Carbon dioxide (CO2) laser resurfacing is the gold standard of facial resurfacing. It corrects skin laxity as well as pigment and texture irregularities, softens and improve scars and removes seborrheic keratoses(barnacles) and warts. There are two kinds of CO2 laser resurfacing, continuous wave and fractional. More aggressive procedures done with the former result in greater skin contraction but longer duration of complete healing (redness). This section deals with the former.
The UltraPulse® CO2 laser emits a sterile beam of light that not only removes the top layer of skin but also throws heat into the second layer of skin causing immediate, significant skin tightening (up to 35% that could take off as much as 25 years). In some patients and results are often sustained for 10 years or more. We have patients who have maintained results for more than 25 years. It also results in smaller pores with a smoother skin texture and correction of most pigment irregularity due to sun. After laser resurfacing, there is a marked increase in collagen deposition in the skin over a period of several months, even up to one year. For many people, this procedure has replaced face lifts as it improves texture, tone and tightens the skin without pull lines or surgical scars, leaving a more youthful appearance.
Laser resurfacing can be performed with topical anesthesia and local nerve blocks. Oral pain medication is optional; however, patients may not drive for the remainder of the day after receiving internal medication. The majority of patients rate discomfort of the procedure at a “4” of “10” with “0” being no pain and “10” being the worst pain they could imagine. Usually there is some stinging after the procedure for 20-30 minutes which is reduced with the Zimmer chiller. Rarely does a patient request pain medication postoperatively as there is usually no significant pain. It is believed that the laser seals nerves.
Postoperatively, there will be a small amount of drainage from the treated areas in the first day or two. Redness, swelling, bronzing, crusting, and peeling are a normal part of the healing process and usually last 4-7 days. Aftercare includes keeping the skin clean, soaking and applying a thin layer of petroleum jelly until the crusts fall off naturally. While healing, it is important to avoid sun exposure and wear a good sunscreen such as the EltaMD® products.
The rate of healing depends on the area being treated, the depth of laser resurfacing, and the patient’s age. The skin may remain pink for 2 months or more, however, makeup can be used. After the procedure, sun exposure should be kept to a minimum and sun protection should be used.
Scarring due to acne, trauma, or surgery and some pigmentation abnormalities can all be treated with the CO2 laser. We have been treating facial irregularities, including wrinkles and scars, with laser resurfacing since 1988. We use the UltraPulse® CO2 5000 C™ laser with its computer scanner or the newer UltraPulse® Encore™ for fractional resurfacing (see below). We often do combination procedures.
Skin tags, flat warts, and seborrheic keratoses, also known as ‘barnacles’ or ‘old age warts’ are easily removed with the CO2 (carbon dioxide) laser. The CO2 laser is absorbed by water in the lesions, which vaporizes them, causing the lesions to crust up and fall off. There may be some residual mild pinkness which fades as the area heals. Most keratoses disappear with one treatment. Since seborrheic keratoses are hereditary, new lesions will develop over time. We often remove 300-400 or more keratoses in one office visit. Once cleared, short annual or bi-annual treatments will maintain clearance.