Laser skin resurfacing describes a process by which a laser or similar device is used to deliver heat to the skin in a very specific manner. In response to this stimulus, the skin undergoes a healing process that results in elimination of discolored, sun-damaged areas, producing fresh, new skin. The regenerated skin is smoother in texture and more youthful in appearance. Laser skin resurfacing was first introduced in the early 1990s. The original procedure removed the entire outer layer of the skin’s surface, smoothed deep wrinkles, rejuvenated even severely damaged skin and helped smooth acne scars very effectively.

Traditional Laser Skin Resurfacing

Traditional laser skin resurfacing procedures produce excellent results that last for many years.  Dramatic reduction in discoloration and wrinkling caused by sun damage and aging can be produced by traditional resurfacing.  Acne scarring and other scars can also sometimes respond favorably to traditional resurfacing.  Even today, more than 20 years after traditional resurfacing techniques were introduced, traditional laser skin resurfacing remains the “gold standard” in rejuvenation treatments.  On account of the depth and amount of injury produced by traditional resurfacing lasers, these treatments are typically performed under general anesthesia.  Post treatment recovery times are often a full two weeks followed by a period of three or more months during which the skin has a pink or red color. When performed properly by an experienced operator, traditional laser skin resurfacing produces superb results that last for many years. However, when performed improperly or by inexperienced operators, this procedure may be associated with long healing times, permanent changes in skin color, scarring and other undesirable side effects.

Ablative Fractional Resurfacing Lasers

An effort to develop skin resurfacing devices that produce significant rejuvenation of the skin without the risk and recovery associated with traditional laser resurfacing techniques led to a concept known as fractional resurfacing. Fractional resurfacing describes the technique in which a grid-like pattern of laser spots is delivered to the skin in such a manner that healthy tissue surrounds each area of laser-induced injury. This differs from traditional resurfacing techniques in which the entire surface in the treated area is affected by the laser, resulting in a relatively long recovery period.  Some ablative fractional resurfacing devices can be used off the face, but this needs to be done with great care by a knowledgeable and experienced physician as skin on the neck, chest, hands, and extremities responds differently to resurfacing than facial skin.

Ablative fractional resurfacing lasers actually remove damaged tissue and stimulate our skin’s natural repair processes.  Due to the fact that laser energy is delivered relatively deeply, either local anesthesia administered via injection in the office or general anesthesia administered at the surgery center are required to maintain patient comfort during the procedure.  Following treatment with ablative fractional resurfacing devices, skin tightening and wrinkle reduction are significantly more apparent than after treatment with non-ablative or superficial resurfacing devices.  There is almost no discomfort during the recovery phase after ablative fractional resurfacing.  During this period, taking care of your skin properly is critical to both help the skin heal quickly and to minimize the risk of complications.  Recovery after ablative fractional resurfacing treatment usually requires five to seven days depending on the device used and the relative aggressiveness with which the treatment was performed. As opposed to the non-ablative fractional resurfacing devices, only one to two treatments are typically required with the second-generation lasers unless extensive, deep acne scarring is being treated. The longer recovery period and improved wrinkle reduction and skin tightening capabilities are the primary differences between and ablative and non-ablative fractional resurfacing devices.

Does it matter which fractional ablative resurfacing device is used?

As is the case with automobiles, clothing, and most other items that we use in our daily lives, some lasers are high quality while others are not.  Dr. Biesman uses several different high-quality ablative fractional resurfacing lasers as there are subtle differences between them.  While it is extremely important to be treated with a high-quality device, the experience and judgment of the operator outweighs the quality of the technology when it comes to both the type of outcomes that can be achieved and the relative degree of safety.

Dr. Biesman has performed extensive research on first and second generation fractional resurfacing lasers and helped develop ideal and safe uses for some of today’s most popular and advanced lasers.

Quick Facts:

  • Traditional ablative resurfacing can produce dramatic improvement in deep wrinkles, skin texture, and the appearance of scars.
  • Recovery time after more aggressive ablative resurfacing is approximately 10-14 days, and the skin remains pink for several months after treatment.
  • Due to the extent of injury produced by traditional laser skin resurfacing, dramatic outcomes can be produced, but the associated recovery time is longer and relative risks are higher than with other resurfacing treatments.
  • Ablative fractional resurfacing is associated with a much lower risk of complications than traditional skin resurfacing treatment.
  • Only 1-2 ablative fractional resurfacing treatments are typically sufficient to achieve best outcomes when treating mild to moderate sun damage.
  • Laser skin resurfacing does not treat red discoloration or “broken capillaries.”
  • Biesman performs extensive research on both ablative and non-ablative resurfacing techniques. He also developed safety protocols and best treatment practices to treat the delicate skin of the eyelids and surrounding area with resurfacing lasers.
  • More aggressive fractional resurfacing treatments using ablative fractional resurfacing lasers can produce more dramatic improvement in skin laxity, deep wrinkles and lines, acne and surgical scars, and even stretch marks with fewer treatments.
  • Biesman has performed laser skin resurfacing for over 20 years and also published a medical textbook on this topic.

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