Fully Ablative Laser Resurfacing
(CO2 & Erbium YAG) - London and Surrey
Co2 laser resurfacing is by far the most powerful skin rejuvenation technique available for facial skin.
It is performed in order to:
- Completely renew facial skin
- Tighten the skin to help reduce the consequences of laxity
- Remove wrinkles
- Improve elasticity and skin thickness
- Procedure Details
- Potential Complications
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This is a facial laser surgical procedure performed under a special type of local anaesthetic. Treatment of skin laxity and wrinkles around the eyes can also be incorporated into the treatment.
Not all CO2 and Erbium YAG laser are the same. This is a fully ablative CO2 laser or fully ablative Erbium YAG procedure that is only performed by a handful of experienced laser surgeons worldwide. It needs to be performed using a surgical-grade CO2 and Erbium YAG laser (not an aesthetic grade CO2/Erbium YAG laser which lacks the power and the ultra-short pulse width required to perform this procedure safely). Dr Hussein is one of the few laser surgeons worldwide who have the knowledge and the experience to offer this procedure and has performed numerous cases. He uses the Lumenis Ultrapulse CO2 and Sciton Joule X Erbium YAG laser. These are the world’s most powerful and state-of-the-art skin resurfacing lasers
As you will see from the photos below Dr Hussein is capable of performing what few others worldwide are capable of. The level of skin rejuvenation is simply outstanding.
This degree of improvement will, however, require 9 days of downtime.
Dr Hussein can perform a full-face treatment including eyes OR periorbital treatment (around the eyes only). Eyelid tightening treatment with fully ablative CO2 technique is the second most effective technique to reduce eyelid laxity after a surgical blepharoplasty. For clients who are not keen on surgical blepharoplasty, fully ablative CO2 eyelid treatment will give a considerable improvement for eyelid skin laxity and wrinkles. It actually improves lower lid wrinkles and skin surface texture over and above surgical blepharoplasty.
The greatest benefit of this procedure is that the results are permanent. Once healing is complete the skin you are left with is your new skin. The procedure doesn’t have to be repeated like other cosmetic treatments such as dermal fillers or BotoxTM. As long as the client takes good care of their skin results will last for many years before they need to consider doing anything further.
New type 3 collagen continues to be synthesized for up to 6 months post-procedure meaning that there is further improvement after the immediate healing phase. Dr Hussein is capable of performing laser resurfacing with fully ablative CO2 and Erbium YAG laser on all skin types. In general, darker skin types may encounter a higher chance of hyperpigmentation but this will eventually settle.
DR HUSSEIN’S CASE GALLERY – BEFORE & AFTER
Once the client has seen Dr Hussein for a consultation and treatment has been deemed appropriate the client will be listed for the procedure. During the consultation, a prescription for prophylaxis medications will be issued. These medications are to be used as instructed by Dr Hussein during the immediate few days recovery period following the procedure. Taking these medications minimises the risk of harmful side effects such as infection following this type of more aggressive skin laser surgery.
It is important that the client has somebody available to drive them home after the procedure is performed. Clients must not expect to drive back home themselves.
Dr Hussein will see the client before the procedure in order to prepare and clarify things. A consent form will be signed giving Dr Hussein permission to carry out the procedure. Antiviral tablets will be then administered as well as an optional sedative. Pre-procedure photos will be taken and following this, the face will be cleansed and prepared with a special type of topical local anaesthetic gel. Sometimes Dr Hussein will occasionally also use additional anaesthetic techniques such as tumescent anaesthesia or nerve blocks. These involve small injections of local anaesthetic under the skin.
Anaesthetic preparation will last for about 45 minutes. Following this, the Client will be moved into the procedure room and prepared for the fully ablative CO2 or Erbium YAG laser procedure. If treatment around the eye area is to be performed then the client will have had anaesthetic eyedrops applied and metal contact lens style eye-shields will be inserted. If the facial treatment only is performed then adhesive eye-shields that stick over the eyes will be applied. In most cases, clients who opt for full-face treatment usually will want to incorporate the benefits of eyelid treatment as well. It is therefore commonplace for clients to have both treatments performed in the same session.
Once Dr Hussein has commenced the procedure it will usually take around 45 minutes to complete. The level of discomfort experienced during the procedure is typically a prickly burning sensation that usually can reach up to a 5 out of 10 subjective severity. Dr Hussein has never encountered anyone who has been unable to cope with the procedure from a pain or discomfort point of view. Pain or discomfort from this type of laser surgery is best described as moderate at the most.
Following the completion of the procedure, the clients face will feel very hot. It is best described as a sunburn sensation. This burning sensation will last for up to 24 hours before settling. Following removal of protective eye-wear, a barrier cream called CU3 cream or Eucerin Aquaphor cream is applied to the freshly treated skin. This cream acts as an impermeable barrier to protect the denuded skin from dehydration and infection.
Detailed aftercare instructions will be discussed and issued in a written format to the client. These instructions must be adhered to strictly. Strict sun avoidance will need to be maintained in the immediate recovery phase and up to a month at least post-procedure. Use of a broad spectrum Sunblock SPF50 minimum is recommended for at least 3 months post-procedure.
Clients are at risk of infection during the first few days following the procedure. It is important to keep the face clean and strictly adhere to the aftercare instructions to minimise this risk. Dr Hussein usually gives a once a day antibiotic dose to minimise bacterial infection risk. There will also be a three times a day antiviral tablet as well. These tablets are to be continued for 7 days after the procedure. There will also be a pack containing medications for use ONLY if instructed to do so by Dr Hussein.
Dr Hussein will typically monitor day by day healing through the use of ‘selfie’ photos taken by the client and sent to the contact details issued by Dr Hussein. Dr Hussein can then provide real-time advice during the recovery period. Any client having this procedure will have a direct line of communication with Dr Hussein at all times throughout recovery. Close monitoring of this nature allows any potential complications to be dealt with quickly and risks minimised.
After 9 – 10 days clients can return to work. There will still be some ongoing redness that will take a few weeks to settle. A light foundation can be applied to mask this redness. Use of perfume free gentle cleanser and appropriate moisturiser is recommended. A high-quality SPF 50 sunblock must be used and steps to avoid sun exposure must be taken for the weeks following treatment. If these steps are ignored clients may find that they develop brown pigmentation on the treated areas of the face (post-inflammatory hyperpigmentation). Although this will spontaneously settle or treated it is better to avoid it by observing the sun avoidance precautions.
Fully ablative CO2 resurfacing is the most aggressive type of skin resurfacing procedure undertaken by Dr Hussein. As Dr Hussein is an expert in cutaneous laser surgery the incidence of side effects is low. In Dr Hussein’s hands fully ablative CO2 laser is a safe procedure.
However with any laser resurfacing treatment complications are possible. In fully ablative CO2 laser these include the following:
Post Inflammatory Hyperpigmentation (skin darkening)
This is the most common side effect. It is more common on darker skin types. Thankfully it usually spontaneously improves. Improvement can be speeded up by the addition of topical treatment such as hydroquinone 4% cream. Duration usually depends on the severity of the inflammation that created it in the first place. Complete resolution can take anything from a few weeks to 6 months depending on severity. Sun exposure is the most common aggravating factor and this is why strict sun avoidance is important in the first few weeks following treatment. If the aftercare instructions are strictly adhered to one is much more likely to avoid this type of complication.
True Hypopigmentation and Pseudo-hypopigmentation (skin lightening)
Hypopigmentation is the medical term for lightening of the skin. After fully ablative CO2 resurfacing it is normal for the skin to be slightly lighter. This is due to the way that the organised collagen in the new skin reflects more light. This gives an impression of a slightly lighter colour. This effect is called pseudo-hypopigmentation. True hypopigmentation is lack of melanin production due to damage caused to melanin producing cells by thermal injury from the laser. This is rare with fully ablative CO2 resurfacing as the new skin is repopulated with new melanin producing cells from the deeper adnexal structures which are a reasonable distance away from the treated surface of the skin. If true hypopigmentation occurs, it can take many months to recover and can indeed be permanent.
This is usually only an issue if a face is partly treated (eg. Treatment limited to around the mouth for smokers lines). The new skin may be subtly different in shade to the surrounding skin leading to a visible line of demarcation between treated and untreated areas. This is less likely in lighter skin types. Dr Hussein usually prefers to avoid part treatment for this reason and will treat the whole face albeit with a variable strength depending on what needs to be achieved. This allows for a more blended result. It is important to note that if lighter freckled skin is part treated there will also be a demarcation between untreated freckled skin and treated freckle free skin.
This can happen in any kind of laser resurfacing. HSV infection (cold sore virus) is the most common kind but is usually prevented by taking an acyclovir tablet three times daily for 7 days during the recovery period. Bacterial infection prophylaxis is also issued by Dr Hussein in the form of a once daily antibiotic tablet taken for 7 days after the procedure. Fungal infection is also a possibility and as a result Dr Hussein will include medications in the aftercare pack to treat this should it occur. It is however only necessary to start these if Dr Hussein instructs. Uncontrolled infection can then go on to result in hypertrophic (raised bumps) scarring. Thankfully if caught and treated early any problems can be prevented. This is why Dr Hussein monitors the healing closely with the use of ‘selfie’ photos daily for the first week.
This is a possibility but exceptionally rare. The most likely cause of scarring would be uncontrolled infection. This is highly unlikely due to insistence by Dr Hussein on direct photo monitoring in the first week post treatment. The second reason is due to a thermal injury directly created from the laser (burn). This is extremely unlikely due to Dr Hussein’s level of experience and expertise.
Ectropion (Applies only to eyelid treatments)
This is a treatment in which the eyelid skin is over-tightened. It can lead to eversion of the eyelid margins and an inability to completely close the eye. Mild cases may improve with non- surgical management but more severe cases may require corrective oculoplastic surgery.
Prolonged redness (erythema)
This is not really a complication. After fully ablative CO2 laser every client will experience this to some degree. It tends to progressively settle and generally tends to takes up to 3-4 months to completely settle. It is important to understand that whilst redness remains the likelihood of developing post inflammatory hyperpigmentation (browning/tanning of the skin) still exists. It is therefore important to take sun avoidance precautions and uses SPF 50 sun block until the redness has completely settle.
Post-resurfacing contact dermatitis
This complication of laser surgery is more likely in aggressive forms of laser resurfacing such as fully ablative CO2 resurfacing. This is a form of increased sensitivity of the skin that is encountered by a proportion of individuals post laser resurfacing. In some cases it can be quite severe. Mild irritants can trigger a disproportionately large irritation of the skin (burning and itching) that then can result in prolonged redness and darkening of the skin. It is usually treated by topical steroid ointment if it occurs and eventually spontaneously settles. Triggering can be minimised by the use of mild perfume free cleansers and skin products post treatment. Dr Hussein can advise on suitable products.
Erosive pustular dermatosis
This is an extremely rare dermatological condition that can be triggered by any type of skin injury including laser. There are only a few case reports worldwide following laser sugery. It is an exceptionally rare consequence but effectively amounts to the failure of the skin to completely heal after treatment. Management would be undertaken in a specialist dermatology unit if this was to occur but the consequence of this could be permanent scarring.
This treatment is designed to renew, tighten and improve the texture of the facial skin. It is an aggressive procedure and requires strict adherence to these aftercare instructions. Immediate and very visible benefits can be seen in the form of reduction in laxity (tightening), reduction in wrinkles, removal of sun damage, increase in elasticity and improvement in collagen density and thickness.
It is a procedure that is also used to improve acne scarring by causing contraction of the skin, a degree of direct physical vaporization of the acne scars and remodelling of the collagen within the deeper layer of skin (dermis). Fractional CO2 laser may also be used for acne scar remodelling.
What you will experience following the treatment:
- You will experience a burning sensation following treatment and swelling of the face will develop over the next 24 hours. The burning sensation takes 24-48 hours to resolve.
- Over the next three to four days the face will feel tight and swollen. There can be weeping of yellowish serous fluid for up to 4 days after the procedure.
- Crusts may develop over the first few days post procedure and must not be removed. They will come away leaving fresh new skin underneath as healing continues.
- It is not unusual to experience some degree of itching between 4-6 days following the treatment. Dr Hussein will advise on how to manage this.
- At the end of 10 days the skin will have largely healed. There should be no further crusted areas. The skin will remain pink and this will settle progressively over the following weeks.
- It will usually be safe to return to a simple skin care regime 10 days post treatment.
Never pick or remove skin flakes or crusts. Allow them to shed naturally. Picking will increase the likelihood of scarring.
Please note the time periods above may vary according to the strength of treatment. For example the duration of crusting may be longer in more aggressive treatments.
You will be issued with a skincare pack containing dermol facewash, CU3 cream and a pack of sterile gauze on completion of the procedure.
Skincare day 1 to day 10
It is imperative that you adhere strictly to the following skin care routine after CO2 laser treatment. The skin barrier has been temporarily impaired by the laser. Premature application of your normal skincare products will result in inflammation, irritation, slow healing and may increase the risk of pigmentation problems and/or scarring. You are more susceptible to contact irritant and allergic dermatitis during this first 14 day period.
After the first 10 days have elapsed you must use a sunscreen SPF50 for the following 6 weeks. You must minimise your sun exposure at all times throughout the treatment and for 6 weeks after treatment.
- Wash the face in the morning with Dermol face wash and allow to air dry OR pat dry gently with a clean face towel or clean kitchen roll (DO NOT RUB).
- Apply CU3 barrier cream to the face. This will protect the skin and stop it from drying out while the epidermal barrier is healing.
- Take any antiviral and/or antibiotic tablets according to instructions that Dr Hussein may have prescribed Complete the course of medication.
Throughout the day
- Top up the CU3 cream at any point when the skin starts to feel dry and tight. This should be at least twice throughout the day. Allowing the skin to become too dry will slow the healing process.
- Repeat steps 1 & 2 (and step 3 if your Doctor has prescribed the medication) before going to bed.
Dr Hussein will review you at 2 weeks following treatment but do not hesitate to contact him before this if you need earlier advice/review/information.
Remember to send healing ‘selfie’ photos at least every two days so that Dr Hussein can monitor your healing. Use the details on the contact card.
Skincare – Day 10 to week 6 post treatment
Your skin will have healed sufficiently by day 10 after treatment. You will now be able to return to work. You will notice that the skin will still be red. This redness will settle over the next 6-12 weeks. During this period your skin will be more sensitive than normal. It is important that very mild cleansers, moisturizers and make-up be used in this period. Some products contain acetyl alcohol, retinoids and alpha hydroxy acids that can potentially irritate the skin and delay healing. These should be avoided or minimised.
Sunscreen is also very important. High factor (SPF30+) is ideal. Sunscreens that contain physical filters rather than chemical filters are preferred as they are less likely to irritate the skin. Physical barrier sunscreens are sometimes less acceptable because they leave a prominent white residue on the skin.
I have recommended a basic skincare regime that can be used during this period that will minimise any irritation to the skin, speed the healing process and optimize the results of your CO2 laser treatment.
Wash face with Avene Cleanance soapless gel cleanser. Apply Avene Hydrance Optimal Light moisturizer. Optional – Lycogel foundation is a specially formulated foundation that can be colour matched to your skin and safely applied post laser treatment to help mask any redness whilst things continue to settle. Apply Heliocare 360 oil free sunscreen. Occasionally this preparation can result in tightness in which case it can be substituted for the Heliocare SPF 50 UVA & UVB protection.
Wash face with Avene Cleanance face wash Apply Avene Cicalfate cream.