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FAQ – CO2 Laser

What is laser skin resurfacing?

Laser skin resurfacing uses a specially crafted beam of thermal energy that breaks down and removes only the very outer layers of the area of skin. This leaves the skin more even as well as encouraging new skin to grow with a healthier look.

Laser skin rejuvenation and resurfacing is a gentle laser treatment for wrinkles and sun damage. This no-downtime procedure is appropriate for the face but also for the chest, neck and hands – anywhere that sun damage shows.

At our clinic the SmartSkin Performa laser skin rejuvenation is a micro ablative, non-invasive procedure whereby the surface of the skin is not damaged or removed. The gentle lasers correct pigmentation irregularities and encourage new collagen growth to smooth out existing facial wrinkles.

The light associated with CO2 lasers is able to stimulate skin rejuvenation, only hitting small areas in depth thanks to Performa SmartSkin fractional DOT technology. This is due to micro beams only targeting a proportion of the skins surface at one time, which allows faster healing, causing a tightening of the skin and stimulation of collagen production, thereby, giving a younger and softer looking skin.

With Performa CO2 laser fractional microablative resurfacing the laser beam is broken up or fractionated into many small micro beams which are separated so that when they strike the skin surface small areas of the skin between the beams are not hit by the laser and left intact. These small areas of untreated skin promote a much more rapid recovery and healing with less risk of complications.

The small areas treated by the Performa fractional micro beams, called micro treatment zones, cause sufficient laser injury to promote new collagen production and resultant facial skin rejuvenation.

SmartSkin Performa CO2 laser can be used to treat these concerns to resurface the skin all over the body:

  • Age (sun) spots
  • Dark circles under the eye
  • Dry, dull skin
  • Fine lines
  • Freckles
  • Hand rejuvenation (age spots, loose skin, and lines)
  • Melasma
  • Redness and flushing
  • Scars
  • Seborrheic keratoses (flat only)
  • Skin texture (treats roughness)
  • Skin tone (treats mottled complexion and skin discolouration)
  • Stretch marks
  • Varicose veins
  • Wrinkles

The skin rejuvenation process is safe for most skin types and colours.

It is suitable for people who have sun damage, stubborn pigmentation, acne scars, rough texture, enlarged pores, fine lines, wrinkles and skin laxity on the face, neck, chest, arms and hands and surgical scars.

The photo below shows the wrinkle removal results achieved with the new Performa CO2 micro fractional ablative laser with only 4-6 days of down time as compared to 3-4 weeks of down time and 3 months of redness with a trditional CO2 Laser resurfacing.

Performa Laser

The new micro fractional ablative Performa CO2 laser resurfacing techniques are very exciting advances in the field of non surgical facial rejuvenation and wrinkle removal.

Many new applications are being used to improve our ability to rejuvenate the skin and improve scars, stretch marks, and remove pigment. New digital multi-functional software allows us to customize power, dwell time, density and scan patterns to perfectly balance your cosmetic and downtime needs.

The Performa Laser from Cynosure is an FDA-approved laser for skin rejuvenation and resurfacing and can dramatically improve the skin appearance without the downtime and discomfort usually required with traditional resurfacing. A typical patient would receive one to three Performa laser skin resurfacing treatments. During each one, the laser creates thousands of microscopic spots, almost like tiny “apple-cores”.

How does the SmartSkin CO2 laser work?

With Performa SmartSkin CO2 micro ablative resurfacing the laser beam is broken up or fractionated into many small micro beams which are separated so that when they strike the skin surface small areas of the skin between the beams are not hit by the laser and left intact.

These small areas of untreated skin promote a much more rapid recovery and healing with less risk of complications. The small areas treated by the Performa micro beams, called micro treatment zones, cause sufficient laser injury to promote new collagen production and resultant facial skin rejuvenation .

Performa Laser

Before and After Ablative CO2 Laser Resurfacing

Dr Ayham Al-Ayoubi explains: In the above skin diagram, the first red area on the left represents traditional ablative CO2 and Erbium laser resurfacing. To ablate means to surgically remove and the skin tissue is removed by the heat of the CO2 or Erbium laser. Since these lasers were not fractional, all of the skin in the treated area is removed creating an open wound that takes a long time to heal.

The second drawing is the fractional CO2 laser which fractionally ablated the surface of the skin down to a depth of 70-100 microns. This laser is fractional and the skin heals much quicker, but depth of penetration is not deep enough to produce substantial wrinkle removal, skin tightening and skin rejuvenation.

The third red areas represent non ablative fractional laser technologies which heat but do not ablate the skin. This laser heats small columns of the deep skin layers to promote new collagen production and plump the skin and skin wrinkles. Recovery time is much less than with traditional ablative CO2 and Erbium lasers. This laser procedure is excellent for improving skin texture, plumping wrinkles and acne scars, and shrinking pores.

The Performa CO2 fractional micro ablative lasers which have been developed to actually remove the heated column of skin tissue and provide more substantial wrinkle removal and superficial skin tightening than the non ablative fractional lasers (See last figure on right in above diagram). This new micro ablative fractional Performa CO2 laser has the advantage of producing better wrinkle removal and skin rejuvenation.

Performa Laser

These fractional micro ablative Performa CO2 lasers reach much deeper into the skin, 600 to 1000 microns, and can produce much more effective wrinkle removal and skin rejuvenation with significantly less down time and recovery than traditional CO2 and Erbium non fractional ablative laser resurfacing.

The SmartXide laser skin re-surfacing treatments represent the very latest in tissue rejuvenation laser technology. This great breakthrough in laser utilizes a CO2 fractional system with a super-fast scanner that allows the doctor to do a “Dot Resurfacing”.

During the procedure, the SmartSkin laser will be used to effectively stimulate and rejuvenate both the outer (epidermis) and inner (dermis) layers of your skin.

The SmartSkin is comprised of a C02 laser that is applied to the treatment areas with a unique scanning handpiece. The laser has a wavelength of 10,600 nm and delivers laser pulses to the skin that measure 350 µm in diameter. Each laser pulse creates a micro-zone of ablation in the epidermis, and the number of pulses in a given area can be carefully controlled. Adjusting the spacing of the laser pulses allows us to leave some of the skin surface untouched, leading to faster healing and less downtime. We also control the timing and power level of the pulses, allowing for more or less aggressive procedure outcomes.

The primary target of the C02 laser is water. Once it has passed through the epidermis, the laser energy is delivered to the deeper, collagen bearing tissues below. It is this interaction of water, the C02 laser, and collagen that ultimately leads to the collagen rejuvenation and skin tightening that is one of the hallmarks of a SmartSkin procedure

By removing a customized pattern of dots and not the entire skin surface, unlike other CO2 lasers, this technology combines the best of both worlds – the great and proven results of a traditional ablative laser, but without the pain and the traditional downtime.

Does SmartSkin CO2 laser treatment hurt?

Local anaesthetic is applied prior to SmartSkin CO2 laser treatment.

There is slight discomfort during the procedure. Rarely, a mild burning sensation may occur. Topical anaesthetic is required and protective eye shields must be worn.

How long does the CO2 laser treatment take?

This exciting new SmartSkin laser treatment is performed by Dr Ayham Al-Ayoubi, a specialist laser Surgeon. The SmartSkin CO2 laser treatment is quick, lasting only 15 to 45 minutes. With Smartskin CO2 laser usually a course of treatments are required two to four weeks apart.

How many laser treatments are needed?

Depending on the degree of damage to the skin and desired results, most patients require 1-3 Smartxide CO2 laser treatments, spaced 4 – 6 weeks apart.

What to expect during and after the laser procedure?

Laser resurfacing is done by a plastic surgeon or a cosmetic doctor. It’s an outpatient procedure, meaning the patient will not need to stay overnight.

The doctor may treat wrinkles around your eyes, mouth, or forehead individually or treat the entire face.

For small areas, the doctor will numb the areas to be treated with a local anaesthetic and may also sedate the patient. Treating just parts of the face takes about 30 to 45 minutes. A full-face treatment takes up to one hour.

Swelling after laser skin resurfacing is normal. The doctor may prescribe steroids to manage swelling around your eyes. Sleeping on an extra pillow at night can also ease swelling. The patient may feel itching or stinging for 12 to 72 hours after the procedure.

Five to seven days after laser resurfacing, the skin will become dry and peel. Depending on the problem that was treated, healing typically takes 4-10 days. Once the skin heals, patients can wear oil-free make-up to minimize redness, which usually fades in two to three months.

Patients will also probably notice that their skin is lighter for a while after surgery. It is particularly important that they use a “broad-spectrum” sunscreen, which screens ultraviolet B and ultraviolet A rays, to protect the skin during that time.

When selecting a sunscreen, look for one specially formulated for use on the face with a sun protection factor (SPF) of 30 or higher. Patients must limit the time in the sun, especially between the hours of 10 a.m. and 2 p.m., and wear protective clothing, such as long-sleeved shirts, pants, and a wide-brimmed hat.

It is also important to keep the new skin well moisturized. If the patient uses Retin A or glycolic acid products, he/she should be able to start using them again after about six weeks or when the doctor says they can.

What happens after laser skin resurfacing?

Following laser resurfacing, a sterile dressing is applied to the treatment sites for 1-2 hours. Patients will be required to clean the treated areas every 3-4 hours with sterile water which will be supplied by our clinic as well as an ointment which is used to soothe and protect the skin.

This after care is intended to prevent the skin from drying out. In general, the areas heal in 3-5 days, depending on the nature of the condition that was treated. The new skin can remain pink for several days after but can be concealed with camouflage make-up.

Darker pigments and freckles may get darker after the initial laser skin rejuvenation and resurfacing treatment and flake off in a few days. All these changes are normal and the recovery depends on the individual and the treatment strength performed. Blisters are extremely rare.

Because the lasers reduce wrinkles by encouraging new collagen growth, wrinkle improvement is gradual.

Aging is progressive. The wrinkles and sun damage that are visible today were often caused years before. Care should be taken to wear sun block so no new sun damage can occur. Additionally, new wrinkles can not necessarily be stopped from appearing. However, the laser’s encouragement of new collagen growth should help slow the appearance of new wrinkles.

It’s also important to understand the post-procedure course, and the impact it may have on the activities in the days following the procedure.

How much improvement can the patient expect?

Patients can expect to see improvement in the colour, texture and quality of the skin within a week or two after the SmartSkin CO2 laser treatment. However, more significant improvement will be seen after the series of SmartSkin CO2 laser treatments is complete.

Skin laxity can be further improved by combining SmartSkin CO2 laser with radio frequency skin tightening and in some cases adding a feather lift procedure for very loose skin.

Are there any side effects?

Heat build up occurs in the skin during the laser procedure and is managed with cold air gently directed over the epidermis.

Redness of the skin usually occurs and lasts one to three days. (Make-up can be applied the following day.) Expect very mild peeling to take place over the first week.

Unlike traditional laser skin resurfacing, blistering and crusting does not usually occur for several days following the procedure. Dryness of the skin is treated using petroleum jelly, forming a seal that prevents further water loss. There is a very small risk of pigment change and scarring following laser treatment.

Is the SmartSkin Performa CO2 laser treatment safe?

There is no evidence to suggest whatsoever that SmartSkin Performa CO2 laser treatment can be linked to skin disorders or increased risk of skin cancer. Our laser clinic is registered with the Health Care Commission ensuring the highest level of safety for our patients. Our lasers are cleared by the American Food and Drug Administration (FDA) and have full CE clearance for Europe.

What other lasers and methods are available?

The Er:YAG laser causes more heat damage to the surrounding structures than the SmartSkin Performa CO2 laser resulting in a long downtime of 2 weeks to 2 months. The popularity of the Er:YAG laser procedures has fallen considerably in the last few years.

Also the Er:YAG laser treats the entire skin’s surface removing the upper layers of skin and due to the need to commit to 10–15 days of intensive wound care, weeks of post-operative redness and risks of pigment change, the new SmartSkin Performa CO2 laser resurfacing is becoming a much more popular choice.

Deep peels almost always result in redness of the skin lasting several months and are sometimes complicated by eventual lightening of the skin. Dermabrasion is technically difficult and can result in altered pigment and scarring if the depth of skin penetration is too deep.

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