Overview of Laser Carbon Dioxide Resurfacing
Carbon dioxide (CO2) lasers have been around since the 1960s. Originally, they were mainly used for cutting tissue or destroying it. The initial type of CO2 lasers could destroy tissue up to a depth of 400-500 μM (a μM is a thousandth of a millimeter), making it useful for a variety of medical treatments, like treating pre-cancerous conditions in the neck of the womb (cervical intraepithelial neoplasia) and surgery on the upper eyelid (upper eyelid blepharoplasty).
In the 1990s, the technology advanced, resulting in high-energy pulsed CO2 lasers. These new lasers could remove tissue at a shallower depth, between 20 to 100 μM, and also avoid heat damage to deeper tissues. This kind of laser is especially useful for less aggressive procedures like skin resurfacing, which is when the top layer of skin is removed to promote new skin growth.
A significant development came in 2004, with the introduction of fractional CO2 laser systems. Fractional treatment splits the main laser beam into a large number of microbeams, creating columns of destruction through the skin while leaving surrounding skin undamaged. This approach potentially has fewer side effects than non-fractional treatment, particularly when it comes to avoiding skin discoloration after treating patients with darker skin.
Anatomy and Physiology of Laser Carbon Dioxide Resurfacing
Laser resurfacing is a procedure where a specific type of energy is used to remove the top layers of skin. This can be done in two ways. The ‘total’ method removes all portions of the treated area, while the ‘fractional’ method only targets certain spots, leaving surrounding areas untouched. This creates a pattern of treated and untreated areas.
A special tool, known as a carbon dioxide laser, is often used in this process. This laser produces energy that is absorbed by water inside skin cells. This process removes the outermost skin layers, which encourages new skin growth from remaining skin features, such as sweat glands and hair follicles. The heat generated also causes the collagen (a protein in our skin that gives it strength and firmness) to contract and remodel itself in the deeper layers of the skin. This contraction leads to the overall skin tightening.
Compared to other lasers, carbon dioxide lasers create more heat and help control bleeding when treating a large area. This is because they cause the small blood vessels in the skin to clot. The heat from this process also encourages the deeper layers of the skin to heal and regenerate faster, leaving the treated surface nearly sterile or free from potential infection-causing bacteria.
Why do People Need Laser Carbon Dioxide Resurfacing
Doctors use carbon dioxide lasers to treat a variety of skin issues. These lasers can be used to treat and prevent damaging effects of sun exposure and reduce the appearance of scars. They can also be used to prevent and treat pre-cancerous skin growths and certain types of skin cancer, like squamous cell carcinoma and basal cell carcinoma. It is often used on skin growths such as hamartomas.
People with fair-skinned “Fitzpatrick type I-II skin” often see the best results from this treatment. This is because they have fewer melanocytes, the cells that produce skin color, which can cause skin discoloration after the treatment.
Using a CO2 laser can also improve the look of signs of aging and wrinkles. Aging skin can become more lax, uneven in color, and rougher in texture. Ageing also causes wrinkles, which stick around even when the muscles are relaxed. If one compares with other treatments like dermabrasion and chemical peels, lasers offer better control due to their precision. Some studies have reported significant improvements in the look of faded, wrinkly skin on the forehead, between the eyebrows, and around the eyes and mouth.
This treatment might also be used for scarring from acne, trauma or other surgical procedures. CO2 lasers work well for these issues because they cause small, controlled areas of damage below the of level of the scar, so that a fresh layer of collagen — a protein that gives skin its strength and elasticity — can form. This also “blends” the scar with the surrounding skin. Moreover, CO2 lasers cause less bleeding for treating surgical scars and offer lesser side effects like skin crusting as compared to dermabrasion.
However, for treating pre-cancerous skin growths and sun damage, CO2 lasers may not always be the most efficient. When compared to other treatments like 5-fluorouracil or trichloroacetic acid chemical peels, CO2 lasers have shown equal effectiveness in shrinking the size of pre-cancerous growths and certain forms of skin cancer. However, patients reported more satisfaction and lower incidence of cancers when using trichloroacetic acid compared to other treatment methods.
CO2 lasers can effectively treat keratinocyte skin cancers, a type of skin cancer. They may be especially beneficial for patients on blood thinning (anti-coagulating) medication, as the heat from these lasers makes the blood clot (coagulate), thereby reducing bleeding. However, a possible disadvantage is that doctors cannot confirm complete removal of skin cancers due to the impact of thermal heat, contributing to difficulty in the microscopic assessment of the treated areas. Still, the method has shown promising results; in one study, when doctors treated several basal cell carcinomas (a form of skin cancer) with CO2 lasers, none of the treated areas showed signs of cancerous tissue upon follow-up exams.
When a Person Should Avoid Laser Carbon Dioxide Resurfacing
There are times when using a CO2 laser for skin resurfacing isn’t recommended. If someone has active acne, it might lead to an infection or unusual bacteria growth after the procedure. Any open sores or current infections, especially caused by the herpes simplex virus, would mean that the procedure should be delayed until these have cleared up.
Issues with skin accessory structures, possibly caused by autoimmune diseases, burns, or exposure to radiation, can impact skin re-growth. People with a history of these conditions might not be suitable for treatment with CO2 lasers. If a person has recently been using isotretinoin, an oral medication for severe acne, in the past 6 to 12 months, this could slow down wound healing or cause unwanted scarring.
Lastly, if a person has a history of diseases that get worse when the skin is injured, like vitiligo (a disease that causes loss of skin color in patches) or psoriasis (a skin condition that speeds up the life cycle of skin cells), this would also rule out the use of this therapy.
Equipment used for Laser Carbon Dioxide Resurfacing
A carbon dioxide laser is a tool that produces a focused beam of light. This light beam is made by a special mix of gases—carbon dioxide, nitrogen, hydrogen, and helium—which work together to generate a specific type of infrared light, with a precise length (10,600 nm). This laser light is primarily absorbed by water molecules, which is important in medical treatments as our bodies contain a lot of water.
When using these lasers, it’s critical that everyone in the room wear protective eyewear. This is because the lasers produce light that could harm your eyes if directly exposed. This includes both the person operating the laser and the patient. The patient’s eyes can be shielded with damp gauze and special sun-blocking eye protectors. The operator and any other personnel in the room have to wear protective goggles that are designed to block the specific wavelength of light produced by the laser. Interestingly, goggles made for carbon dioxide lasers are usually clear, unlike other types of laser goggles that might be tinted.
Who is needed to perform Laser Carbon Dioxide Resurfacing?
The CO2 laser resurfacing is a procedure that requires a team of medical professionals. This team is led by a licensed doctor who could be a skin specialist (dermatologist), ear, nose, and throat doctor (otolaryngologist), plastic surgeon, or oral surgeon. The doctor may also be a medical professional who’s supervised by another doctor. They are helped by physician assistants or nurses who’ve been trained in using lasers for skin treatments.
These medical professionals all have training in how to use lasers safely. The same team is responsible for making sure you’re suitable for the procedure, giving advice and guidance before it takes place, and checking your recovery afterwards.
Preparing for Laser Carbon Dioxide Resurfacing
Before starting any kind of laser treatment, it’s important for the doctor to understand your medical history and to conduct a physical examination. They will pay special attention to what’s known as your Fitzpatrick skin type, which basically refers to how your skin responds to sunlight and what risks you might face with laser treatment. People with darker skin types—those with a higher Fitzpatrick class—may need to use a special combination of skin-lightening cream (hydroquinone) and an exfoliating acid (glycolic acid) to prevent changes in skin color.
During your pre-treatment visit, your doctor should explain to you what you can expect from the treatment and how you should look after your skin before and after the procedure. You also have the right to be informed about any potential complications that might result from the treatment.
If you’re getting laser resurfacing around the mouth area, it’s a good idea to start taking antiviral medication the day before or the morning of the procedure. This is to avoid the risk of developing a severe herpes outbreak, which can lead to notable scarring. There are various antiviral medications available, but one example is valacyclovir, which is typically taken twice daily for 14 days.
How is Laser Carbon Dioxide Resurfacing performed
When you’re getting facial resurfacing with a CO2 laser, it’s necessary to manage any discomfort you might feel. Depending on if you’re having a full face treatment or just a smaller area, you’ll either be given general anesthesia, where you’re asleep, or a more targeted anesthetic cream and shot. This is similar to what you might get at the dentist. You’ll also have protective eyewear to keep your eyes safe during the procedure.
Before the procedure, you’ll likely be given antiviral medication, because most people have been exposed to the herpes simplex virus. This medication reduces the risk of potential infection. After the procedure, you’ll often be prescribed an antibiotic to further protect against infection. You might also be treated with an antifungal medication, which has been shown to speed up healing time. This medication is usually given on the same day as the laser treatment.
The laser used in the procedure is set to a very specific setting. The energy applied is around 5 J/cm^2 and it’s applied for less than a millisecond. While this might seem very science-y, what you need to know is that these settings help to remove the top layers of skin without causing too much heat damage. The exact settings will depend on your specific skin type and concerns.
After your procedure, your skin will usually start to heal within about a week. You might notice some crusting in the area where your skin has been treated, similar to when you have a scrape. To help with your recovery, you’ll be given special creams or gels to take care of your skin for the first 48 hours. These will keep your skin moisturized so it can heal properly and they help to reduce the formation of crusting. For about 1 to 2 weeks, you may experience some swelling, redness, and discomfort. The inflammation will typically go away after six weeks, but in some cases, it may last up to 6 months.
Possible Complications of Laser Carbon Dioxide Resurfacing
After a medical procedure, the typical recovery involves redness, peeling, and sensitive skin, which can continue up to three months after treatment. There can also be some short-term complications including the appearance of small, white bumps called milia, and acne-like breakouts in the area that was treated. There’s also a chance that the herpes simplex virus, which causes cold sores, could reactivate. If you have a history of these cold sores, your doctor might recommend a medication called valacyclovir to prevent this.
Like with any medical procedure, there’s always a small risk of infection. Bacterial and fungal infections are less likely after certain procedures, like a type of laser treatment called CO2 laser resurfacing. This is because the heat from the treatment can kill off harmful bacteria or fungi. However, these infections can still happen, particularly if bandages that cover the skin are left on for too long. Generally, it’s advised to remove these within 48 hours after the procedure.
Changes in skin color, either darkening (hyperpigmentation) or lightening (hypopigmentation), are also common. These changes can be more likely in people with darker skin tones. Darkening of the skin is usually temporary and tends to return to normal by itself. It’s also the more common effect of skin procedures. There are creams and chemical peel treatments available that can lessen the appearance of darkened skin. Lightening of the skin, however, is a bit trickier. It can happen more frequently with CO2 lasers than with other types of lasers because of the heat and subsequent inflammation they cause. If this happens, potential treatment options include different types of laser treatments or light therapies.
What Else Should I Know About Laser Carbon Dioxide Resurfacing?
Carbon dioxide (CO2) laser skin resurfacing is a method used to treat and prevent wrinkles and loose skin that come from sun damage. It also helps treat and prevent certain types of skin cancers. This technique is used for both cosmetic and medical purposes.
Picking the right patient for this treatment and making sure they understand what to expect is extremely important. CO2 laser treatment works best on individuals with lighter skin (known as Fitzpatrick skin types I-II). However, it can also be used on darker skin (types III-VI), as long as the settings are carefully adjusted, and they are using a specific delivery system.
There are potential infection risks, such as herpes reactivating, or bacterial and fungal infections, which can slow down healing. Any patients undergoing this treatment should be closely monitored to handle any complications right away, such as providing proper preventive measures.