Overview of Laser Erbium-Yag Resurfacing
As we age, our skin starts to change due to time and sun exposure. It loses its elasticity, changes color, and can develop scars due to injuries, acne, and other causes. To refresh the look and feel of skin, especially on the face, a technique known as laser skin resurfacing is often used. This technique is now a standard option to enhance the texture, color, and firmness of facial skin.
For a long time, a kind of laser known as carbon dioxide (CO2) laser was the only one used for skin rejuvenation. But today, several other options are available, including the solid-state erbium-doped yttrium aluminum garnet Er:YAG laser, diode laser, and erbium:glass lasers.
The Er:YAG laser got its approval from the FDA (Food and Drug Administration) in 1996 for skin surface treatment. A comparison with CO2 lasers showed that the Er:YAG laser worked just as well, but people might recover faster after its use. At first, short-pulse Er:YAG lasers were used, which had pulse lengths of 250-350 microseconds, but later, in 1999, longer-pulse Er:YAG lasers were introduced. These later models were designed to improve coagulation (blood clotting), which would reduce bleeding when compared with procedures using short-pulse Er:YAG lasers.
Anatomy and Physiology of Laser Erbium-Yag Resurfacing
The Er:YAG laser works at a wavelength of 2,940 nm, which is very close to the absorption peak of water at 3,000 nm. This simply means that the laser works very well with water. When the laser pulse is applied, the light energy it emits gets absorbed by water in the two upper layers of the skin, also known as the epidermis and papillary dermis. This results in two positive effects for skin rejuvenation.
The first is that the outer layer of the skin or the epidermis gets vaporized. Then, the hair follicles and sweat glands heal the skin surface. The second effect is that the heat injuries in the dermis layer stimulate the production of collagen, a protein that contributes to the firmness of our skin. This process improves the appearance of damaged skin while reducing visible signs of aging and scars. The process of evaporating of water also acts like a heat sink – it absorbs the heat and reduces the amount of heat damage to the surrounding skin tissues. This allows the same target area to be lasered multiple times in the same session without causing a burn, providing improved results with fewer treatment sessions.
There are typically two types of laser skin rejuvenation treatments: ablative and non-ablative. Ablative lasers vaporize and coagulate the most superficial layers of skin, resulting in skin rejuvenation through reepithelialization (healing of the skin surface) and collagen stimulation. Non-ablative lasers, on the other hand, do not remove the outer layer of skin (epidermis) but still cause thermal injuries that stimulate collagen and elastin production. While ablative treatments often yield more dramatic results, they also come with higher risk and longer recovery time, which is why many patients prefer non-ablative lasers. But, more treatments with non-ablative lasers are often required to achieve the same effect as a single treatment with an ablative laser. The Er:YAG laser falls into the category of ablative lasers.
Treatments with ablative lasers can be done in two ways: full-field therapy, which treats the entire target area, or a fractionated beam that treats microscopic columns within the treatment area while leaving areas in-between unaffected. This leaves some skin and hair follicles untouched, enabling quicker recovery, fewer side effects, and better collagen production. The aim is to go down to the papillary dermis layer of the skin. The thickness of this layer varies across the facial area, with the eyelids being the thinnest at about 150 micrometers and the chin being the thickest at about 200 micrometers. Though the thickness varies broadly, using the precise nature of the laser skin treatment benefits, it efficiently rejuvenates the skin.
Why do People Need Laser Erbium-Yag Resurfacing
Er:YAG laser resurfacing is a treatment that can be used for a variety of skin issues. Some of these include certain types of skin damage, uneven skin color, wrinkles, scarring, loose skin, or for improving rough skin texture. This treatment tends to be safer for people with lighter skin tones (known as Fitzpatrick skin types I and II). But, it can also be used on those with slightly darker skin (types III and IV) by using a less intense procedure.
The Fitzpatrick skin classification is a system that groups skin types based on how well they tan and how easily they can get sunburnt. Type I skin is very fair, often freckled, with green or blue eyes and red or blond hair. People with this skin type always burn and never tan. Type II skin burns easily and tans minimally. These individuals typically have fair skin, blue eyes, and blond or brown hair. People with Type III skin burn moderately and can tan to a light brown color. They’re usually fair-skinned with brown hair and brown eyes, and are typically of European descent. Type IV skin, often seen in people of Mediterranean or East Asian descent, can tan easily to a moderate brown color and burn minimally. They have dark hair and eyes. For darker skin types (V and VI), it is safer to use a technique known as fractionated beam resurfacing, as this reduces the risk of uneven skin color or texture. Even so, treatments should be done carefully.
Er:YAG laser resurfacing brings visible improvements to facial wrinkles within 3 to 8 weeks after the treatment, especially around the mouth and eyes. On a microscopic level, there’s a noticeable increase in skin collagen six weeks after the treatment. This type of laser has also been shown to effectively remove benign (noncancerous), pre-cancerous, and cancerous skin growths. For any skin lesion, the laser is applied several times in a row until the growth is no longer visible. This technique has been effective for treating pigmented birthmarks in newborns and adults, although this may lead to lighter or darker patches in the treated area. The Er:YAG laser can also treat seborrheic keratoses (benign skin growths), skin tags, and superficial intradermal cysts effectively.
When a Person Should Avoid Laser Erbium-Yag Resurfacing
There are certain situations when Er:YAG laser facial resurfacing, a procedure that uses laser technology to improve the appearance of your skin, is not recommended. For example, if you have recently used isotretinoin (a medication for severe acne) in the past 6-12 months, have had radiation therapy in the past, have a history of keloid scarring (which are thick, raised scars) or if you have a condition called ectropion (where your lower eyelid turns outwards), this procedure may not be suitable for you.
Also, this treatment is more appropriate for patients with lighter skin tones (known as Fitzpatrick type I-II), although some methods can be performed on darker skin tones (Fitzpatrick type III-IV). If you have very dark skin (Fitzpatrick V-VI), it’s generally advised to avoid this laser procedure as it may result in uneven skin color (dyspigmentation) after the operation. The same caution applies for those with vitiligo, a skin disorder characterized by patchy loss of skin color.
Other things that may delay the healing process or potentially complicate the procedure are health issues such as diabetes and autoimmune diseases, which may impact the body’s ability to recover from the treatment. Additionally, if you have skin infections, such as acne, cellulitis, impetigo, or herpes outbreaks, it is important to wait until these clear up before going ahead with the laser treatment.
Equipment used for Laser Erbium-Yag Resurfacing
When using a laser for medical treatment, safety measures are crucial for everyone involved. One critical safety measure is the use of protective eyewear that shields from harm specifically at a wavelength of 2,940 nm. The entire healthcare team present during the procedure needs to wear these safety goggles to protect their eyes, particularly the cornea, from any harm caused by the laser.
The type of laser used in this procedure is the Er:YAG laser, which gives off energy that is near-infrared. This means that even though the goggles protect against this laser, they still allow those wearing them to see clearly. The patient also needs to protect their eyes during the procedure, for which they can either wear safety goggles or use special steel eye shields, depending on where the laser is being used.
As an added measure of safety, a fire extinguisher should be easily accessible anytime lasers are being used, especially if there’s also an oxygen source. In case a fire does occur, a container of water should also be readily available to help put it out.
Another safety tool that should be present during laser procedures is a smoke evacuator with an ultra-low particulate air (ULPA) filter. This device helps to clear away smoke and tiny particles that could carry harmful microorganisms. Also, instead of wearing the usual surgical masks, anyone present during the procedure should wear special masks that are rated for laser use. These measures help prevent anyone from breathing in any harmful substances.
Who is needed to perform Laser Erbium-Yag Resurfacing?
Laser resurfacing is a simple procedure that doesn’t require a lot of medical staff. Usually, it only needs a doctor and a trained professional, like a nurse, to handle the laser equipment. This can be done in a regular doctor’s office. However, if a larger area, like the whole face, needs to be treated, a strong sleeping medication is suggested. This would mean having an anesthesiologist around. An anesthesiologist is a doctor trained to give sleeping medications and make you comfortable during procedures.
Preparing for Laser Erbium-Yag Resurfacing
Before starting Er:YAG laser therapy, a detailed health check-up is necessary. Patients need to be aware of possible risks linked to this treatment and what they can expect as a result. The doctor will also check for any reasons why the treatment may not be suitable for them. If the area around the mouth is to be treated, patients should inform the doctor if they have ever had cold sores, as the laser can trigger another episode. They’ll also have to mention any skin disorders, like vitiligo, on the areas that will be treated. Patients also need to give details about their exposure to the sun, usage of sunscreen, and any personal or family history of skin cancer.
If the area around the mouth is set for laser treatment, the patients must take preventative medication to avoid herpes simplex (which appears as cold sores) outbreaks after the treatment. These sores might lead to scarring and might also get infected with bacteria such as Staphylococcus aureus. A common preventative treatment is valacyclovir, 500mg taken orally twice a day for 14 days. This treatment begins the day before, or on the day of the laser treatment.
How is Laser Erbium-Yag Resurfacing performed
For treating skin spots, a type of laser is used that can produce short bursts or “pulses” of light. These pulses reach about 10 micrometers deep into the skin, which is roughly a tenth of the thickness of a human hair. The skin typically heals over the course of 4 to 7 days after this treatment.
This laser technique can also be adjusted to treat larger skin areas; for instance, a small region with acne scarring, specific sections of the face like cheeks and forehead, or even the whole face. Depending on what is needed, the laser can penetrate at different depths into the skin. It can reach 250 micrometers for general skin rejuvenation, while for deeper scars, such as those caused by acne, surgery, or injury, it can go as deep as 1000 micrometers.
There are various available laser machines that can deliver this kind of laser treatment. Some use a tube and mirror system and others an optical fiber. They all test the laser on a wooden tongue depressor to ensure it’s functioning properly before the procedure.
The duration of the individual pulses can increase the heat under the skin which can enhance the results but can also increase the risk of adverse effects. However, shortening these pulses and increasing their overlap can lead to better skin rejuvenation with fewer treatments. During the treatment, the laser removes upper layer of the skin and then exposes the collagen underneath. This results in a skin tightening effect while reducing bleeding.
It’s important to use a smoke evacuator to prevent inhalating any potential viruses in the smoke during the procedure. If there’s any bleeding, a gauze soaked in a vasoconstrictor, a type of medicine that narrows blood vessels, can help control it.
For superficial resurfacing of the skin, a certain amount of laser energy is used, removing part or all of the skin’s top layer. This can help improve the look of aging skin with a shorter recovery period and less need for anesthesia.
The specialist keeps using the laser until enough skin has been treated, as indicated by visual signs. These include tiny spots of bleeding, a yellow color (chamois color), which indicates deeper treatment, or visibly smoother wrinkles. The best results usually mean matching the treated areas with the natural divisions of the face.
To make the procedure more comfortable, it can be done under local, regional, or general anesthesia depending on the extent of treatment. After the procedure, the treated area is kept moist with a saline-soaked bandage and ointments or hydrocolloid dressings to help the skin heal. Healing usually completes between 5 to 7 days after treatment but the redness may last for a few months.
Possible Complications of Laser Erbium-Yag Resurfacing
If you undergo Er:YAG laser therapy, a type of skin resurfacing treatment, there are a few short-term side effects that might occur. For example, you could experience redness and bleeding or even see a return of a previous cold sore infection. Some people could get a bacterial or fungal infection on their face, usually from species like Staphylococcus or Candida, but this can be easily treated with medication.
After the treatment, you might see changes in the color of your skin in the areas that were treated, or you might even develop some scarring. Having lighter or darker patches of skin is a common side effect of this type of treatment. Generally, the Er:YAG laser therapy is less likely to darken the skin compared to another popular laser treatment called CO2. However, some studies suggest that they might have the same side effects.
The longer the laser pulses are during your treatment, the higher your chances are of experiencing changes in your skin color. This is because longer pulses deliver more energy per pulse, which can cause more damage to your tissues due to the heat produced. However, a technique that delivers the laser in a fractionated beam can reduce the risk of changes to your skin color. Usually, these color changes will fade with time. Darker patches are more common and tend to disappear more often than lighter ones. If your skin becomes darker and doesn’t go back to normal, a skin-lightening cream containing 4% hydroquinone could help. If your skin becomes lighter, topical steroids might be recommended, or other options including sun exposure, blue laser therapy, intense pulsed light, or CO2 laser treatments.
People with darker skin tones are more likely to experience prolonged redness and pigment changes. You might also see other side effects, like the appearance of acne, small, white cysts called milia, or dermatitis on the area treated. If you’ve undergone a fractionated beam treatment, you might notice a grid-like pattern on your skin, but this usually fades over time and could be treated with topical steroids or more laser treatment if it doesn’t go away on its own. The biggest concern is if too much energy is used during the treatment, resulting in a burn and possibly a scar. You could treat this with laser therapy like you would for any other scar, but many people are understandably hesitant to undergo more treatment if they’ve already had a negative experience.
One of the most serious side effects that could result from this treatment is an eye injury, particularly to the cornea, which is the transparent front part of the eye. This can be prevented by using an eye lubricant and corneal shields during your treatment, and your eye doctor should be consulted if a corneal injury does occur. The healthcare staff conducting the laser treatment should also protect their own eyes with glasses that can block light of a certain wavelength.
In order to lower the chance of these risks, it’s essential that your medical history is thoroughly reviewed and that you’re physically examined before your treatment. You should also be educated about how to care for your skin during the healing time after your treatment. You’ll need to be aware of the typical changes that will occur as your skin heals, and be clearly informed about the risks for infection, scarring, or a longer than expected healing time.
What Else Should I Know About Laser Erbium-Yag Resurfacing?
Er:YAG laser skin resurfacing is a popular technique for treating various skin conditions. It can be used for targeted treatment of specific areas or entire sections of the skin. The laser emits light at a particular wavelength that is absorbed by water in the top and middle layer of the skin, which are known as the epidermis and dermis.
By removing the epidermis layer, this treatment can help fix problems like sun damage, uneven skin tone, and rough skin texture. The heat from the laser also causes some damage to the dermis, the layer below the top one, which stimulates the production of collagen, a protein responsible for making the skin firm and plump. This can reduce loose skin and help with the appearance of static wrinkles. With the right choice of patients for this treatment, it can significantly improve the appearance of the skin.
The Er:YAG laser treatment is especially beneficial for patients with lighter skin tones (known as Fitzpatrick skin types I-II) but can also be used carefully for people with slightly darker skin tones (known as Fitzpatrick skin types III-IV).
What’s more, the Er:YAG laser isn’t only useful on its own. It can work well alongside other treatments, like CO2 laser treatment. Research has found that using these two lasers together can reduce the crusty bits and itching sensations that can sometimes happen after skin resurfacing treatments. The Er:YAG laser can also be used in addition to surgical procedures like facelifts and eye lifts.