Laser skin resurfacing

There are many types of lasers and there are a number of new pro-
cedures now available that complement or even surpass previous
scar revision techniques such as those that I describe later in the
chapter. Treatment with some of these devices can be used to help
improve and treat acne itself (see Chapter 14 where I discuss other
types of lasers that treat acne in more detail), and as a simultane-
ous benefit, they can stimulate collagen remodeling and result in
the improvement of the appearance of acne scars.
Laser resurfacing can result in uneven skin tones in people with
darker skin.
Treatment with laser resurfacing takes place in an office setting.
Typically three sessions are performed. For a “full-face” resurfac-
ing, the cost can be $3,000 to $8,000 and up!
Sometimes, laser resurfacing and other surgical treatments
(described in the “Considering other surgical treatment options”
section) for acne scars are combined. The surgical treatment is
usually completed 6 to 12 weeks before the laser is called into
action. This waiting period gives your skin time to heal and
remodel itself.
The two major categories of lasers that are used in acne scar ther-
apy are the resurfacing (ablative) lasers and the non-ablative lasers.
Ablative lasers
The powerful ablative lasers literally remove the outer layers of
the skin by using high-energy light to burn away scar tissue, and
stimulate the dermal collagen to tighten, reducing the amount of
scar visibility.
This procedure is used for deeper scars and carries the risk of fur-
ther scarring. Because the skin is injured and unprotected tissue is
exposed, great effort must be put into post-operative wound care
and infection prevention. The skin may remain reddened for sev-
eral months or a year afterwards.
Non-ablative lasers
At first, ablative lasers were used to recontour or vaporize the skin’s
surface. Now, techniques involving non-ablative lasers have taken
over because of their ability to promote collagen growth beneath an
acne scar without creating an external injury. The non-ablative
lasers produce a controlled injury to certain target structures in the
dermis, while completely sparing the epidermis from damage.The laser beams can penetrate into the dermis without injuring the
epidermis. By heating dermal collagen, they help to “tighten” the
dermis and result in less visible scarring. The theory is that the ther-
mal injury caused by the laser triggers a wound repair response,
including fibroblast activation and new collagen formation.
Non-ablative laser resurfacing can be effective for treating shallow
boxcar scars, as well as for smoothing and tightening scars that
have been treated previously. It is not very effective for deep,
depressed, craterlike scars.
A topical anesthetic is applied by a doctor or his medical assistant
about an hour before performing these procedures to make the pain
tolerable. The surface of the skin is cooled to prevent the laser from
damaging the epidermis. A patient will feel both the cold spray as
well as some amount of stinging and heat during the session.