Clinic of Dermatology

Ablative laser therapy

Ablative lasers that break the integrity of the epidermis

Lasers have been implemented in the field of clinical dermatology for more than 30 years, starting with the utilization of continuous wave (CW) laser systems – argon and CO₂ lasers. The onset of widespread application of neodymium:yttrium – aluminum – garnet (ND:Yag), pulsed dye and Q – switched laser in dermatology is in the middle of the 80’s and the beginning of the 90’s of the last century. The middle of the 90’s of the 20th century marks the greatest demand for lasers, both by physicians and patients considering the introduction of ultrapulsed and scanning CO₂ laser systems. A procedure, named “ablative laser resurfacing” introduced an option for the development of numerous ablative and non – ablative, contemporary and widespread technologies.

The possibilities of CO₂ laser resurfacing to reduce superficial and medium – depth wrinkles, visible and considerable effects of improvement of the facial skin texture without surgery paved the way for widespread laser application in the fields of dermatology and aesthetic medicine. CO₂ and Erbium:Yag ablative laser resurfacing substituted to a great extent the traditional methods dermabrasion and deep chemical peel, reducing the side effects, which these methods carry – scar formation, hypo- and hyperpigmentations.

What does ablative laser resurfacing mean?

Ablative laser resurfacing stands for the process of thermal destruction and removal of the epidermis and the upper dermis with subsequent physiologic and regenerative reactions in the skin, starting with retraction and leading to rearrangement of collagen fibers in the dermis. The skin surface smoothens clinically – wrinkles and fine lines decrease, pigmentations and dilated capillaries disappear, the skin tan becomes even, its texture improves resulting in visible rejuvenation and fresh appearance.

What is the mechanism of action of ablative lasers?

The therapeutic action of ablative lasers is based on the unique properties of laser light and its interaction with the tissues treated. When temperature in the dermis reaches around 55°C – 62°C interpeptide bonds of the collagen molecule begin to disintegrate and its tertiary structure alters. The normal length of the collagen molecule is reduced to 50%. The process continues with the phase of healing and production of new collagen in the dermis, which forms and accumulates around the shortened half of the polypeptide chain, that plays the role of a matrix.

What are the main indications for ablative laser resurfacing?

Ablative laser resurfacing is a new trend in dermatology and aesthetic medicine, which utilizes laser technologies for the management of various dermatological conditions, as ageing skin, pigment disorders, medium and deep wrinkles, acne scars. Excellent results are achieved in the treatment of some types of moles, freckles, seborrheic warts and other benign, as well as some malignant formations.

Ablative laser resurfacing can be applied alone or in combination with other surgical procedures, like facelift, blepharoplasty, excision, etc. Combination with non – ablative procedures, like IPL (Intense pulsed light) is possible.

What types of patients are appropriate for ablative laser resurfacing?

Choosing this procedure requires estimation of the indications and the possible side effects in each separate case. Most appropriate for this manipulation seem to be patients with medium-depth wrinkles and photoageing skin, as well as those with acne scarring. Although procedures with CO₂ and Erbium:Yag laser may lead to a considerable improvement of the skin tone and texture, resurfacing cannot substitute surgical correction of loose skin entirely. Certain limitations regarding management of vascular changes in photoageing skin are encountered.

Is preliminary preparation for the procedure necessary?

The initial examination by a dermatologist is obligatory, in order to suggest a therapeutic plan that determines the most appropriate treatment in compliance with the problem and to arrange visiting hours for the procedure. Usually, the procedures are held during autumn and winter, in order to avoid risks of hyperpigmentation or secondary bacterial infection.

Patients are presumed to plan absence from work and reduction of social contacts during the healing period – at least 7 – 10 days ; photoprotection and make-up must be applied between the 7-14 day after the procedure. Antibiotic and sometimes, antiviral prophylaxis may be necessary, which starts one day prior to the procedure. Some patients are recommended to prepare their skin with topical application of tretinoin for a few weeks.

Is anesthaesia necessary?

Anesthaesia varies according to the procedure type. Application of topical anesthaetic (EMLA®, Lidocain) suffices for most of the Erbium:Yag laser procedures; some require intradermal administration of the anesthaetic and intravenous/inhalation painkiller is reserved for deep skin resurfacing only. Preliminary consultation with an anesthaesiologist is obligatory prior to deep laser resurfacing.

How many procedures?

Epidermal ablation is achieved through one CO₂ or Erbium:Yag laser procedure utilizing standard individual parameters. Ablation is 20 – 60 ?m deep but in addition, one or two procedures more are necessary for retraction and subsequent alteration of the dermal collagen to achieve durable clinical results.

What are the main advantages of the method?

• The skin of the face smoothens – deep wrinkles decrease considerably; fine lines, pigmentations and dilated capillaries disappear; the skin tan is evenly spread; the skin shows visible signs of rejuvenation and tone.
• Safety of the procedures. Intravenous anesthaesia is reserved for deepest resurfacing only.
• Durable results. Two or three procedures suffice to achieve excellent clinical results. Clinical studies observe that collagen synthesis stimulation starts immediately after the procedure and continues for the next 8 – 10 months.

What should I expect?

Visible results are seen on the second or third month after the procedure and the skin shows continuous improvement in the next 6 – 8 months. Repetition of the procedure is possible at least after 6 months have passed since the previous one.

CO₂ laser resurfacing is a better choice for deep wrinkle management, tightening of loose skin and evenly spread tan. Erbium:Yag laser procedures remove pigmentary disorders and fine lines.

What should I do after the procedure?

Your dermatologist will give you instructions, which you must follow strictly, in order to minimize infection risks and optimize the healing process.

There are two postoperative options for the patient, who has undergone ablative laser resurfacing – staying in the hospital or control visits, according to the physician decision. Photoprotection throughout the whole year is obligatory!

What are the possible side effects?

Slight swelling and redness of the skin appear immediately after the procedure; they are temporary and disappear within 10 – 14 days. Redness may persist until the 2nd – 3rd month since the procedure; it subsides gradually and can be covered easily by make – up application.

Hypo- and hyperpigmentations, infection, scarring and problems with skin healing are extremely rare, observed in patients that failed to abide by the physician’s instructions.