Laser skin resurfacing offers the most striking results—"phenomenal," says Richards. "It can be a huge change, depending on how damaged your skin is to start with," says the surgeon, who has seen the procedure turn the clock back 20 years.
To achieve its dramatic—and long-lasting—results, laser resurfacing acts like a "souped-up microwave," Richards says, using high-energy light to vaporize the damaged outer layers of skin and de-emphasize wrinkles, superficial scars, and uneven skin pigmentation.
Two of the most commonly used skin-resurfacing lasers are the pulsed carbon dioxide laser, often referred to as the "CO2" laser, and the Erbium YAG laser. For advanced skin damage, doctors' technology of choice is the CO2 laser, based on its ability to penetrate deep into the skin.
Recovering from Laser Resurfacing: "No Picnic"
Richards chose the CO2 laser for Margaret Copeland (her name has been changed), a 74-year-old skin cancer survivor who wanted to rid herself of the health-threatening lesions that kept reappearing on her face.
Though the procedure is sometimes performed under local anesthesia, especially when limited to specific areas of the face, Richards performed Margaret's all-over facial resurfacing under general anesthesia. The former schoolteacher says of waking up from the outpatient procedure, "I knew my face was going to be bandaged, but I had no idea...I looked like the man in the iron mask."
After about 10 days, the "mask" was removed to reveal a bright red face. Though she kept up most of her routine for the three months it took to get her normal skin color back, Margaret admits that recovery was "no picnic." She experienced significant discomfort for some weeks after the procedure, and remembers the itchiness as the skin healed as the hardest part. But she is pleased with the results. "I have a healthy skin now, no question," she says, adding that one of the happy by-products of the procedure is that she lost her wrinkles.
The major healing takes seven to 10 days in most patients, says William A. Zamboni, M.D., a Las Vegas plastic surgeon and professor and chief of plastic surgery at the University of Nevada School of Medicine. But the red phase after healing can last for weeks or months.
For most patients, wearing makeup for that time period is all that's required. Sometimes, though, the skin's pigmentation remains permanently blotchy, with the laser-treated areas taking on a darker or lighter appearance than the rest of the face. With experience, Zamboni explains, doctors can learn which patients might be susceptible to such uneven pigmentation. In patients with darker skin and some others, doctors first apply the laser to a test patch in an inconspicuous area of skin to make sure the patient is a good candidate.
Laser resurfacing is very "technique-dependent," explains Richards, with both the quality of the machine and the doctor's skill greatly impacting the results. Clearly, it pays to find the right doctor. Bad results are rare in the care of an experienced doctor.