Fractional Resurfacing
The fractional lasers are the main lasers used throughout the country for the treatment of acne scars. Fractional skin tightening works well and generally patients see their acne scars improved by a considerable degree after the treatment(s).
In the above drawing, the first red area on the left represents traditional ablative CO2 and Erbium laser resurfacing. To ablate means to surgically remove and the skin tissue is removed by the heat of the CO2 or Erbium laser. Since these lasers were not fractional, all of the skin in the treated area is removed creating an open wound that takes a long time to heal. There are few doctors that do this now because there are concerns about long term scarring that can occur.
The second area on the drawing from the left respresents a fractional laser that ablates the surface of the skin down to a depth of 70-100 microns. This treatment allows the skin to heal much more quickly, but depth of penetration is not deep enough to produce noticeable wrinkle reduction or texture improvement.
The third area of the drawing is the Fractionated Laser Treatment (FLT) is an innovative, non-invasive laser therapy designed to dramatically repair fine lines, wrinkles, and acne scars while improving skin texture and pigmentation – even on delicate skin. It is a proven, safe approach to repairing aging and sun-damaged skin, with many of the benefits of ablative laser skin resurfacing (resurfacing the skin by removing it or vaporizing it), but without the downtime, side effects, and lengthy recovery periods.A Fractionated laser represents a new science and category of cosmetic skin surgery that offers patients the positive results of ablative laser resurfacing with the low-impact benefits of non-ablative laser or light-based therapies.
The fourth area of the drawing is the Carbon Dioxide (C02) Fractional Laser Resurfacing that removes layers of skin tissue in a fractionated method (columns of skin are removed, leaving the skin surrounding each column intact to aid in healing) to help reduce “age-spots” (also called sun freckles, liver spots, and lentigines), fine lines, wrinkles, scarring, uneven coloration, skin laxity, textural irregularities, dull tone, and a thinned collagen layer of the face, neck, and chest.
CO2 is the best treatment if you wish to get the most results with one treatment. If you have the ability to take some time to heal (7-14 days), having this one treatment is like having multiple other non-invasive treatments at once. It is also the best single treatment for advanced skin damage and wrinkling.
CO2 is an in-office procedure that requires pre and post-treatment medications to ensure proper healing and comfort during the procedure. Discomfort varies on the depth of the treatment. For your comfort during the treatment, we may apply a topical anesthetic or inject local anesthetic and/or tumescent anesthetic and prescribe sedative medications to reduce discomfort. After the treatment most patients describe the post-procedure feeling as a bad sunburn for about 12 hours to 2 days. Please also follow the instructions for all other prescribed pain medication is needed post treatment. We also recommend pain or relaxation medications prior to treatment therefore you will need to have somebody drive you home after treatment.
Typically one laser treatment with C02 is recommended. Occasionally, in an area that cannot be treated aggressively, we may need to do more than one treatment to optimize results. Maintenance treatments may also be necessary to maintain results, especially if sun is not avoided or proper skin care used. Occasionally, even with the best care, another treatment may be necessary in a few years (in the area around the eyes, it may only be 1-2 years).
How do I know if I need CO2?
Anyone who has sun damaged, aging skin, irregularly pigmented skin, wrinkles, sagging, irregular texture of the skin or other skin condition that could be expected to be improved with this treatment that understands the risks, costs and time necessary to achieve the full benefit of the procedure and who has realistic expectations of the ultimate outcome.
This is not a good treatment for skin of color. The reason is that this is an aggressive treatment that does result in prolonged healing of the surface. Pigmented skin tends to heal with hyperpigmentation and that does occur with this procedure upwards of 30% of the time. It can take many months of topical treatments and sometimes additional laser treatments to correct this. If this treatment is to be undertaken on dark skin, it will need to be part of a series of gentler treatments and not a single treatment.
This is also not a treatment for any woman who is pregnant or anyone who has been treated with isotretinoin (or Accutane) within 6 months. In addition, if there are any conditions resulting in delayed or abnormal healing or a history of cold sores or herpes virus it is important to tell your physician at the pre-treatment stage to prevent complications.
How does CO2 work?
The Carbon Dioxide (C02) Fractional Laser Resurfacing removes layers of skin tissue in a fractionated method (columns of skin are removed, leaving the skin surrounding each column intact to aid in healing) to help reduce “age-spots” (also called sun freckles, liver spots, and lentigines), fine lines, wrinkles, scarring, uneven coloration, skin laxity, textural irregularities, dull tone, and a thinned collagen layer of the face, neck, and chest.
What benefits can I expect?
Results that are expected are a very significant and noticeable reduction in the components of sun damaged skin such as “age-spots” (also called sun freckles, liver spots, and lentigines), fine lines, wrinkles, scarring, uneven coloration, skin laxity, textural irregularities, dull tone, and a thinned collagen layer. The skin will continue to improve for a period of 6 months following the procedure provided proper skincare is used and sun exposure is minimized. Sometimes the results are not significant until the 6th and even the 9th month, depending on the person’s age, their aftercare routine and their history of smoking
What are the risks and side effects?
The main negative of the CO2 is the downtime. Depending on the area and the aggressiveness of the treatment, it will take7-14 days for the skin to heal. This downtime will include significant redness crusting (possibly minor bleeding and oozing depending on treatment depth), dryness, and peeling and flaking (it is important to keep the skin moist after treatment). This does mean that social and work activities will have to be curtailed during this time, although you should be perfectly capable of working from home after the first day or two. It could be a very painful procedure but we provide full facial anesthesia so there should be no or minimal pain during the procedure or even in the hours following it. Other potential side effects may include but are not limited to: skin wound, infection and scarring, hypo and hyper-pigmentation.Prior to treatment all potential risks and side effects will be discussed with you by your medical provider and cosmetic coordinator.
How will I look and feel after the treatment?
After the treatment, you will go home and sleep mostly for the first day. After the first day your skin will be raw and you will follow the instructions as to how to keep it healing maximally. We usually see you in the office on the first, second or third day after the procedure to ensure that healing is going according to plan. By the 7th day you can usually apply makeup or venture out in public, but your skin will still be pink and will be very sensitive for the better part of 1-3 months. It is most important to follow the instructions given to you by your provider. A strict skincare regimen and sun avoidance is recommended for best healing and optimal results for a period of 6 months following treatment. Failure to do so may result in sub-optimal results or side effects such as listed above.
Your skin will continue to age as time goes on due to sun exposure, environmental stress, overall health and lifestyle choices such as smoking. To maintain your results we recommend a healthy skincare routine including cosmeceutical products, medical grade facials, and other procedures as directed by your provider.
Is there another way to get the same effect?
Alternatives to the CO2 Fractional Laser Resurfacing treatment include photodynamic photorejuvenation (using Levulan with IPL), Fraxel laser, E3 (Ematrix with Sublime and IPL) or other brands of C02 Laser resurfacing. Typically, there are no other treatments that can give you as much of an overall effect with only one treatment. You would have to combine the above with fillers or tissue tightening devices to achieve similar effects.
Can this be combined with other treatments?
CO2 can be combined with other treatments although we cannot do other treatments in the same area(s) treated on the same day. We may recommend botulinum toxin 2 weeks prior to the treatment as studies have shown that this may enhance the effect on wrinkles caused by movement, but we typically wait one month before or after doing fillers. PRP combined with fractional is also an option.
What is the cost of CO2?
Depending on the area treated the cost of a CO2 treatment ranges from $300-$500. If multiple areas are treated (such as adding on neck and chest), this may be more.
