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Laser Resurfacing An Alternative to the Conventional Face Lift

Almost every adult suffers from some degree of sun damage (photoaging) to their skin. The effects of sun damage on the face may appear as blotchy areas, brown spots, yellow or sallow coloration, and/or broken blood vessels. The skin may also have a pebbly texture and appear either thin or leathery and thickened. Of course, wrinkling of the skin is one of the most common visual consequences of sun damage.

With frequent periods of sun exposure or exposures for long durations, sun damage moves deeper into the skin, where it affects collagen and elastic fibers. When this happens, the skin loses elasticity and sags. Fortunately, laser resurfacing can promote rejuvenation of both the outer layer (epidermal) and inner layer (dermal) of the skin.

To understand how aesthetic surgeons use lasers, it helps to first understand how lasers work. Lasers use high-energy light in a very controlled and predictable fashion. They do not burn the skin. Instead, the level of energy is so intense it immediately vaporizes water in the skin and, in turn, the skin tissue. The energy only penetrates the skin to a prescribed depth, and the heat does not penetrate by conduction, therefore there is no scarring. There are a variety of lasers used for both aesthetic and medical procedures. The most commonly used lasers for skin resurfacing include the CO2, erbium, and long-pulse erbium.

Depending on the technique and type of laser used, tissue can be removed from only the epidermal layer or both the epidermal layer and the dermal layer. Once tissue has been vaporized, the body’s natural healing processes then replace those layers of skin with new, unblemished healthy tissues.
Lasers also offer a unique benefit that is unattainable through any other form of resurfacing, such as chemical peels or dermabrasion. With laser resurfacing, the aesthetic surgeon can induce tightening of the skin’s collagen and elastic fibers.

Collagen is an interlaced triple-coiled fibrous structure located in the dermis. When sun damage penetrates deep enough, it disrupts and disconnects these fibers. The result is loose and sagging skin.

The aesthetic surgeon can use either a CO2 laser or a long-pulse erbium laser to induce tightening within the triple-coil structure of the collagen. As a result, the collagen coils will tighten approximately 20 to 30 percent and stay that way. This procedure is particularly effective in the mid-face area such as the lower forehead, around the eyes, and the inner aspects of the cheek around the mouth. These areas of the face are not always well-addressed with traditional surgical lifting techniques.

Laser resurfacing can also be an excellent complement to a surgical face lift, either before the surgery or after. Oftentimes, after deep resurfacing with the laser, patients decide not to have a surgical face lift — because the lifting effect of the tightened collagen and elastic fibers has corrected the problem to their satisfaction. Remember, even the most well-performed face lift will not give you new skin: it will only tighten your old sun-damaged skin. Laser resurfacing will result in replacing this outer layer of sun-damaged skin with new healthy non sun-exposed skin. Laser resurfacing is also well-suited for improving the fine scars that may be left after a surgical face lift.

Laser resurfacing takes about one hour to perform. Intravenous (IV) sedation is the preferred anesthesia. Light resurfacing to correct skin discoloration and general sun-induced blemishes, usually requires about one week to heal with most of the redness fading in one week to 10 days. Deep resurfacing, which rejuvenates the sun-damaged surface skin and produces collagen tightening, will usually require about two weeks to heal. The patient can then wear makeup to cover the redness, which fades in six to eight weeks.

As with all resurfacing procedures, there is a small risk of complications. One to four percent of patients may incur infection. Infection can be avoided with prophylactic (preventative) antibiotics and close postoperative observation. There is a 5 to 20 percent chance of diminished pigmentation, which may appear as a coloration shift from the face to the neck. Lightly resurfacing the neck will usually blend its pigment and texture to match the face. This diminished pigmentation is most commonly the result of removal of sun-damaged skin and its replacement with non sun-damaged skin. To evaluate this type of pigment change, observe the color of your sun-exposed facial and neck skin versus the color of non sun-exposed skin such as the inner aspect of your upper arms. This lighter skin color is the natural pigment of your skin without sun exposure and is the color that your newly resurfaced skin will begin. The risk of scarring is less than one percent. Overall, significant problems occur in only one to two percent of patients, and these are usually capable of being corrected as healing proceeds.