self. Arrange for someone to drive you home following a laser resurfacing procedure.


Ablative laser resurfacing is usually performed in your dermatologic surgeon's office. Before the procedure, your face will be thoroughly cleaned. The areas to be treated will be numbed with a local anesthetic to help reduce pain. You may also be given a sedative to help you relax.

You will wear protective eye shields during the procedure to protect your eyes. Your doctor will hold your skin taut while the laser is fired. The intense heat from the laser causes just the right amount of controlled damage to the small targeted area of skin. This removes aged or sun-damaged skin and at the same time, encourages healthy collagen to grow in its place.

Ablative laser resurfacing typically takes between 30 minutes and two hours, depending on the technique used and the size of the area treated.


After laser resurfacing, an ointment and dressing will be applied to your skin. Your face will be covered with a mask bandage for a few days.

Your skin will look and feel as though it is severely sunburned. It may be raw, oozing and have significant drainage for up to two weeks following laser resurfacing. You will be instructed on how to care for your skin during the initial healing process. It is important not to pick or scratch at the skin while it is healing.

You may experience pain, tingling, burning and itching. You may use pain medicine and ice packs to relieve your pain.

Remain at home and avoid strenuous activity. It is important to complete the antiviral medication that the doctor has given you to reduce the chance of infection. You will need to have multiple follow-up appointments so your doctor can monitor your recovery.

It typically takes two to four weeks for your skin to completely heal. After about two weeks, new skin grows and covers the wounds. The skin can remain pink and red for many months after the procedures; however most patients can use makeup to cover the skin color after about two weeks.

It is critical to minimize excessive direct sun exposure and use proper sun protection following laser resurfacing. Too much sun may cause permanent irregular coloration in your facial skin.

Ablative laser skin resurfacing is a process where the upper layers of aged or damaged skin are vaporized by applying a controlled laser beam. The resulting healing and restructuring of the skin is believed to reduce the appearance of wrinkles. Do not confuse ablative laser resurfacing with nonablative laser treatments where the skin surface remains largely intact.

Laser resurfacing (a.k.a. laser peel) is one of the most popular invasive procedures in cosmetic surgery. Claims of the benefits of laser resurfacing, depending on the source, range from remarkable to minimal. The dangers of laser skin resurfacing -- again, depending the source -- range from relatively minor and infrequent to rather significant. The situation is very confusing to a person trying to decide whether to go ahead with laser resurfacing and, if yes, how to best proceed.

This article attempts to introduce some clarity into this complex situation by looking at possible benefits, risks, techniques and current research on laser resurfacing.


Most research studies agree that properly performed laser resurfacing can visibly reduce the appearance of fine lines and, in some cases, deeper wrinkles. It is used either on the entire face, or, more commonly, in the areas around the eyes and mouth. Some surgeons combine laser resurfacing with a facelift or other procedures to produce maximal effect. The advantages of laser over other resurfacing methods (deeps chemical peels and dermabrasion) include greater precision, less bleeding and discomfort and, possibly, shorter recovery time.

The results of laser resurfacing are particularly noticeable after the initial healing and for about a year thereafter. According to different sources, the results generally last from one to five years. (The results of lower eyelid resurfacing tend to be less lasting - one to two years). Maintenance treatment with topical agents may prolong beneficial effects of laser resurfacing on the skin appearance. Generally, the wrinkles solely due to skin aging respond better than those due to facial movement, such as smiling, frowning or squinting. Even if successfully removed, movement wrinkles tend to recur relatively quickly.

It appears that the results of laser resurfacing vary greately, depending on the technique, skill of the surgeon and patients unique physiology. Some people experience results exceeding their expectations, while others see little benefit, or even have negative reactions.


Whether you call it a laser peel or resurfacing, it is still an invasive surgical procedure where top layers of your skin are vaporized by a laser-generated energy burst. In most cases the damage is well controlled and the recovery is smooth. Possible adverse reactions include excessive scarring, infection, loss of normal skin pigmentation, skin redness and dryness, and others. When the procedure is performed skillfully and the patient and technique are properly selected, side effects are relatively infrequent. If you opt to undergo a laser peel, it is critical to find a board-certified physician with extensive hands-on experience in this procedure.

Keep in mind that due to variations in individual physiology, adverse reactions can occur even if you are treated by a highly skilled professional. In particular, people with darker skin are more likely to develop uneven pigmentation whereas people who were on accutane (a common acne treatment) or those with certain connective tissue disorders are more prone to scarring. Various inflammatory skin conditions also increase the risk of adverse reactions. Also, laser peels can activate herpes virus and possibly other dormant pathogens. In most cases, a patient is given an oral antiviral drug and sometimes antibiotics before and after the procedure.

It may be prudent to perform a test patch (a small test treatment), particularly in people with darker skin pigmentation to assess the risk of skin discoloration and other side effects.

Laser techniques

There is a considerable variety in the equipment and treatment techniques user for laser resurfacing. The two most common lasers for wrinkle removal are carbon dioxide and erbium:YAG lasers. Carbon dioxide laser appears to be somewhat more effective for treating deep wrinkles but has longer recovery time and tends to cause greater adverse reactions. Some surgeons use both carbon dioxide and erbium:YAG lasers in the same procedure: erbium laser for fine lines and small wrinkles and carbon dioxide laser for deeper wrinkles. Such an approach may provide the best risk-to-benefit ratio.

Another important technical aspect is the number of passes the surgeon makes when treateing skin with a laser. Multiple passes, particularly with carbon dioxide laser, produce greater thermal injury and lead to greater side effects and longer recovery. Some surgeons assume that more passes results in a greater wrinkle reduction. However, research indicates that the benefit from additional passes may be small whereas additional risk is substantial. Some surgeons use a combination protocal where problem areas (around eyes, mouth and on the foreehad) are first treated with one pass of carbon dioxide laser and then with one or more passes of less injurious erbium laser. The rest of the face may be treated with one pass of erbium laser.


No mater what equipment or techniques is used, laser resurfacing rarely removes or markedly reduces deep wrinkles or facial sag. If wrinkles are movement related, Botox (botulinum toxin) injections are likely to be both safer and more effective. Another alternative for deep wrinkles, whether related to movement or not, are wrinkle fillers, such as Restylane. Facelift remains the procedure of choice to correct marked facial sag.