CO2 Laser Resurfacing, At A Glance
- Best ResultsOne session
- Treatment Recovery4-14 days
- Procedure Time30-60 + minutes
- Skin SpecialistDavin Lim. Dermatology nurse.
- Duration of Results10+ years
- AnaestheticSedation, blocks, numbing
- Back to Work4-10+ days
- Cost$$- $$$+
CO2 Laser Resurfacing
Ablative CO2 laser resurfacing is the ultimate in skin rejuvenation as it can markedly improve skin quality issues such as deep wrinkles, sun damage, blemishes & scars. This can reset your skin’s age & appearance by up to 20 years. It is important not to overlook volume replacement as this will balance the improvement in skin texture & tone.
What can ablative CO2 laser resurfacing do for my skin?
CO2 Laser Resurfacing
CO2 laser resurfacing, along with deep chemical peels occupy the top of the ladder when it comes to skin rejuvenation. Essentially laser resurfacing ‘resets’ your skin’s age, often up to two decades. Laser rejuvenation can-
- Markedly decrease wrinkles,
this includes super deep wrinkles around the eyes, mouth & cheeks. It is the best treatment for ‘smoker’s lines.’
- Markedly improves skin texture & quality.
This means it removes dull & aged skin & resets your cells to produce fresh skin & collagen. Additionally, CO2 lasers will remove stubborn pigmentation & sun spots, including precancerous cells.
- Removes blemishes & scars,
including surgical scars, traumatic scars, & acne scars. Resurfacing remodels collagen & scar tissue, replacing old scars with new collagen, elastin & hyaluronic acid.
- Reduces pore sizing,
especially on the nose. Deep resurfacing can treat enlarged pores as well as tissue such as rhinophyma.
Who is the ideal candidate for fully ablative CO2 laser resurfacing?
You should approach resurfacing with a plan in mind, namely, to give your skin a second chance. CO2 resurfacing is best applied to improve skin quality. This means textural changes such as sun damage, pigmentation & severe wrinkles. The ideal patient should have-
- Moderate to severe wrinkles, pigment, blemishes, scars. For mild textural changes this treatment may be an ‘overkill’. There are far less invasive treatments and lasers that can address these concerns.
- Fair skin patients, namely skin types 1.2 & 2+. If you have darker skin, the use of fractional lasers may be more appropriate. Less risks of skin colour changes.
- Have a lot of downtimes. Depending on the density & depth, downtime varies from 4 days to 14 days.
- Committed to looking after your skin. Think of this as a big procedure, a once-in-a-lifetime procedure. If you are keen to look after your skin post-procedure, one resurfacing treatment will last you a very, very long time.
How long is the recovery following CO2 laser resurfacing?
Recovery is directly related to the depth and density of CO2 laser resurfacing. As a guide-
- Light resurfacing: 2-4 day recovery. Redness for 48-72 hours.
- Medium resurfacing: 3-6 day recovery. Redness for around one week.
- Heavy resurfacing: 6 to 14 day recovery. Redness for 4-12 weeks. For heavy resurfacing I normally use a healing ‘vascular laser’ at weeks 4-8 to markedly reduce redness.
Can the neck & decolletage be treated at the same time with CO2 laser resurfacing?
Yes, however you should be aware that these areas will generally require 2-4 sessions to approximate the outcomes you will get from facial rejuvenation. This is because this area has less pilosebaceous units, namely hair follicles. This means it takes much longer for the skin to heal up & the risks of scarring exponentially increases with increasing depths. On this basis, I normally treat the neck area with fractional CO2 lasers. Typical downtime for the chest and neck area is around 7-14 days.
If you have splotchy red and brown pigment, you may benefit from other lasers such as 1927 Thulium- Fraxel or LaseMD. Red pigment is treated with vascular lasers or IPL-BBL.
If you have deep lines & wrinkles along the neck, my favoured treatment is with collagen stimulating Ca OH Apatite in a bespoke concentration. Occasionally I use monofilament threads including MINT or Minimally Invasive Non-Surgical Threads.
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When will I see the results?
Within a week you will notice a significant improvement in your skin. Wrinkle will be less visible & pigment will be gone. The positive effects will compound over a period of 3-6 months.
At the 4 week mark your skin will feel & look tighter. Redness will start to fade. Your pores, blemishes & scars will appear less noticeable. This is when you can compound your gains with sensible clinical skin care including retinol/retinoids, niacinamide, ascorbic acid, AHAs & antioxidants.
At the 12-week mark redness would have gone away. Your skin will look at its best with maximal collagen remodelling.
What CO2 machines do I use for resurfacing?
I employ a variety of CO2 lasers, depending on the job. Lasers should ALWAYS be viewed as tools, and not highlighted as a brand. Why? If you have a hammer, everything looks like a nail. A good operator will always pick the best instrument for the job.
As a guide-
Ultrapulse By Lumenis: For bigger jobs including fully ablative resurfacing (performed by myself). This laser can tighten skin, reduce wrinkles, pigmentation, scars and pores. Considered one of the best & most powerful lasers in dermatology. It has to be respected.
eCO2: Is actually more powerful than the Lumenis laser when it comes to clinical outcomes. This laser is most frequently used in ‘fractional mode’. Ideal for mild to moderate to severe wrinkles, sun damage & scarring. Most commonly used with erbium CO2 modulation with the Sciton laser.
Mixto: CO2 laser that is great for darker skin types, including ethnic – Asian skin. A medium power laser made in the United States. I have primarily replaced this laser with eCO2.
CO2 CORE laser is a very nice, delicate and precise laser by Candela. Though it is nearly a decade old, I do use this laser for upper and lower laser blepharoplasties, as well as treating fine & delicate areas.
Fraxel RePAIR; is an old laser. Given the consumables and lack of penetration depth, I do not employ this laser anymore.
YouLaser MT: Is a great laser for lighter skin types, especially in combination with the non-ablative laser wavelength. Overall I think it is one of the most advanced & adjustable lasers out there, however my preferred non-ablative wavelength is 1927.
Sciton Joule: Is technically an erbium laser with ability to mimic CO2 with the modulation function. I normally use this as a first pass laser, followed by Ultrapulse or the eco2 for deep ablative resurfacing.
Juliet Laser: Much like the Sciton, it is an erbium laser with CO2 like modulation.
What are the risks associated with CO2 laser resurfacing?
As with any invasive procedures, there are risks associated with this procedure. Studies have shown that risks are directly proportional to the depth of ablation. The deeper the resurfacing procedure, the better the outcomes, and unfortunately the greater the risks of adverse outcomes. Hence the balance between outcomes and risks are carefully calculated. Risks of CO2 resurfacing include-
- Infection occurs in less than 3% of cases. Mitigated with anti-cold sore tablets & antibiotics.
- Scarring occurs in less than 3% of cases, managed with close follow up & early treatment. This is usually due to poor post op wound care or infection.
- Colour changes, in particular hypopigmentation (loss of colour); directly proportional to the depth of ablation. Hyperpigmentation is more common, loss of colour is rare.
- Dry eyes can occur if the laser is used to tighten the lower lids. Most cases settle within 4-8 weeks with eye ointment.
Other things to consider include flare up of some skin conditions including rosacea, persistent flushing, blushing, & redness. If you are tanned or have had a lot of sun, demarcation lines are possible, especially around the neck & chest area. These can be reduced with ‘feathering’ of the borders during the laser procedure itself.
What are other effective options for my skin?
Here is the truth, unless you have a huge amount of sun damage/wrinkles/ smoker’s lines, the majority of people do not require fully ablative CO2 resurfacing. In the majority of cases a gentle to medium laser resurfacing procedure would suffice.
Options include a 1927 fractional thulium laser (Fraxel or LaseMD) coupled with low density CO2 fractional laser resurfacing. This procedure has a significantly shorter downtime, less risks, expense, & follow ups. This is an ideal way to freshen or renew mild to moderate sun damage, wrinkles & pigmentation.
If you have mild sun damage, an even gentler treatment is Fraxel or LaseMD. In some cases we combine IPL/BBL with fractional laser resurfacing.
For now downtime skin rejuvenation, pico or fractional Clear & Brilliant maybe the best option. Other choices include Laser Genesis or Dermal Toning. Confused? Book a free appointment with my clinical nurses. They can guide you according. Alternatively, I would be more than happy to provide you with a treatment plan. * Consult fee applies if I am involved in your management.
What is the fundamental difference between laser surgery conducted by me versus lasers with my nurses?
Two words- depth and extent of laser resurfacing. My laser nurses deliver CO2 and or erbium to a depth within the upper dermal layer, at around 250 microns. My usual depth of resurfacing starts at 500 and goes to 12000 – 1700 microns. Additionally I treat the entire surface of the skin. This is known as fully ablative laser resurfacing.
Note: most people do not require high cost, long downtime lasers (unless you have an extraordinary amount of sun damage & wrinkles). A good hybrid or combination fractional laser procedure conducted by experienced nurses can give 80-85% of the results I can achieve with super deep laser resurfacing.
Why should I consider dermal fillers as part of my skin rejuvenation?
Laser resurfacing tightens collagen and improves skin quality. This means wrinkles, sun spots, pigmentation & superficial laxity. Laser does not have any effects on volumetric work, namely the fat pads, retaining ligaments and other deeper structures.
For a balanced & natural look, consider strategic & age related volume replacement. This will enhance & compound the outcomes of skin resurfacing. As a guide, the majority of patients can do with one syringe of filler for each decade of life. Hence if you are in your 50s, you may benefit from 5 syringes of dermal filler. 5 syringes seems a lot, but this equates to one teaspoon only. If you are risk adversed to dermal fillers & uncertain if you would ‘accept’ the after effects, go slowly, namely one syringe at a time. Yes, this means one milliliter only.
If you have high volume deficits, I suggest fat transfer as a natural method of volumetric filling. I normally harvest fat from the abdominal area, along with ASC or adipose stem cells. This autologous fat is then transferred to areas such as the temples & cheeks & under eyes. There are two major downsides with fat transfer. Firstly, fat is not as malleable as dermal fillers, hence it does not give as much lift, nor finesse. Secondly fat has a variable resorption rate ranging from 20% to 80%. Hence the predictability of fat transfer is limited.
When is the best time to get dermal fillers?
I normally deliver dermal fillers at the 4 to 8 week mark when your skin is producing more collagen. Unlike laser resurfacing, dermal fillers have no downtime. The results are instant, and it compounds the effects of laser resurfacing.
In most cases I employ hyaluronic acid fillers. If you are volume depleted, I also use collagen stimulating fillers such as calcium hydroxyapatite or poly-L-Lactic acid.
Can CO2 laser resurfacing provide a face lift?
Lasers can contract collagen to provide some degree of lifting. Lasers do not lift the deeper SMAS layer (lifting this layer is a true lift). In some patients, this collagen contraction can lift the jowls & marionette lines.
Face lifting is considered a bonus with laser resurfacing.
How much does laser resurfacing cost?
Cost will vary depending on the depth and extent of resurfacing. As a guide-
- Light to Medium resurfacing by my laser nurses; $1390
- Heavy resurfacing by my nurses $1990 +
- Medium ablative by me $ 3490
- Heavy ablative by me $6900 to $8900
*My aim is not to perform heavy or deep lasers on everyone. Suitable candidates are patients with a lot of sun damage & heavy wrinkles. Most patients age 30 to late 50s will benefit from sensible medium resurfacing by my nurses. What you save, you can invest in volume replacement (fillers) and lifting procedures (RF, HIFU or threads).
Does Medicare cover laser resurfacing?
In some cases, patients receive a Medicare rebate for this procedure. A rebate applies if I am treating severe sun damage / superficial skin cancers, severe scarring seen at conversational distances, severe acne scars & surgical/traumatic scars.
The word severe, in the context of Medicare rebates is an objective measurement, not a subjective definition. Medicare does not cover resurfacing for cosmetic purposes (wrinkles, age warts), nor for reduction of enlarged pores.
What should I consider prior to ablative CO2 laser resurfacing?
A deep fully ablative CO2 laser procedure is a big deal. The downtime is nearly twice as long as a face lift. You should realistically have one of these procedures (done properly) in your lifetime. Don’t get me wrong, I still enjoy performing this transformation as the results are outstanding. I do think that you should have a checklist before seeing me. Things to consider-
- Can I have the downtime of a week and a half ? This allows me to resurface without downtime limits. This means better results.
- Can I take a week and a half off exercise? Yes, this means all exercises apart from gentle walking. You will recover faster if you limit your exercise.
- If you smoke, are you ready to quit? No kidding, smoking does age your skin. You will get much better results if you look after your skin and health post laser resurfacing.
- Will I be better off going for a smaller procedure that is more cost effective without the downtime? Remember, it is more than just skin quality that is important for facial rejuvenation. Think big picture, namely skin texture, tone and volume. The majority of patients will benefit from a lighter procedure. The balance you save can be invested on volume correction & lifting procedures.
- Follow ups are important. Why? Because they mitigate the absolute majority of side effects. As part of the procedure, you will be brought back several times for my clinical team to tend to your recovery. This ensures your skin heals in a timely manner, reducing side effects such as infection & scarring.
- Can you handle the weeks to follow deep CO2 fully ablative laser resurfacing? Your skin will be red for up to 12 weeks (though improving with each week after the second week). I normally do not terminate the redness until week 4. This is done with healing vascular lasers. This free service is part of the resurfacing procedure. Most patients undertake a series of 2-3 healing lasers over a period of 3-6 weeks.
How do chemical peels compare to laser resurfacing?
Chemical peels including deep phenol croton oil peels are comparable to laser resurfacing. Peeling is more technically challenging, and cardiac monitoring is mandatory for phenol peels. On this basis I limit my peels to segmental peeling, an example is upper lip deep peels with a blend of ablative laser.
I also perform Jessner TCA medium depth chemical peels. This peel is a good option for mild sun damage and wrinkling. The advantage of this peel is that they can cover the entire surface of the skin, unlike fractional laser resurfacing.
If you are interested in peels over lasers, book an appointment with myself to discuss the pros & cons of each.
Davin’s viewpoint; ablative laser resurfacing CO2
I still perform CO2 resurfacing at least twice a day, for the past 15 years. Why? Because the demographics in Queensland lends itself to this procedure. Our geographical location in Brisbane, the Gold & Sunshine Coast means a whole heap of cumulative UV radiation over many decades. For ultra deep laser resurfacing my choice is the Ultrapulse or Sciton Erbium laser. The downside is that downtime is significant, however the after results are predictably spectacular.
How I approach skin rejuvenation is to balance the improvement in skin texture or quality, tone or tightness, & volume. In the absolute majority of cases a more finesse approach to skin rejuvenation is the balance of improving skin quality as well as volume.
It is important to choose the right specialist based upon their perception of what ‘ideal rejuvenation is’. This means how they employ surgical, laser, energy devices & most importantly dermal fillers & volume replacement in the context of facial rejuvenation. Remember, balance is the key for the best & most natural results.
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