Laser facial resurfacing: skin care after the procedure

• smoothing out medium wrinkles on the forehead (including between the eyebrows), around the eyes;
• elimination of senile and extensive wrinkles;

rejuvenation of different parts of the body.

During gas laser resurfacing, general or local anesthesia is used.

(depending on the amount of work). The procedure itself takes about an hour and is performed on an inpatient basis.

Erbium laser

This type of laser allows you to very accurately direct the beams to a specific area of ​​the skin and is easy to operate. Water contained in skin cells absorbs spectral light from an erbium laser 10 times faster than from a carbon dioxide laser.

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This means that the evaporation of the stratum corneum occurs faster, and the layers of the epidermis are significantly less exposed to thermal effects

.

Erbium laser peeling is so gentle that its pulse can remove skin as thin as 5 microns. As a rule, devices with erbium lasers have a very wide range of types of work, which allows you to select an individual regime for each patient.

Advantages:

• it is extremely effective for neat and gentle rejuvenation of the face, décolleté, neck, and back of the hands;
• Only this laser can gently treat problem areas and remove fine wrinkles;
• rays quickly smooth out scars;
• eliminate large pigmented spots.

But the most important thing is that there is no need for anesthesia

, if desired, you can use an anesthetic cream. The procedure takes no more than an hour.

Depending on the method of exposure, ablative and non-ablative lasers are distinguished. The main distinguishing feature between them is the ability to initiate ablation (evaporation) of the outer layer of the skin.

How often can I have laser facial resurfacing?

Cleansing the face using laser irradiation damages the structure of the skin, so repeating the procedure requires time to fully restore the damaged tissue. The interval between photothermolysis sessions should be at least 4 weeks. During this time, all structures are almost completely restored.

Depending on the severity of the pathological condition of the skin, the doctor determines the number of sessions required for relief. In this regard, the problem arises whether the relief effect is worth the risk of new pathologies or relapses. According to statistics, the time to maintain healthy skin lasts several years. In this case, the number of procedures can vary from 4 to 8.

It should be remembered that it is forbidden to use lotions containing alcohol. Sun protection creams should be used to avoid exposing the treated skin to sunlight.

Pigment disorders are one of the most common types of dermatoses - in some populations, the percentage of people with such defects reaches 60%. This can be either hereditary or acquired darkening or lightening of skin areas, and even dyschromia of unusual color. Most pigment defects are associated with qualitative or quantitative disorders in the production or deposition of melanin, however, abnormal variations of other endogenous pigments are also found, and in some cases, even the deposition of exogenous pigments can lead to dyschromia (read our material about argyria). However, it is certainly defects associated with excess melanin deposition that make up the bulk of pigmentary disorders.

Today, lasers and intense pulsed light (IPL) sources are becoming increasingly popular in their correction. Sometimes they are considered almost a magical tool that can remove any type of damage. However, effective and safe removal of pigmentation is not possible with any device, and in order to choose them, you need to understand the peculiarities of the interaction of laser radiation with the skin and its chromophores. It is also necessary to take into account the main pathophysiological processes leading to this particular pigment disorder, as well as the types and location of pigments in the skin. Experts from the European Society of Laser Dermatology analyzed nearly 1,000 studies and articles published from 1983 to April 2022 and formulated a Position Statement regarding the correction of various types of dyschromia using lasers and IPL devices.

Types of lasers for correcting pigment defects

The principle of light therapy for pigment defects is based on the concept of selective photothermolysis. It lies in the fact that melanin, like other skin chromophores, is able to absorb certain wavelengths more intensely than the structures surrounding it. Ideally, "pigment" lasers should generate radiation that is absorbed only by melanin, with minimal absorption by hemoglobin or water. However, the absorption spectrum of melanin overlaps with the absorption spectrum of these chromophores. The range between 630 and 1100 nm is considered relatively selective for affecting melanin, where there is good penetration of radiation into the skin and preferential absorption of melanin compared to oxyhemoglobin.

The intensity of melanin's absorption of light energy decreases with increasing wavelength of radiation, but a longer wavelength allows it to penetrate deeper into the skin. At the same time, shorter waves (<600 nm) can damage pigment cells with relatively low energy, while longer waves (>600 nm) penetrate deeper, but require more energy to cause damage to melanosomes. Thus, it is not possible to achieve an isolated effect on melanin only by selecting the wavelength (optical selectivity).

Therefore, another task arises - it is necessary to deliver the maximum number of photons to the target chromophore before they are “captured” by competing chromophores that are located near the target. This is possible thanks to the optimal selection of pulse duration and radiation energy density.

Since melanin and the melanosomes containing it are very small, their destruction requires less prolonged heating than, for example, coagulation of blood vessels. It is believed that in order to achieve selective laser action, the pulse duration must be at least equal to, and ideally several times less than, the thermal relaxation time (TTR) of the target structure - the period during which the heated target dissipates about 50% of its heat, i.e. cools (thermal selectivity). Otherwise, it does not have time to cool down and significant heating spreads to adjacent non-target tissues, causing them thermal damage.

The TTR of melanosomes is 0.25 μs, and that of melanocytes is 0.1 μs; accordingly, for their effective and safe destruction, the duration of the laser pulse must be in the nanosecond and even picosecond range. In this case, the pulse energy must be high enough to destroy the target.

Taking this into account, the main lasers used to correct pigment defects are devices with Q-switched (QS) technology. This technology allows you to get very short and very powerful pulses. When they are absorbed, the target is instantly heated with rapid thermal expansion, leading to their explosion - a photoacoustic effect. Moreover, the shorter the pulse duration, the greater its severity, with a corresponding decrease in the thermal component. Currently, there are both nanosecond and picosecond Q-switched lasers, although the Q-switched prefix is ​​usually used only next to nanosecond ones.

Intense pulsed light (IPL) sources can also be used with filters to target pigmentary pathology. In addition, for some purposes (for example, to enhance the penetration of depigmenting agents), conditionally non-selective, water-targeting lasers can be used, such as non-ablative Er laser with a wavelength of 1550 nm, ablative 2940 nm Er:YAG, ablative 10,600 nm CO2 laser and the later 1927 nm thulium laser.

Position of the European Society of Laser Dermatology 2019

As already mentioned, experts analyzed about 1,000 studies and articles published from 1983 to April 2022. For many types of pigmented lesions, the level of evidence was low and was primarily based on anecdotal case reports with no further substantiation. Moreover, in most cases, post-treatment follow-up was very limited, making it difficult to draw conclusions about the long-term effectiveness of the procedures. Thus, some recommendations are based more on expert opinion. These limitations clearly highlight the need for controlled studies when evaluating laser therapy (when possible and compared with first-line treatments).

However, the analyzed information allowed the authors to create a whole list of recommendations on devices and parameters of their effects for the correction of various pigment defects - both epidermal, dermal and mixed. You can read more about them in the next issue of the journal “Hardware Cosmetology”, and now we present short conclusions on the optimal correction options for various types of pigmentary pathology.

• Actinic lentigo with a relatively small number of lesions - ultrashort nano- or picosecond QS lasers. It usually takes one to two sessions for the lesions to completely disappear.
• QS lasers are excellent for lentigo In the case of multiple lentigines, it is imperative to exclude a connection with systemic diseases before starting treatment.
• Freckles - due to the high content of pheomelanins, correction of ephelids is best done using QS 532 nm lasers. In this way, improvements can be achieved, but they are usually temporary and relapses are possible. Regular use of sunscreen is recommended to maintain results.
• Café au lait pigment spots are difficult to treat with lasers and have a high recurrence rate. Patients should be warned about the possibility of such outcomes. It is also possible to conduct a test session to predict the effectiveness of treatment.
• Linear nevoid hypermelanosis - QS lasers are effective with a small number of sessions, but it is unknown how long the effect will be.
• Spotted nevus (Naevus spilus) - can be effectively treated with QS lasers, but, unfortunately, relapses are not uncommon. The macular type responds better to treatment than the papular type.
• Becker's nevus (Naevus Becker) - excess hair growth on a nevus can be easily eliminated using long-pulse lasers, but the treatment of the hyperpigmented defect itself is much more difficult. Despite some successes, failures and relapses are common.
• Cutaneous hypermelanocytosis: Nevus of Ota, Nevus of Ito - the gold standard for the treatment of these pathologies are QS lasers with a wavelength of 1064 nm.
• Acquired dermal melanocytosis : including acquired bilateral nevus of Ota (ABNOM) - the diagnosis should be recognized by clinicians. QS lasers with a wavelength of 1064 nm are highly efficient.
• Congenital nevomelanocytic nevi - the use of pigment-specific QS, long-pulse and fractional lasers can improve the cosmetic appearance of this pathology. They can also be used as complex therapy.
• Post-inflammatory hyperpigmentation (PIH) - Laser treatment can improve the appearance of PIH, but can also worsen or cause it to appear. Before using the laser on the entire affected area, it is recommended to conduct a test on a small area.
• Melasma - Experts believe that the gold standard treatment for melasma is still Kligman's triad. Laser treatment should only be considered after topical depigmentation agents and peels have failed. The most effective laser approach appears to be using wavelengths that target vascular components.

For non-melanogenic pigment defects:

• Drug-induced non-melanin hyperpigmentation - QS lasers are the best treatment option. They eliminate hyperpigmentation caused by drugs and metal salts. Cessation of exposure to the etiological factor is mandatory, if possible.
• Exogenous ochronosis - multiple sessions of QS lasers and/or fractional ablative lasers.
• Siderosis and hemosiderosis are effectively treated with several sessions of QS lasers.
• Seborrheic keratosis pigmentosa and papular nigra dermatosis - LP Nd-YAG laser (1064 nm) and ablative erbium laser.

Read more about the recommendations, as well as other interesting news regarding the use of lasers and other high-energy devices, in the upcoming issue of the Hardware Cosmetology magazine.

Sources:

1. Halder RM, Nootheti PK Ethnic skin disorders overview. J Am Acad Dermatol 2003; 48: 143-148.
2. Anderson RR, Parrish JA Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science (New York, NY) 1983; 220:524-527.
3. Calderhead RG, Vasily DB Low Level Light Therapy with Light-Emitting Diodes for the Aging Face. Clin Plast Surg 2016; 43(3): 541-550.
4. Patil UA, Dhami LD Overview of lasers. Indian J Plast Surg 2008; 41(Suppl): S101–S113.
5. Garden JM, Bakus AD, Domankevitz Y. Cutaneous compression for the laser treatment of epidermal pigmented lesions with the 595-nm pulsed dye laser. Dermatol Surg 2008; 34: 179-183.
6. Passeron T., Genedy R., Salah L., Fusade T., Kositratna G., Laubach HJ, Marini L., Badawi A. Laser treatment of hyperpigmented lesions: position statement of the European Society of Laser in Dermatology. Journal of the European Academy of Dermatology and Venereology 2019; 33:987-1005.

Laser processing steps

The doctor performs initial treatment with a laser beam, removing the surface layer of the epidermis

. After treatment, the facial skin becomes whitish. This means that the laser beam has affected the basement membrane. If local anesthesia was performed, the anesthetic cream is reapplied. After 5-10 minutes the procedure is repeated.

The procedure is carried out until damaged areas of facial skin are removed or until droplets of blood appear. This will indicate that the laser beam has penetrated the papillary or papillary layer of the dermis, which is located under the basement membrane and contains a large number of blood vessels and capillaries. It is at this level that an excellent effect is achieved, and the risk of complications is minimal.

After the procedure, a soothing mask

, consisting of absorbent, basalming and epithelializing components. With it, the recovery processes will go much faster. If classic deep facial resurfacing is performed, the patient can be left in the hospital for 2-3 days under the supervision of a doctor.

People with dark skin, allergies, and a tendency to poor healing of scars should be especially careful when performing the procedure. If there are contraindications or allergies, you should consult your doctor. After taking retinoids, you should wait 2-3 months before resurfacing.

Care after laser pigment spot removal

After the procedure, the patient can go home immediately. But it is necessary to follow the rules of rehabilitation:

• During the first 24 hours after the laser, it is unacceptable for water to come into contact with the treated areas. You can't put on makeup or wash your face.
• For 2 weeks, it is prohibited to use cosmetics containing alcohol, exfoliate, use a hard washcloth, or expose pigmented areas to UV radiation.
• The crusted area of ​​skin is treated with disinfecting and healing preparations prescribed by the doctor. To combat dryness, apply a moisturizing cream with a non-aggressive composition. The skin will finally heal after 1 month. The crust ideally disappears on its own and does not leave behind scars or scars.
• Be sure to use a cream with a sun protection factor of 30 or higher. You cannot visit the bathhouse, solarium, sauna and swimming pool. In the summer, you should wear a wide-brimmed hat when outdoors. Summer is generally a less suitable period for laser procedures precisely because of the sun. It is better to sign up for sessions in autumn and winter.

Care after laser pigment spot removal is mandatory.

Reviews

Real reviews about laser facial resurfacing are contradictory, because the effect depends on the individual characteristics of the body and the condition of the skin. In most cases, girls note the positive effect of the procedure and talk with delight about how their skin has evened out, scars have smoothed out and age spots have disappeared.

Many negative reviews are associated with discomfort after the procedure, a long recovery period and the inability to completely eliminate the defect at one time. There are also negative comments. Some girls are completely disappointed in laser resurfacing and do not recommend it.

Complications of laser hair removal

Laser hair removal is one of the most effective methods of getting rid of unwanted hair on the body and face today. However, if the specialist who performed the procedure makes mistakes, as well as in the case of using old, uncertified equipment, or the patient does not comply with care recommendations, various side effects of laser hair removal may occur:

• exacerbation of herpes infection;
• skin burn;
• allergic reaction in the form of severe itching, urticaria, allergic dermatitis;
• inflammation of the hair follicle (folliculitis);
• hypo- or hyperpigmentation, usually due to skin burns;
• the appearance of scars;
• increased hair growth (paradoxical hypertrichosis);
• prolonged redness of the skin that does not go away for more than three days.

Results of laser treatment

After polishing, deep wrinkles are smoothed out, and small ones completely disappear. The skin is tightened and age-related irregularities disappear. Already after the first procedure, the traces left from acne are noticeably reduced and pimples disappear. Collagen production is activated, so the skin becomes more elastic.

The procedure is done several times a year, this ensures maximum effect.

If the defects are pronounced, to completely eliminate them you will need to undergo a course of 3 or more procedures. The price of laser resurfacing depends on the financial policy of the cosmetology center; it ranges from 7 to 12 thousand rubles. In the capital, laser resurfacing will cost more. The recovery period after the procedure lasts from 2 to 4 weeks.

Burns and blisters

Negative consequences - blisters - occur if the laser power was selected incorrectly, the skin was not cooled sufficiently, or the recommendations were violated.

Before the procedure, the patient should not use decorative cosmetics; they can cause a burn with blisters.

If blisters appear on the face after removing blood vessels with a laser, this indicates excessive intensity of radiation energy.

Treatment for burns of this nature is as follows:

• The damaged area is cooled;
• Bubbles and blisters do not open after laser removal of blood vessels;
• If the bladder wall is damaged, treatment is carried out with an antiseptic drug;
• If the bladder is not damaged, hormonal ointment and panthenol are applied 3-4 times a day. Hormonal ointment for no more than 5-7 days, then only panthenol.
• If the bubble is injured and liquid comes out, a crust forms at this place, which is strictly forbidden to be torn off! Otherwise there will be a scar or pigmentation.

What is skin hyperpigmentation: understanding the anatomy

Age spots are accumulations of melanin pigment in our skin. This pigment is created by our body to protect our body from negative external influences, most often from ultraviolet radiation contained in sunlight. The brown pigment serves as an “umbrella”, preventing UV radiation from penetrating deep into our internal organs. It is what creates a tan on our skin.

Exactly how much melanin needs to be synthesized is regulated by the hormonal system. But each person also has a genetically programmed pigment production program, which determines the color of our skin and the ability to tan.

If a hormonal imbalance occurs in the body, then the production of melanin may become excessive, it will be unevenly distributed throughout the thickness of the skin - this is how areas of hyperpigmentation or age spots are formed.

Increased formation of melanin can also be caused by injuries, skin damage due to aggressive procedures or mechanical stress (for example, when removing inflammatory elements), as well as taking certain medications or deficiencies of vitamins and microelements.

Hot and cold lasers

Lasers that solve a cosmetic problem by heating are called “hot”. Previously, in the aesthetic laser equipment market, all lasers were like this. But in recent years, models of “cold” laser devices have appeared. The brightest and most interesting representative of this variety is the picosecond alexandrite laser Picosure from the American manufacturer of premium equipment Cynosure.

On the one hand, the Picosure laser is similar to other alexandrite lasers - it emits pulses in the same way that transmit energy to target cells, destroying them. The main difference is in the amount of energy transferred and the duration of the pulse: enormous power is transmitted in such a short time that it has a photomechanical effect rather than a photothermal one.

It turns out that Picosure does not heat the melanin cells, it simply smashes them into dust with a powerful energy “push” - and so quickly that the surrounding cells do not feel any impact.

This technology is the most gentle way to solve the problem of pigmentation today.

Pros and cons of skin rejuvenation using laser peeling

What laser peeling can do:

• restores elasticity to the skin and tightens the oval of the face;
• removes pigmentation, scars, scars, moles, eliminates stretch marks and other blemishes;
• reduces deep wrinkles on the forehead, in the corners of the eyes, near the lips;
• tightens pores and makes rosacea less pronounced;
• makes the complexion more even and beautiful.

Laser peeling can also be used on certain areas of the body, showing high results after the first session.

The disadvantages of the procedure include:

• Painful sensations. They arise due to the strong heating of the skin during laser treatment.
• Long rehabilitation period. Recovery after laser peeling takes up to 10–14 days.
• Adverse reactions and possible complications. After the session, the face becomes red. The intensity of the shade does not decrease immediately, but over several days. Hyperemia and swelling often occur as a result of laser exposure; antibiotics (in the form of ointments) may be needed during the rehabilitation process.
• Exfoliation of the top layer of skin. The laser beam destroys intercellular connections in the stratum corneum of the epidermis. Some time after the session, dead particles peel off, and in the deeper layers accelerated cell division and renewal of the epidermis occurs. That's why crusts form on the face first, and then the skin begins to peel off in whole pieces.
• Expensive. Compared to other anti-aging procedures and cleansing, laser facial peeling has a higher cost.

In some situations, you will have to refrain from this type of exposure to the skin so as not to cause harm to your health. Laser peeling has the following contraindications:

• presence of cancer;
• epilepsy attacks;
• fever and inflammation;
• diseases of the circulatory system;
• diabetes;
• severe chronic diseases;
• presence of a pacemaker;
• all trimesters of pregnancy and breastfeeding.

Edema

Redness and swelling after coagulation of spider veins are natural and disappear on their own in the first three days. In rare cases, they are stored for 5-7 days.

However, if there is severe swelling on the face after laser removal of blood vessels, it is recommended to see your doctor.

Immediately after the procedure, ice helps remove swelling, but it cannot be kept on the skin for a long time. The exposure time is no more than 20-30 seconds, otherwise the facial nerve can get cold.

Price

Hardware therapy is widely used in modern cosmetology. Laser treatment solves a wide range of problems in eliminating aesthetic defects and rejuvenating the skin. In addition, laser procedures, which give a quick, visible effect, are one of the safest methods of treatment, with a minimum of contraindications. However, even with laser exposure, various complications and side effects are possible.