Introduction

The desire to look young is unavoidable, and ageing can cause psychological problems, prompting people to seek proper solutions.¹ 

Overview of Skin Aging

Skin ageing is a natural process that occurs due to skin folding, line formation, and skin elevation.⁹

We can say that a skin ageing event develops when the connection between the dermis (the underlying skin)  and epidermis (the outer skin layer) breaks down, moisture levels in the skin drop, and physical mass decreases.⁹ It happens as a result of many pathways including the cell cycle, free radical, glycation, and Cellular and molecular pathway/s of skin ageing.⁹

The changes that occur during skin ageing are influenced by two types of factors

• Internal factors (endogenous): cell activity, genetic change, and hormones influence
• External factors (exogenous): UV exposure which triggers photoaging, and being in contact with chemical, toxic, or contaminating substances^1,9

The signs of ageing skin involve decreased skin elasticity, reduced skin thickness, wrinkles resembling cigarette, paper blood vessel growths (angioma), and non-cancerous growths (keratosis).¹

The ageing process includes changes in the physical traits of skin cells in addition to alterations in the elements of the extracellular matrix like proteoglycans, elastin, and collagen which are essential for skin moisture content, elasticity, and stretching strength respectively.¹

Using Lasers to Treat Aging Skin

In the past, skin rejuvenation was linked to aggressive interventions like peeling, but recently, the need for non-invasive alternatives has increased significantly. The preference for faster healing and natural results has led to a shift in rejuvenation techniques.¹ One technique is lasers, and its use for skin rejuvenation dates back to 1980.¹

Recently, low-power lasers have become widely used in skin rejuvenation because high-power lasers and heat peeling can cause side effects, and nearby damaged tissues heal like wounds.¹

What is laser skin resurfacing?

Laser resurfacing is a treatment that uses an energy-based device to enhance the appearance and texture of the skin.¹¹ It is also known as lasabrasion, laser vaporization, or laser peel.²

How does laser skin resurfacing work?

It's all about using light beams, which are short and focused to remove damaged skin layers precisely.²

Types of lasers used for skin rejuvenation

There are several types of lasers for skin rejuvenation:

• Ablative lasers
• Non-ablative lasers
• Fractional laser¹

Ablative Lasers

Ablative lasers are used to treat skin issues like deep wrinkles, scars, and pigmentation by removing the epidermis and heating the dermis. This stimulates collagen production, leading to tighter and smoother skin.^1,11

These lasers are more intense than non-ablative lasers and require a longer recovery time; however, they provide more noticeable results and are preferred for severe skin conditions.¹

The most used ablative lasers for skin rejuvenation are carbon dioxide CO2 and Erbium lasers combination of them.^1,11

Non-ablative Lasers

In recent years, non-ablative lasers have become the choice for various cosmetic treatments.¹

They are less invasive than ablative lasers, and they effectively tighten the skin by targeting the dermis without damaging the epidermis, which is kept cool during the procedure.¹

These lasers help firm the skin by promoting collagen production in the dermis. While less intense than ablative lasers, they have fewer side effects like scarring and infections and are preferred for moderate skin conditions. However, safety concerns still exist when used on darker skin tones.¹ 

Two types of non-ablative lasers are erbium (Er: YAG) and intense pulsed light (IPL).¹¹

Fractional Lasers

Fractional lasers include both types of lasers; ablative and non-ablative, they penetrate the skin at different depths, 1 mm for non-ablative and 2.5 mm for ablative.¹ Because they make the recovery time shorter and reduce the chances of side effects, they become the preferred choice.¹¹

Who is the ideal candidate for laser skin resurfacing?

You might be a good candidate if you have sun-damaged skin or skin that hasn't responded to a facelift, enlarged oil glands on the nose, acne scars, uneven skin tone or feel, birthmarks, liver spots, age spots, or fine lines and wrinkles around the mouth, eyes, or forehead.^8,10,11

On the other hand, you might not be a good candidate for this procedure if you have deep wrinkles, active acne, very dark skin, or sagging skin (significantly loose).^3,8

How is the laser skin resurfacing performed?

To minimize risks and enhance outcomes six weeks or more before the laser procedure your plastic surgeon may suggest a few personalized skin treatments that help prepare your skin for resurfacing.⁵

Performing the procedure can take anywhere from 30 minutes to 2 hours, and usually does not require a hospital stay.⁵

Things to check before laser resurfacing

When discussing laser skin resurfacing with your surgeon, ask about these things:

• Their certification
• Their training
• Facility accreditation
• Your candidacy
• Procedure details
• Recovery
• Risks, and expected results
• Before-and-after photos⁴ 

Preparing for laser skin resurfacing

• Apply sunscreen daily for a month before the procedure and avoid prolonged sun exposure⁸
• Avoid deep facial peels, laser resurfacing, or strong chemical peels for one month before the treatment⁸
• Refrain from using medications that can cause photosensitivity, such as doxycycline and minocycline, for at least 3 days before the treatment⁸
• If you have herpes or shingles, it’s important to tell your doctor. You may need to start taking antiviral medication as directed, two days before your procedure and continue for three days afterwards⁸
• You may need to use a topical retinoid for about one month before your treatment⁸

Complications and risks of laser resurfacing

• Changes in skin colour: after the treatment your skin might become darker (hyperpigmentation) or lighter (hypopigmentation). Usually, hyperpigmentation happens in darker skin and can be solved by using a bleaching agent after the procedure.^3,8,10,11 Keep in mind that you should use a broad-spectrum sunscreen for weeks before and after the treatment to prevent changes in skin color⁸
• Milia: small white bumps may develop in the treated areas, during the healing phase, these bumps can usually be removed with soft washing using a washcloth^8,11
• Herpes simplex: herpes can be reactivated after the treatment, especially if the treated area is around the mouth. Your doctor might give you antiviral medication before and after laser treatment to reduce this risk^8,11
• Bacterial infections: You might experience bacterial infection after the treatment, and you can take antibiotics before and after laser treatment to reduce the chances of bacterial infection.^8,11
• Fungal infections might also happen¹¹
• Swelling: especially around the eyes, oral steroids may be prescribed to help manage it^8,11
• Expect clear drainage or minor bleeding in the treated areas on the day of surgery and the next day⁸
• Scarring: although rare, it is a potential side effect in laser-treated areas^8,10,11

Recovery and care after laser resurfacing

• Make sure to clean the area as instructed by your doctor.⁸ You might use a vinegar wash to gently clean the treated area during the healing process⁸
• Use an ice pack or cool compress as necessary⁸
• Apply an occlusive moisturizer (moisturizer that stops moisture evaporation by forming a barrier), or an antibiotic ointment to promote healing^8,12
• Avoid harsh skin treatments for 6 weeks and activities that cause skin redness for 2 weeks⁸
• Use an extra pillow while sleeping for the first four nights after the procedure to help minimize swelling⁸
• Avoid smoking as it can slow down recovery⁸
• Once your skin heals, use a daily sunscreen with at least SPF 30 that protects against both UVA and UVB rays along with a moisturizer, which is essential for skin protection^8,11

Expected Outcomes After Laser Skin Resurfacing

After the procedure, your skin may feel sensitive and appear red, like sunburned skin. It may itch, swell, sting, ooze a yellow liquid, or even blister in the first few days. It's important not to scratch flaky skin to avoid scarring and infection.^6,8

After about a week, your skin will begin to be pink, dry, and peel and will gradually lighten over the next two to three months.^6,8

You can expect immediate improvements in your skin. The skin's appearance can enhance for up to a year, with results lasting several years. As ageing continues, new wrinkles may form, which can be treated again with laser resurfacing.^7,8 

Summary

Laser therapy is a commonly used procedure for reducing signs of aging, it is an effective, non-invasive option for skin rejuvenation, and it includes different laser types (ablative, non-ablative, and fractional lasers) that are used depending on the severity of the skin condition.

As skin ages, internal and external factors cause visible signs of ageing, and laser treatment can reduce wrinkles, improve skin texture, and enhance skin tone. Although results last for several years, repeat sessions may be required as the skin continues to age, and proper post-care, such as avoiding sun exposure and using moisturizers, is essential for effective recovery and long-lasting outcomes.