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Dr. Amber Bocknek

Lasers for skin tightening, firmness, treating laxity, fine lines, scars and more.

Textural disturbances (stretch marks, laxity, crepe-y-ness, fine lines, scars and some resistant pigmentation) can be helped with lasers.

In our office, we have several methods to try to assist with these problems.  We have microneedling and PRP can also be used for some of these issues and they are discussed under their own separate tabs.  This section is focused on laser therapies.  There are 2 main types of lasers: Ablative and non ablative.

Both of these types of laser technologies are used for collagen stimulation and skin rejuvenation. While both aim to promote collagen production, they differ in their mechanisms of action, depth of penetration, and associated downtime. Here's a comparison of ablative and non-ablative lasers for collagen stimulation:

Ablative Lasers:

  1. Types of Ablation Devices: In our office, we have 2 main types of ablative technology.  Fractional CO2 laser resurfacing and Fractional Plasma resurfacing – the similarities and differences will be discussed further down this web page, after the explanation of Ablative vs Non ablative.
  2. Mechanism of Action:
    • Removal of Tissue: Ablative lasers work by removing layers of skin tissue. They cause controlled damage to the outer layers, stimulating the body's natural healing response.
  3. Depth of Penetration:
    • Deeper Penetration: Ablative lasers penetrate more deeply into the skin, reaching the epidermis and often extending into the dermis.
  4. Targets:
    • Fine Lines, Wrinkles, Scars: Ablative lasers are effective for treating moderate to severe signs of aging, such as fine lines, wrinkles, and certain types of scars.  They can also be effective on stubborn pigmentation that fails to respond to milder treatments
  5. Downtime:
    • Extended Downtime: Ablative laser treatments are associated with a more extended downtime. Patients COMMONLY experience redness, swelling, and peeling for several days to weeks, depending on the intensity of the treatment.  Make up generally can not be worn until approximately 6-7 days after the treatment
  6. Painful Procedure:
    • Both of these fractional resurfacing devices (CO2 and fractional RF ablative plasma) are painful treatments.  We generally have our patients prepare by using some or all of the following:
    • 1 hr pre treatment – 2 extra strength Tylenol and apply freezing cream to the entire zone to be treated.  Then cover all the cream with saran wrap to improve the penetration of the medicated cream and the freezing effect
    • At treatment, we prescribe a anesthetic puffer to be used to help with the acute pain.  The only people who can’t use this puffer are those with a known allergy to general anaesthetics, severe kidney/liver disease and/or a condition called malignant hyperthermia.
    • After treatment, a fan (and the air conditioning in your car on the way home) for 2-4 hrs helps to significantly reduce the sunburn feeling.
    • Usually after 2-4 hrs, the pain passes and the healing process continues.
    • For those with a history of cold sores or frequent skin infections we use antivirals and antibacterials, respectively over the course of the first 5-7 days.
  7. Collagen Stimulation:
    • Stimulates Collagen Production: By causing controlled damage, ablative lasers trigger a significant increase in collagen production during the healing process.

Considerations:

  • Treatment Goals:
    • Ablative lasers are often chosen for more significant improvements in wrinkles, scars, and skin tightening.
    • Non-ablative lasers are preferred for those seeking milder improvements with less downtime (see Clearlift).
  • Skin Type:
    • Non-ablative lasers may be suitable for a broader range of skin types, including individuals with darker skin tones, as they pose a lower risk of post-inflammatory hyperpigmentation.
  • Number of Sessions:
    • Ablative lasers may achieve results in 1-3 sessions, while non-ablative lasers (see Clearlift) often require 5-10 sessions for optimal results.

It's essential to consult with a qualified healthcare professional to determine the most suitable laser treatment based on individual skin characteristics, concerns, and desired outcomes. The choice between ablative and non-ablative lasers will depend on various factors, including the depth of treatment needed and the patient's tolerance for downtime.  Alternatively, we can simply start with the non-downtime procedures (see Clearlift) and if your progress is too slow or not as much as desired, then we can consider the more aggressive procedures.  There is flexibility around these choices.  Sometimes we rotate through a number of different procedures depending on the time of year (we try to avoid ablative lasers in the sunny months) and we can mix PRP, microneedling, non ablative and ablation depending on the context of your life’s demands, etc.

Ablative Laser Resurfacing and Ablative Plasma Resurfacing (RF resurfacing) should also be discussed further for those patients interested in the more assertive treatments

In the “old days” we did full zone resurfacing – we essentially treated the entire area which produced many weeks of downtime and far more complications related to the long healing time, infection risk, etc.  We generally do not do that type of resurfacing now.  If you think of your face as your front lawn as an analogy, old school resurfacing would be like removing all the grass and waiting for the new grass to grow up from the roots left behind in the soil.  It would take a long time!

Fractional laser resurfacing using this same grass analogy is like aerating the lawn.  In this analogy, much of the grass remains and the little holes grow over quickly.  This is fractional laser and fractional plasma (RF) resurfacing.

So, in laser terms on skin, fractional laser resurfacing treats only a fraction or fractionated zones of the skin, leaving surrounding areas intact. This approach promotes faster healing and reduces downtime compared to non-fractionated laser treatments.

Here's a breakdown of the fractional laser resurfacing process:

  1. Consultation: Before the procedure, individuals typically have a consultation with a dermatologist or skincare professional. During this consultation, the provider assesses the skin, discusses the individual's concerns, and determines if fractional laser resurfacing is a suitable option.
  2. Pre-Treatment Preparation: Patients may be advised to prepare their skin by avoiding sun exposure and certain skincare products in the days leading up to the procedure. Topical numbing agents or local anesthesia may be applied to minimize discomfort during the treatment.
  3. Fractional Laser Treatment: During the procedure, a fractional laser device is used to deliver precise, controlled laser beams to the targeted areas of the skin. The laser creates micro-injuries or thermal columns in the skin, stimulating the body's natural healing process.
  4. Treatment Depth and Density: The provider can adjust the depth and density of the fractional laser treatment based on the specific skin concerns being addressed. Deeper treatments may target wrinkles and scars, while more superficial treatments focus on improving skin texture and pigmentation.
  5. Collagen Stimulation: The micro-injuries created by the laser trigger the production of collagen, a protein that contributes to skin structure and elasticity. Collagen remodeling helps improve skin firmness and reduce the appearance of wrinkles or scars over time.
  6. Downtime and Recovery: While fractional laser resurfacing is designed to have less downtime than traditional laser treatments, individuals may experience redness, swelling, and mild discomfort after the procedure. The recovery period varies depending on the treatment depth and individual skin response.
  7. Post-Treatment Care: Patients are typically provided with post-treatment care instructions, including the use of gentle skincare products, avoiding sun exposure, and the application of sunscreen. Follow-up appointments may be scheduled to monitor progress and address any concerns.
  8. Results: Results from fractional laser resurfacing are not immediate and often develop gradually as the skin heals and collagen production increases. Improvements in skin texture, tone, and the reduction of fine lines and scars can continue for several months.
  9. Repeat Treatments: For optimal results, individuals may require multiple sessions of fractional laser resurfacing. The number of treatments depends on the specific skin concerns and the desired outcome.

Fractional laser resurfacing is commonly used to address a range of skin issues, including wrinkles, fine lines, sun damage, acne scars, and uneven pigmentation. It is essential to consult with a qualified skincare professional or dermatologist to determine the most appropriate treatment plan based on individual skin characteristics and concerns.

Side effects from fractional laser resurfacing (both CO2 and Plasma/RF): Fractional laser resurfacing is generally considered safe and effective when performed by a qualified and experienced healthcare professional. However, like any medical procedure, it may be associated with some side effects and risks. The severity and duration of these side effects can vary based on the specific type of fractional laser used, the treatment depth, and individual skin characteristics. Common side effects may include:

  1. Redness (Erythema) COMMON, nearly 95% of patients:
    • Description: Redness of the treated area is a common side effect and is usually temporary.
    • Duration: It may last from a few days to several weeks, depending on the aggressiveness of the treatment.
  2. Swelling - COMMON, nearly 95% of patients:
    • Description: Swelling may occur, especially in more aggressive treatments.
    • Duration: Swelling typically resolves within a few days but may persist for a week or more in some cases.
  3. Peeling and Flaking - COMMON, nearly 95% of patients:
    • Description: The treated skin may peel or flake as it undergoes the healing and regeneration process.
    • Duration: Peeling is usually temporary and can last for a few days to a week.
  4. Itching and Dryness – less common, approx. 35% of patients:
    • Description: Some individuals may experience itching or dryness in the treated area.
    • Duration: These symptoms are generally temporary and can be alleviated with moisturizers recommended by the healthcare provider.
  5. Pigment Changes – uncommon, less than 5% of patients:
    • Description: Changes in pigmentation, such as hyperpigmentation or hypopigmentation, may occur, especially in individuals with darker skin tones.
    • Duration: Pigment changes are usually temporary, but in some cases, they may persist.
  6. Bruising – uncommon, less than 5% of patients:
    • Description: Bruising at the treatment site is possible, especially in more aggressive treatments or in individuals prone to bruising.
    • Duration: Bruising typically resolves within a week or two.
  7. Infection – uncommon, less than 5% of patients:
    • Description: While rare, there is a risk of infection, particularly if proper post-procedure care is not followed.
    • Duration: Infections require prompt medical attention and treatment.
  8. Scarring – uncommon, less than 1% of patients:
    • Description: Although uncommon, scarring may occur, especially in individuals with a history of abnormal scarring or an infection during recovery that was not well controlled.
    • Duration: Scarring can be permanent and may require additional medical interventions.

Here is my recent series of pictures.  Pretreatment with freezing and saran wrap, then immediately after, day 3 and day 5.  Then there is a picture of the small scabs falling off (on me the pre was the morning of day 5, the post was the evening of day 5).  The last 2 are the improvments I had as seen at day 10.

It's crucial for individuals considering fractional laser resurfacing to have a thorough consultation with their healthcare provider. During this consultation, the provider can assess the individual's skin type, discuss potential risks, and establish realistic expectations for the treatment. Adhering to post-procedure care instructions, including avoiding sun exposure and using recommended skincare products, can help minimize side effects and optimize results. 

After care for laser resurfacing:

Proper aftercare is crucial to promote healing and minimize potential side effects after fractional laser resurfacing. The specific instructions may vary based on the intensity of the treatment and individual skin characteristics, so it's essential to follow the guidance provided by your healthcare provider. Here are general aftercare recommendations:

  1. Keep the Treated Area Clean:
    • Gently cleanse the treated area twice daily with a mild, fragrance-free cleanser recommended by your healthcare provider.
    • Avoid harsh or abrasive cleansers that may irritate the skin.
    • Cetaphil or Spectro gel are good choices and are available at most pharmacies
  2. Moisturize:
    • Apply Vaseline twice daily after cleansing and any time the skin feels dry
  1. Use Sunscreen:
    • Protect the treated area from sun exposure by applying a broad-spectrum sunscreen with at least SPF 30. Start this at 1 week post treatment
    • Avoid direct sunlight and wear protective clothing, such as hats and sunglasses, when outdoors entirely during the 1st week of recovery, and then continue to be vigilant after the first week, even when wearing sunscreen.
  2. Avoid Sun Exposure:
    • Minimize sun exposure for several weeks after the procedure, as the skin will be more susceptible to damage.
    • If sun exposure is unavoidable, take precautions to protect the treated area.
  3. Avoid Scratching or Picking:
    • Refrain from scratching, picking, or rubbing the treated area, as this can disrupt the healing process and increase the risk of infection.
    • If itching occurs, consult your healthcare provider for appropriate remedies.
  4. Stay Hydrated:
    • Drink plenty of water to keep the body hydrated, which can contribute to overall skin health.
  5. Avoid Irritants:
    • Steer clear of products that may irritate the skin, such as products containing alcohol or strong acids.  Wait 1 full week before resuming retins or vitamin C serums
    • Avoid using makeup or skincare products that are not approved by your healthcare provider during the first week.
  6. Follow Prescribed Medications:
    • If your healthcare provider prescribes any medications, such as antibiotics, antivirals or topical ointments, use them as directed.
  7. Attend Follow-Up Appointments:
    • Attend any scheduled follow-up appointments with your healthcare provider to monitor your skin's progress and address any concerns.
  8. Report Problems Quickly:
  • If you note you were doing well, but you develop new tenderness, new worsening redness, new itch or irritation, new heat in an area, any discharge, any odour or any fever, notify the team immediately.  These could be signs of infection and we would want to initiate treatment swiftly.

Always consult with us if you have any questions or concerns about your aftercare routine. Individual recovery experiences may vary, and your provider can offer personalized advice based on your specific needs and the intensity of the fractional laser resurfacing treatment.

At a glance

Downtime
7 days on face
10-14 days on body

Procedure length
20-60 minutes

Discomfort
Anaesthesia options are provided

Session protocol
2-4 teatments, done 4-8 weeks apart

Maintenance
Single session every 6-24 months