Cosmetic Plastic Surgery Articles

In my last blog post, we started our deep dive into laser resurfacing treatments in an effort to pinpoint which one is right for your particular skin type and issue. We’ll wrap it up here with a look at nonablative and ablative resurfacing lasers.

Resurfacing lasers work a bit differently than true lasers. Rather than melanin or capillaries, they target water molecules within the collagen layer of the dermis. Heating them creates a kind of grid, which tricks the skin into a healing phase, triggering the production of collagen.

Nonablative resurfacing lasers

This segment refers to fractional lasers that keep the skin’s surface intact and picosecond lasers outfitted with something called a diffractive lends, which essentially breaks up the beam. They cover widespread areas, as opposed to lone spots. They’re mainly used to refresh and rejuvenate by building new collagen, helping to smooth the skin, and eliminating some of the pigmentation that results from sun damage.

Nonablative resurfacing lasers are considered safe for most skin types. As to which one is appropriate for you, that depends largely on what’s being treated. Baby fractional lasers, as they’re called, achieve a striking radiance boost, but only subtle textural improvements. (It’s a popular choice for treating melasma.) Picosecond lasers go a little deeper and, in turn, have more of an effect on fine lines, wrinkles, and scarring. And, a stronger fractional laser is effective for correcting significant sun damage on the face, neck, chest, arms, and hands.

Numbing cream may be used before baby fractional and picosecond procedures, but neither is all that painful. They feel like mild, prickly zaps. The stronger fractional lasers require topical numbing and some ibuprofen beforehand.

The treated area’s going to feel dry for about a day following the mild resurfacers. With the stronger fractional lasers, the skin will look red and then dirty for up to a week as the tarnished cells are shed.

Ablative resurfacing lasers

These lasers generate greater heat, which is then used to create a purposeful wound on the skin’s topmost layer. The ablation, and the resulting injuries, equals a more generous collagen renewal over the weeks following the treatment.

You may have heard stories about the non-fractionated ablative lasers of old. They live on in infamy for the pain they inflicted, their risk, and the significant recoveries they entailed. The latest generation of fractional ablative lasers is far safer and more predictable. (That said, they’re not recommended for dark complexions.)

If you want to smooth out deep wrinkles or delete severe sun aging or prominent scars, your plastic surgeon is likely to recommend an ablative laser.

You’ll be prepped for the treatment with numbing cream, lidocaine injections, and Percocet and/or Valium. Afterward, plan on laying low for about a week. The treated skin is going look swollen and scabby, which you’ll need to be prepared for, mentally. But, given that, the healing phase is surprisingly painless.

“Laser” is a term that’s entrenched in the mainstream vocabulary, yet its meaning is often lost. Did you know, for example, that laser is an acronym? It stands for light amplification by stimulated emission of radiation.

That’s worth noting, not as some sort of intellect flex, but because “laser” has become a generic catchall for a bunch of sophisticated dermatologic machines that rely on different kinds of energy to achieve distinct results. Enter into a treatment with any one of them blindly or under-informed and you may be in for far more (or less) than you expected.

In that vein, I’ll be dedicating our next two blog posts to taking a deeper dive into laser resurfacing treatments. Lasers are now being used to treat pretty much every kind of skin condition, from sun damage and aging to acne scars and regrettable tattoos, often with little to no downtime. Which one is the best for your particular skin type and issue? Let’s find out.

Vascular lasers

Lasers are characterized by a few key features, namely their wavelength, which is absorbed by the target on the skin, and their pulse width, or the rate at which the beam of light is delivered. Generally, the longer a wavelength, the deeper it will penetrate. And the quicker the pulse, the better suited it is for treating small targets.

Vascular lasers—most commonly a pulsed dye laser (PDL) or a KTP laser—are used to treat sun damage, new stretch marks, and certain types of scars. They heat hemoglobin, a protein in red blood cells, destroying blood vessels in the process.

Despite being around for decades, vascular lasers are now playing an integral role in scarless treatments for basal and squamous cell cancers. Since 80% of non-melanoma skin cancers are on the head or neck, the noninvasive treatments have become a real game-changer.

Any treatment with a vascular laser, cosmetic or otherwise, is fairly painless. With the PDL, you’ll see the reflection of the laser’s flash through your opaque goggles, but you won’t feel much of anything. And, KTP lasers feel like a cool blast and then a quick pinch. Your skin may be a little pink and puffy afterward, but that should disappear within a few hours.

Pigment lasers

Pigment lasers fall into one of two main categories: Q-switched (the Ruby, Alexandrite, Nd: YAG) and picosecond (PicoSure, Pico Genesis, PicoWay). Q-switched lasers are a popular go-to for treating sunspots, often in a single shot. With a span of wavelengths, they’re also a safe option for every skin tone.

Picosecond lasers fire faster, so fast that the skin doesn’t even register their heat. In doing so, they generate a strong acoustic wave that obliterates pigment particles. While they’re plenty effective (and safe) for treating sunspots in all skin types, they’ve made the tattoo removal process much more effective than it was only a couple years ago. Blue, green, and purple ink was very difficult to remove with traditional Q-switched lasers, but they respond beautifully to the picosecond pulse.

As for how they feel, Q-switched lasers create a sensation akin to a rubber-band snap. The picosecond laser may necessitate some numbing cream and/or a lidocaine injection before treatment. Dark spots treated with a Q-switched laser will change color immediately and then turn into a scab, which will take about a week to flake off. Similarly, tattoos treated with a picosecond laser will change color right way and then form a scab, which will need to be covered for about a week. But, as the pigment fades, the treated area will feel less sore following each new treatment.

While microneedling may seem like it’s on everyone’s lips these days, it’s actually been around for a while. The skin treatment’s discovered a second life as an effective alternative to laser and injectable treatments.

Devotees swear by it (we see you, Gwyneth), and the super-loyal following has in turn spawned an avalanche of at-home kits. None, however, are nearly as powerful as in-office microneedling with a board-certified plastic surgeon.

How it works

The science behind it is pretty straightforward: Create a series of very small injuries in the skin to help promote collagen. A handheld device with small needles on its head is used to pierce the epidermis and dermis. And it’s the body’s natural healing process that helps promote the production of collagen, which helps thicken the skin, minimizing fine line lines, enhancing tone, and even diminishing pigmentation—largely the same effect of many of the new laser treatments.

Where microneedling has the upper hand over lasers is that it’s tolerated by a wider range of skin tones. Those prone to hyperpigmentation—a condition where patches of skin become darker than the surrounding skin—like many women of color tend to be, don’t respond well to the heat of some laser treatments.

Another benefit of microneedling that often gets overshadowed by the fountain-of-youth aspect is that it makes it easier for skin care products to be absorbed deeply into the skin. The micro-channels that form in the skin as a result of a treatment theoretically aid in the maximum absorption of topical nutrients, which can also jumpstart the body’s own collagen and elastin production.

What to expect

As the microneedling pen moves across the cheeks, chin, nose, and neck, it can feel like a light, sandpaper-like vibration. It’s often compared to a cat licking your face. It can sting a bit more on the bony parts of the face, namely the forehead. Just remember that the sensation is only momentary (a couple minutes, at most), while your reinvigorated skin will last for weeks.

Immediately after the treatment, your face may be irritated in spots, but it’s more of a pinkish flush than full-on red and swollen. You may also see the slight indentations all over your skin. Don’t be concerned. They’ll disappear quickly. And once they do, they’ll give way to a smooth radiance, the kind almost exclusive to baby skin.

Over the next few days, your pores will look smaller and your fine lines should smooth out. And any discomfort you felt during the treatment will already be a distant memory.