Carbon Dioxide Laser Resurfacing (Ablative Laser Resurfacing)
Historically, ablative CO2 resurfacing has been the gold standard for skin resurfacing. The major disadvantages were long recovery period, prolonged erythema, pigmentary changes etc.
To avoid significant potential side effects a new concept was introduced called as Fractional Photothermolysis. It delivers micro thermal zones- columns of controlled thermal injury to the skin, leaving healthy untreated skin in between to allow rapid epithelization. This technology not only allows dermal cooagulative injury that stimulates neocollagen formation, but also controlled epidermal removal for texture improvement.
What are the indications of Fractionated CO2 laser?
Fractionated carbon Dioxide laser can be used for following conditions-
- Acne Scars
- Facial wrinkles and Rhytids
- Eyelid Skin tightening
- Facial and Neck Skin tightening
- Decolletage skin rejuvenation
- Freckles treatment
- Hand rejuvenation
- Post burn Scars
- Hypertrophic scars
- Stretch marks
- Post Surgical scars
There are some new and advanced uses of fractionated laser. It can be combined with other treatment for dramatic improvements.
Fractionated Co2 laser Plus Ultherapy
Microfocused ultrasound (MFU) using Ultherapy system is capable of heating tissue up to 60 degrees C, producing small zones of thermal damage at depths of 4.5 and 3.0 mm, while sparing overlying skin. This causes controlled collagen stimulation and neocollagenesis. The result is skin tightening and lifting of lax tissue of skin and neck.
Whereas Fractionated laser works at the superficial dermal and epidermal level erasing the static lines, wrinkles and sun damaged skin. Both the treatment in single combined sessions gives a more dramatic improvement.
Fractionated CO2 laser plus Intralesional corticosteroid injections
This can be combined for hypertrophic scars and keloids caused by burns or surgery. It is a very effective treatment for abdominoplasty scars, breast lift scars, faces lift scars etc.
Fractionated CO2 laser with Subcision and microfat grafting
Severe acne scars can be treated by a procedure that combines subcision and fat grafting under the scars while at the same time co2 fractionated laser ablates the skin superficially. The combined treatment improves the aesthetic outcome.
Fractionated CO2 laser Plus carboxytherapy
Extensive striae gravidarum (stretch marks) with hypo or hyperpigmented skin can be improved by combining CO@ fractionated laser and carboxytherpay. Carboxytherapy is a treatment that involves injection of CO2 gas under controlled temperature and flow rate under the stretch marks. This stimulates the formation of collagen under the epidermal layer to sort of repair the damaged dermis. Ablative laser additionally improves the texture of the skin and further causes skin contraction.
What does the Fractionated laser treatment involves?
In this treatment the skin is prepared for atleast 2 weeks with Retinoic acid and Hydroquinone cream (in patients with risks of pigmentation). On the day of laser treatment, patients are advised to apply topical anesthetic cream (Emla cream) before an hour of the procedure.
During the procedure the eyes are protected using safety eye goggles or complete occlusion with a shield. The procedure starts with a mild energy in a thick skin area to test the patient’s tolerance to pain and reaction of the skin. The power is adjusted according to pain tolerance and skin condition. Ice packs are applied intermittently to cool the skin. It takes about 20-30 minutes to complete the procedure.
How much pain is expected during and after the treatment?
Local anaesthetic and Ice packs minimizes the pain, but patient often feel pin prick sensation and warm. The burning sensation can last upto an hour. It can be minimized by applying normal moisturizer cream prescribed by the doctor and application of ice packs.
What is the after care and recovery post laser?
After the procedure patients are adviced to avoid sun exposure and hot water exposure for three to four days. Initially the skin appears like sun burns with tiny dots of crust. This starts clearing off after three to six days depending upon the power used. Patients apply prescribed moisturizing cream twice a day for four to five days.
Once the skin clears off, it appears red for few days.
Concealers and Makeup are permitted after three to four days.
How many sessions are required?
There is a standard protocol that we follow for different skin conditions and skin types (Fritzpatrick skin type I to VI). On an Average patient require from three to six sessions. Then it can be performed as maintenance every year if patients desire further improvement.
Historically, ablative CO2 resurfacing has been the gold standard for skin resurfacing.