Ablative Fractional and Full Laser Resurfacing
Whilst Non ablative Fractional Laser (NAFL) rejuvenation affords subtle improvements with minimal downtime, ablative laser resurfacing procedures can produce more dramatic improvements in the dermis over a longer downtime period. Ablative fractional laser resurfacing and ablative full laser resurfacing are both advanced dermatological procedures aimed at addressing various skin concerns such as pigmentation issues, wrinkles (rhytids), and even mole removal. These treatments utilize laser technology to target specific areas of the skin, stimulating collagen production, and promoting skin regeneration.
Ablative fractional and full resurfacing lasers are generally of two types, Erbium and Carbon Dioxide gas types. Carbon dioxide (CO2) lasers employ longer wavelengths of infrared light (10 600nm) that can penetrate deeper into the tissues. Here at Main Street Skin Clinic we use a CO2 laser with deeper dermal penetration.
Fractional ablative laser resurfacing works by creating tiny, controlled micro-injuries in the skin while leaving the surrounding tissue intact. This produces a column of ablated epidermis and dermis of varying depth and prompts the body’s natural healing response, resulting in the formation of new, healthy skin. This treatment is particularly effective for treating pigmentation irregularities, such as sunspots and solar lentigo, as well as reducing the appearance of fine lines and wrinkles. It is also an ideal treatment for boxcar, rolling and hypertrophic acne scarring as it can help improve skin texture and tone.
Full ablative laser resurfacing involves removing the entire outer layer of the skin, known as the epidermis, along with some of the underlying dermis. An entire area (as opposed to a column) is removed. This more aggressive approach is typically reserved for more severe skin concerns, such as deep wrinkles, prominent scars, or stubborn pigmentation issues. Full ablative laser resurfacing provides more dramatic results compared to fractional treatments but requires a longer recovery time. Additionally, it can be utilized for mole removal, effectively targeting and eliminating unwanted moles while promoting skin regeneration in the treated area.
Both fractional ablative and full ablative laser resurfacing treatments are performed by trained skin physicians in a controlled clinical setting. Prior to undergoing either procedure, patients undergo a thorough evaluation to determine the most suitable treatment option based on their specific skin type (Fitzpatrick), concerns and desired outcomes.
A special compounded anesthetic cream is applied to the treatment area 1-hour prior to their appointment. At the appointment, the patient lies down, the skin is cleaned and protective eyewear is applied. The ablative laser and evacuator machines are turned on and the procedure is performed.
Post-ablative laser instructions typically vary depending on the specific type of laser treatment performed and individual patient factors. However, here are some general guidelines that are often provided:
1. Protect the treated area from direct sunlight and harsh environments. Use a broad-spectrum sunscreen with a high SPF to protect the skin from UV rays, even if the treated area is covered.
2. Avoid picking or scratching. It’s important not to pick at any scabs or crusts that may form on the skin after the treatment. This can lead to scarring or infection.
3. Moisturize. Use a gentle, non-comedogenic moisturizer to keep the skin hydrated as it heals. Avoid products containing harsh chemicals or fragrances that may irritate the skin.
4. Follow prescribed medications. Not applicable to everyone and dependent upon your skin type and healing response. If your healthcare provider has prescribed any topical creams or ointments, make sure to use them as directed.
5. Avoid excessive heat. Avoid activities that may cause excessive sweating or heat exposure, such as hot baths, saunas, or strenuous exercise, until your skin has fully healed.
6. Keep the area clean. Clean the treated area gently with water. Avoid using harsh soaps or scrubbing the skin too vigorously.
7. Attend follow-up appointments scheduled with your healthcare provider to monitor your progress and ensure proper healing.
8. Be patient. It may take several weeks of downtime and the full results of the laser treatment to become after 3 – 6 months. This is how long it takes for collagen neogenesis and remodelling to take place.
Yes, like any medical procedure, ablative laser resurfacing carries potential side effects and risks, These include:
1. Swelling: After the procedure, patients commonly experience redness and swelling in the treated area, similar to a sunburn. This typically resolves within a few days to a week but can persist for longer periods in some cases.
2. Redness. Temporary but may take weeks to months to resolve. Camouflage makeup is appropriate and helps in this instance.
3. Discomfort or Pain: Patients may experience discomfort or pain during and after ablative laser resurfacing. Topical anesthetic cream is applied 1 hour pre-procedurally to help minimize operative pain. Post procedurally, cold water-soaked gauze and over-the-counter pain medications aid in the initial sensitive period.
4. Itching and Peeling: As the skin heals, patients may experience itching and peeling, which are normal parts of the recovery process. It’s important not to scratch or pick at the treated area to avoid complications. Moisturizing with additive free products is important during this stage.
5. Changes in Pigmentation: Ablative laser resurfacing can sometimes cause temporary changes in pigmentation, including darkening or lightening of the skin. These changes usually resolve on their own over time but may be more pronounced in individuals with darker skin tones. The risk of post inflammatory hyperpigmentation may be mitigated in the perioperative period with topical and systemic therapies. This potential complication particularly demonstrates the need for pre-laser consultation.
6. Infection: There is a small risk of infection following ablative laser resurfacing, particularly if proper post-procedure care is not followed. Patients should keep the treated area clean and follow any instructions provided by their healthcare provider to minimize this risk. Preoperative consultation addresses the risk of viral and bacterial infections and appropriate need for prophylaxis. Post procedurally, infections are treated with prescription medications.
7. Scarring: While rare, ablative laser resurfacing can potentially cause scarring. The risk of scarring can be minimized by choosing a skilled and experienced provider and following post-procedure care instructions diligently.
8. Eye Injury: Ablative laser resurfacing near the eyes carries a risk of injury to the eyes if proper eye protection is not used during the procedure.
Before and after multiple sessions
