What is Laser Skin Rejuvenation?
As we all age, we experience changes in the quality, texture, and pigmentation of the skin. Sun worshippers and smokers tend to see these skin aging changes earlier and more severely. Laser Skin Rejuvenation is a group of procedures designed to improve the appearance of the skin, to give a more youthful appearance. Wrinkles, age spots, acne scars, pigmented areas, and small blood vessels on the face, neck, and even hands can be quickly and effectively treated.

There are many types of lasers used for skin rejuvenation, but many experts feel the "gold standard" for rejuvenation is to use a CO2 (carbon dioxide based) laser. For over a decade, CO2 laser resurfacing has been done, but recovery from this procedure was long and difficult, and patients often developed problems with pigmentation changes in their skin. A more advanced version of this procedure, called Fractional Laser Skin Resurfacing was developed in just the last couple of years to eliminate many of the problems associated with traditional CO2 laser skin resurfacing. Fractional CO2 laser skin resurfacing was developed to remove wrinkles and rejuvenate the skin with minimal downtime, quick recovery and normal skin color and texture after the skin rejuvenation procedure.

There are several types of fractional CO2 lasers, but generally they are either "ablative" or "non-ablative." More on that below.

How does fractional CO2 skin resurfacing work?

The basic cause of skin wrinkles and skin aging changes is loss of collagen in the skin, which leads to a loss of elasticity. Collagen in the deep layer of our skin provides moisture, nutritional support, and a firm, smooth appearance.

As we age, exposure to years of ultraviolet (UV) radiation from sunlight, toxins in our diet and environment, and unhealthy lifestyles such as smoking all contribute to the destruction of collagen in our skin. When collagen is lost, our skin loses its smooth texture, elasticity and fullness. Sagging skin, and wrinkles result. In an effort to protect itself, our skin surface responds to these aging changes by producing pigment to block the UV sunlight, and our skin thickens with extra layers of dry old looking skin.

All cosmetic laser skin rejuvenation methods attempt to restore skin to a youthful state by stimulating the skin to grow new collagen to replace lost skin collagen to plump and tighten loose skin. In addition, many cosmetic laser skin rejuvenation methods strip away the damaged surface skin cells to remove pigment and dead thickened skin and stimulate new healthy looking skin cells to grow. The latest and most advanced lasers, the "ablative" ones, actually remove tiny columns of tissue to help with skin tightening and wrinkle reduction.

Fractional laser skin resurfacing is a skin rejuvenation technique which removes dead surface skin cells and pigment and stimulates the deep layer of the skin, the dermis to produce new collagen to replace the collagen that has been lost by facial aging changes. In summary:

Skin aging results in:

• Loss of collagen in the skin=wrinkles and loose skin
• Skin surface changes=dry, pigmented, course skin

All cosmetic laser skin resurfacing methods rejuvenate skin by:

• Removing aged skin surface cells and promoting new skin cell growth
• Promoting new deep skin collagen to plump wrinkles and tighten skin

Why is Fractional Laser Skin Resurfacing Better?

Older CO2 laser resurfacing, called flat beam laser resurfacing produced excellent wrinkle removal and skin tightening, but recovery was very difficult, requiring weeks for the skin to heal. In addition, traditional laser skin resurfacing damaged pigment cells in the skin which often caused the skin to turn white. These problems were caused by the fact that the older lasers treated the entire surface of the facial skin, thus healing required new skin cells to be produced by hair follicles and sweat glands in the skin. This was a very slow process requiring up to two weeks for new skin cells to cover the surface of the face.

New fractional laser skin resurfacing is very effective but much safer and easier to recover from than traditional CO2 resurfacing. The fractional laser resurfacing beam is broken up into many small beams so that the laser affects only small focused areas of the skin. Fractional laser resurfacing leaves untreated "in-between" areas on the skin that are left normal and undamaged. These untreated skin cells are able to rapidly heal the treated skin with new skin cells. The treated areas, called micro treatment zones are healed in 48-72 hours with the CO2 fractional lasers like the Lumenis ActiveFX and DeepFX and the Fraxel re:pair.

Fractional lasers are also able to penetrate the skin into the dermis much deeper than flat beam techniques. Deeper penetration causes more effective new collagen production. This characteristic results in improved skin plumping and better skin texture.

Fractional laser skin resurfacing is better than old time flat beam laser resurfacing because skin healing is much quicker, and the risk of white skin, hypo pigmentation is much less.

The benefits of fractional laser skin resurfacing are:

• Quicker skin healing
• Deeper penetration for better collagen production
• Less risk of hypo pigmentation
• Improved skin texture
• More gentle, quicker recovery
• Improved wrinkle removal, pigment removal and skin tightening

What Is Non-ablative Fractional Laser Skin Resurfacing--Fraxel re:store, Starlux Lux1540, Affirm?

The first fractional lasers were introduced 3-4 years ago and are non-ablative 1450nm and 1540nm (nm=nanometers or one millionth of a meter, and are the units used to measure the wavelength of a particular laser) Erbium lasers. Non-ablative laser skin treatments go deep into the dermis of the skin to promote new collagen, but non-ablative lasers to not ablate or remove the surface skin cells or deeper columns of tissue.

Thus the non-ablative fractional skin resurfacing lasers remove wrinkles by building new collagen in the skin, but do not remove the surface aging changes of the skin.

The benefit on the non-ablative technique is that there is less recovery time for healing as the skin is not broken. You are pink after a treatment, but can wear makeup and no recovery time is required.

Because non-ablative treatments are weaker, you need 4 treatments scheduled 4-6 weeks apart for a good result.

Because the skin surface is not ablated, wrinkle removal is less effective with the non-ablative lasers, thus new ablative fractional laser resurfacing technology has been developed in the past year and a half.

What Is Ablative Fractional Laser Resurfacing?

For ablation, different laser wavelengths, the 2940nm Erbium laser and the CO2 laser are used. These laser wavelengths are more powerful and vaporize the skin cells on the surface as well as causing inflammation deep into the dermis. Also, deeper columns or cores of skin tissue can be ablated, to actually remove volume from the overall skin--this produces a dramatic tightening effect, similar to though often more subtle than a traditional surgical facelift. We can vary the depth and overall density (surface area coverage) of the columns, to be more or less aggressive with the treatment. We see stimulation of new collagen production in the surrounding untreated areas around the columns, which further helps reduce wrinkles and improve skin tone. The most popular ablative fractional CO2 lasers include the Lumenis ActiveFX/DeepFX and the Fraxel re:pair.

Because surface skin cells are removed, the ablative fractional lasers are more effective at removing wrinkles, pigment, and old dead skin cells. The downside is that some recovery is required for skin healing, however the down time is much less, about a third of the time required recovering from older flat beam laser skin treatments.

The other benefit is that ablative fractional laser skin resurfacing requires only one treatment, as opposed to the 4-6 treatments required for non-ablative techniques. For this reason, I use an ablative CO2 fractional laser . I prefer the laser made by Lumenis, the ActiveFX/DeepFX, in a combined mode I call TotalFX.

How Is TotalFX Laser Skin Resurfacing Done?

The combined fractional laser skin resurfacing treatment is done in my office with a topical local anesthetic cream. Your face will be cleansed and a topical numbing cream applied. I also give you a tranquilizer and an analgesic to help you relax and be more comfortable during treatment. Your treatment is done completely and personally by me, Dr Gary Kawesch. It is not delegated to a nurse, physician assistant, or other ancillary personnel. I feel very strongly that a Board-Certified Medical Doctor (MD) should be personally performing these treatments.

The TotalFX treatment takes about 45-60 minutes, depending on the areas treated. During the treatment I use what is called a Zimmer Chiller to keep your skin cool and thus more comfortable throughout the procedure.

After your treatment we apply cold wet compresses to the skin. Then a soothing ointment will be placed on your skin, and you will go home. During the first 24 hours you will place soothing soaks on your skin and apply ointment every few hours.

By day 2 or 3 you will finish the soaks and only apply ointment as you need it.

You will be given analgesic tablets in case you need them and an anti-viral oral medication to protect you from a Herpes skin outbreak. We also give you prophylactic antibiotics to protect against skin infection during healing.

TotalFX featured on The Doctors

What Will I Look Like After Treatment and How Long Is Recovery?

Your skin will be pink to red after treatment. The first 24 hours your skin will be moist and old skin cells will peel off and be removed by the soaks.

Your new skin will cover your face in 2 to 3 days, very different from the 2-3 weeks required for skin healing after the older flat beam laser treatments.

Your face will remain pink for 5-7 days, but you can wear make up by day 4. This is about a third or fourth of the recovery time from a deep chemical peel or an older flat beam laser treatment.

When Do I See My Final Result?

You will see a remarkable improvement in wrinkles and skin texture with fresh new skin starting at 10 days and for the first 3 weeks. However, new collagen production, one of the important goals of this treatment, does not begin for 6 weeks and continues for one year after treatment.

The initial benefits are due to swelling of the skin which subsides at about 3-4 weeks so expect to see your wrinkles return initially.

However at 3 months you will really start to see the improvement in your skin and at 6 months results are very dramatic.

Occasionally, patients may need a second treatment to get their full desired result. This is relatively uncommon. More commonly, small areas may need to be touched up if wrinkles are deep and severe. Secondary treatments are typically done 6-8 weeks after the primary treatment.

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