What is laser resurfacing

Laser resurfacing is a skin resurfacing procedure that uses a laser to improve the appearance of your skin or treat minor facial flaws by removing layers of skin. With advances in laser technology it is possible to reduce, and in some cases remove, facial wrinkles, acne scars and other facial scars, and a variety of skin growths and blemishes, with minimal disruption and downtime for the patient.

Laser resurfacing can be used to treat:

• Wrinkles
• Age spots
• Uneven skin tone or texture
• Sun-damaged skin
• Scars

Laser resurfacing can decrease the appearance of facial fine lines. Laser resurfacing can also treat loss of skin tone and improve your complexion if you have scars or sun damage. Laser resurfacing does have limitations, however. Understanding the specific techniques, risks and possible results can help you decide if laser resurfacing is right for you.

A LASER (light amplification by stimulated emission of radiation) works by emitting a wavelength of high energy light, which when focused on a certain skin condition will create heat and destroy diseased cells.

Lasers work by emitting a wavelength of high energy light, which when focused on a certain skin condition will create heat and destroy diseased cells.

Various kinds of lasers are available that are differentiated by the medium that produces the laser beam. The medium amplifies the light of a particular wavelength as it passes through it.

Laser resurfacing can be done with:

• Ablative laser. This is a wounding laser, which removes thin layers of skin. Types of ablative treatments include the carbon dioxide (CO2) laser and the erbium laser.
• Nonablative laser. This is a nonwounding laser, which stimulates collagen growth and tightens underlying skin. Non-ablative laser systems target only the dermis, leaving the epidermis intact. The results of non-ablative laser resurfacing are not as effective as ablative laser resurfacing but the excellent safety profile and rapid recovery post-treatment have made these systems popular. Non-ablative laser systems have been divided into 3 main groups, mid-infrared lasers and the two visible light lasers, the pulsed dye laser (PDL) and intense pulsed light (IPL) systems. Although nonablative laser resurfacing is less invasive and requires less recovery time, it’s less effective than is ablative laser resurfacing.
• Fractional laser resurfacing also called fractional photothermolysis (Fraxel) is available in ablative and nonablative forms.
  • Fractional ablative laser resurfacing – Pinpoint laser beams peel away many small areas of skin.
  • Fractional non-ablative laser resurfacing – Pinpoint laser beams that super-heat many small areas of skin leaving microscopic areas of skin intact.

Ablative laser resurfacing treatment produces the best result and is still considered the gold standard against which all other facial rejuvenation systems are compared. Although the results with non-ablative laser therapy are not as significant as those seen with ablative laser therapy it has the huge advantage of low risk and rapid recovery.

Before the laser resurfacing treatment, the area will be cleaned to remove makeup, and numbing cream will be applied for 30–90 minutes. Immediately before laser treatment, the cream is removed and the skin prepared and cleaned. Once the treated area is identified and confirmed by the patient, eye protection is worn by every person in the room. A variety of eye protection may be used for patients including the following: metal-lined adhesive pads, goggles, or eye shields – either over or under the eyelid. Next, the doctor will program the machine with appropriate settings and pick up a handpiece. The handpiece is placed on the skin, and then either a trigger or foot pedal is used to fire the pulse of laser energy targeting a 1–3 cm area of skin. The sensation during treatment is very brief and is often described as a heated pin-prick for each laser pulse. Treatment times vary due to the size of the area to be treated and machine used, but a typical treatment takes approximately 20–40 minutes.

Who is suitable for laser resurfacing?

People with mild, moderate or severe facial wrinkles and sun-damaged skin can all benefit from laser resurfacing. Laser resurfacing is also used for actinic keratoses, actinic cheilitis, facial pigmentation (e.g., solar lentigines), hypertrophic scars, and rhinophyma.

Those who are concerned about the risks of complications, and who wish to avoid long recovery times, are the best candidates for non-ablative laser resurfacing. However, they must understand that results may not be as effective as ablative resurfacing.

All wrinkles are reduced, but those caused by the sun, especially those around the eyes and lips respond best. It is never too late – or too early – to treat wrinkles once they are established. Acne scars and facial scars from surgery or trauma may be reduced but very deep scars cannot be completely removed. Many benign skin growths and scaly patches on the face and elsewhere are removed with ease.

Dark skinned and tanned patients may experience some dyspigmentation of the skin after treatment with non-ablative laser therapy. A test spot should be performed in these patients and they should avoid direct sunlight and use sunscreens after treatments.

Is laser resurfacing an alternative to face lifting?

The procedure does provide a general ‘lift’ to the face, but a face lift is necessary to reverse advanced sagging of the skin of the face. Wrinkles on the lips and around the eyes usually do not respond to face lifting but respond well to laser resurfacing. In some instances both procedures are necessary to achieve the best results.

Does laser resurfacing hurt?

This depends on the type of laser resurfacing being used. Ablative laser treatments are typically more painful than non-ablative laser treatments.

When treating small areas topical anesthetic agents are usually applied when using ablative laser systems. For larger procedures, in addition to topical anesthetics, injectable or inhaled local or regional anesthetics may also be used.

Non-ablative laser resurfacing is minimally painful and may not require any anesthesia. If necessary, topical anesthetic agents are used and applied one hour before the start of the procedure. Cold packs may also be applied immediately after treatment to minimize any discomfort.

How much time off is necessary following the laser resurfacing procedure?

The huge advantage of non-ablative laser resurfacing is that there is little, if any post-recovery period. In most cases patients can apply makeup and return to normal daily life immediately following treatment.

In contrast, ablative laser resurfacing is associated with a long post-recovery period. There may be swelling, redness, exudation and sloughing of the treated area. For the first few days’ treatment with ice packs and keeping the head raised at night should help. Healing is greatly aided by the use of a skin-colored adhesive dressing for the first couple of days. In some cases an occlusive healing ointment is preferred as it improves patient comfort and has shown to speed up the growth of new skin. Usually it takes two weeks to heal completely, with a range from one to four weeks depending on the treatment performed and the depth of skin removal. After two weeks, it is possible to wear camouflage make-up. Sun protection with a non-irritating sunscreen is vital until the redness subsides completely.

CO2 laser skin resurfacing

Carbon dioxide (CO2) laser medium is a mixture of 3 gases consisting of 10–20% carbon dioxide, 10–20% nitrogen, and the remainder is helium.

The CO2 laser produces a specific wavelength of light in the infrared spectrum (10,600 nm).

CO2 laser beams penetrate the top skin layers reaching into the dermis. It creates tiny microscopic areas of thermal damage that stimulate new collagen production and replace damaged skin surface by new epidermal cells.

Traditional ablative CO2 laser resurfacing has been largely replaced by fractional CO2 lasers, which provide excellent results with fewer complications.

Benefits of CO2 laser treatment

For selected skin conditions, carbon dioxide laser treatment offers:

• High-precision, tissue-selective treatment
• Low cost of consumables
• Less invasive than dermabrasion and chemical peeling
• Short downtime – recovery time is about 2 weeks

The US Food and Drug Administration (FDA) has approved a range of carbon dioxide laser machines to treat skin disorders. These include SmartSkin™ ablative skin laser (Cynosure, Massachusetts, USA), AcuPulse™ ablative carbon dioxide laser (Lumensis Inc. California, USA), UltraPulse® (Lumensis Inc. California, USA), FRAXEL® (Solta Medical, California, USA) and QuadraLASE™ (Candela, California, USA). Individual machines are designed to treat specific skin problems.

The following skin disorders can be treated with CO2 laser beams:

• Raised birthmarks
• Moles
• Viral warts
• Rhinophyma
• Acne scarring
• Keloid and hypertrophic scars
• Skin ageing
• Facial lines and wrinkles
• Stretch marks
• Actinic keratosis
• Uneven pigment (brown spots and freckles, lentigines, melasma)
• Pearly penile papules

CO2 laser contraindications

Carbon dioxide laser treatment may be unsuitable in the following circumstances:

• Patients with unrealistic expectations, such as those who seek complete eradication of wrinkles or scars.
• Patients with a tendency to form keloid and hypertrophic scars
• People that have taken isotretinoin within the previous 6 months
• Active cutaneous bacterial skin infections or herpes simplex (cold sores) in the area to be treated
• Prior ionising radiation to the area to be treated
• Connective tissue diseases
• Previous deep chemical peel or dermabrasion
• Fitzpatrick skin phototypes 5 or 6 (darkly pigmented skin)
• Human immunodeficiency virus (HIV) or hepatitis C infections

CO2 laser postoperative care

To reduce the risk of infection, patients may be prescribed:

• Antiviral prophylaxis with aciclovir or similar
• Antibiotics
• Antiseptic facial cleanser

CO2 laser resurfacing side effects

Side effects from CO2 laser treatment may include:

Mild side effects

• Milia
• Acne
• Perioral dermatitis
• Rosacea
• Contact dermatitis

Moderate side effects

• Localized bacterial skin infections, herpes simplex or candida
• Prolonged redness
• Transient postinflammatory hyperpigmentation
• Delayed hypopigmentation (pale patches)

Severe side effects

• Fibrosis (scarring)
• Hypertrophic scarring
• Disseminated herpes simplex or staphylococcal skin infections
• Ectropion (permanently dropped eyelid)

CO2 laser versus Erbium laser

• Erbium:YAG laser resurfacing is used to remove superficial and moderately deep lines and wrinkles on the face, hands, neck, or chest.
• Erbium:YAG laser resurfacing has faster recovery time and fewer side effects than carbon dioxide laser but is less effective for the deeper line and wrinkles.

Erbium laser resurfacing

Erbium YAG (Er:YAG) lasers are solid-state lasers whose lasing medium is erbium-doped yttrium aluminium garnet (Er:Y3Al5O12). The triply ionised erbium dopant (a substance added in minute amounts to another pure substance to alter its conductivity) typically replaces a small fraction of the yttrium ions in the host crystal structure, since the two ions are of similar size. The erbium provides the laser activity in the crystal.

Erbium YAG lasers typically emit light with a wavelength of 2940 nm, which is infrared light. Unlike Nd:YAG laser, the output of an erbium YAG laser is strongly absorbed by water. This fact limits the use of erbium YAG laser in surgery, and in many other laser applications, to where water is present (healthy skin has a high water content).

The following skin disorders can be treated with Erbium YAG laser beams:

• Atrophic acne scars
• Herpes simplex scars, smallpox scars
• Sun damaged skin
• Mild to moderate facial wrinkles
• Uneven pigment (brown age spots, freckles, melasma)
• Seborrheic keratosis and other benign skin growth
• Some superficial non-melanoma skin cancers
• Some vascular birthmarks (capillary vascular malformations)

Commonly used erbium YAG laser settings

Typical settings employed for birthmarks, age spots and superficial skin ablation are wavelength 2940 nm, short pulse, laser output 2.5–5 J/cm², and pulse duration 250 microseconds.

For relatively deep-seated scars, long pulse settings are preferable, at wavelength 2940 nm, laser output 3 J/cm², and pulse duration 1000 microseconds.

Erbium laser treatment benefits

For selected skin conditions, erbium YAG laser treatment offers:

• High-precision, tissue-selective treatment
• Intuitive, easy-to-use parameter selection
• Minimal residual thermal injury to the underlying tissue leading to less chance of persistent post-treatment redness and changes in pigmentation
• Low cost of consumables
• Less invasive than dermabrasion and chemical peeling
• Short downtime.

Erbium laser contraindications

Erbium YAG laser treatment may be unsuitable in the following circumstances:

• Unrealistic patient expectations
• Tendency toward keloid or hypertrophic scar formation
• Reduced numbers of adnexal skin structures (hair follicles, sweat glands), such as in scleroderma, and burn scars
• History of prior ionising radiation to the skin

Erbium laser precautions

All patients should be carefully examined before treatment.

• The eyes must be examined for scleral show (whites of eyes visible below the iris), lid lag (slow movement of eyelids), and ectropion (drooping of the lower eyelid) in patients desiring periorbital laser treatment.
• The presence of cutaneous disorders including seborrhoeic keratoses, solar lentigines, actinic keratoses, and skin cancers should be noted.
• Skin cancers must be treated adequately by other methods before any resurfacing procedure is performed.
• Laser skin resurfacing can lead to reactivation of latent herpes simplex virus infection or predispose the patient to a primary herpes infection before the skin surface has healed.
• Little data exist to support the use of prophylactic antibiotics because of the relatively low incidence of bacterial infections reported.

Erbium laser resurfacing side effects

Side effects from Erbium YAG laser treatment are usually minor and may include:

Mild side effects

• Milia
• Acne exacerbation
• Contact dermatitis

Moderate side effects

• Localized herpes simplex, impetigo and candida infection
• Prolonged redness
• Postinflammatory hyperpigmentation
• Delayed hypopigmentation (white patches)

Severe side effects

• Fibrosis (normal scarring)
• Hypertrophic scarring
• Disseminated herpes or staphylococcal infection
• Development of ectropion (outward rolling of the eyelid margin).

Fractional laser resurfacing

Fractional laser treatment is a non-invasive treatment that uses a device to deliver a laser beam divided into thousands of microscopic treatment zones that target a fraction of the skin at a time, analogous to a photographic image being enhanced or altered pixel by pixel.

Fractional laser treatment has bridged the gap between the ablative and non-ablative laser techniques used to treat sun-damaged and ageing skin. While ablative laser treatments work mainly on the epidermis (surface skin cells) and non-ablative treatments work solely on dermal collagen (mid-layer of skin) only, fractional laser treatment works at both the epidermal and dermal layers of the skin.

The first fractional laser marketed was the Fraxel® device [Reliant Technologies now Solta], which emits a non-ablative 1550-nm wavelength. There are now some machines available that use fractional technology, based on erbium:YAG lasers for superficial treatments and CO2 lasers for deeper ablative treatments (e.g. Fraxel Repair [Solta Medical], Active and Deep FX [Lumenis], Quadralase [Candela] and Pearl Fractional [Cutera]).

Fractional laser treatment is used for the treatment of:

• Facial lines and wrinkles (rhytides)
• Sun damage
• Skin pigmentation associated with photoaging Surgical and acne scarring.

Although fractional laser treatment has been advocated in the treatment of pigmentation disorders such as melasma, the treatment itself can lead to postinflammatory pigmentation.

Fractional laser treatment can be used on any part of the body but is particularly useful on the neck, chest and hands when compared to traditional ablative modalities.

Fractional laser treatment may also be of benefit for poikiloderma of Civatte and stretch marks.

Fractional laser treatment can be used in all skin types and patients, but techniques vary depending on patient age, skin type, sun exposure and body location. Fractional laser treatment can be combined with surgery and other skin treatments.

How does fractional laser treatment work?

To understand how fractional laser treatment works a basic understanding of skin structure is required. Briefly, skin consists of 3 layers, the epidermis (uppermost layer), dermis (mid-layer) and subcutis (lower fat layer). The epidermis contains pigment-producing cells called melanocytes, which are responsible for skin coloring. The dermis is made up of collagen and elastin fibers that provide skin with strength, toughness, elasticity and pliability (click here for detailed information on skin structure).

As the body ages, the appearance and characteristics of the skin alter. The epidermis becomes thinner, so blemishes become more visible, and collagen in the dermis is gradually lost which contributes to the formation of facial lines, sagging skin and wrinkles.

Fractional laser treatment works by targeting both the epidermis and dermis. It does this by delivering a laser beam that is divided into thousands of tiny but deep columns of treatment into the skin. These are called microthermal treatment zones (MTZs). Within each microthermal treatment zone old epidermal pigmented cells are expelled, and the penetration of collagen in the dermis causes a reaction that leads to collagen remodelling and new collagen formation. By using microthermal treatment zones, the laser targets and treats intensively within the zone while surrounding healthy tissue remain intact and unaffected and helps heal the wound. This fractional treatment results in a faster healing process than if all tissue in the treatment area was exposed to the laser.

Fractional laser treatment procedure

Pre-treatment assessment/preparation

• Define problem areas and tailor a treatment pattern to target the areas for correction.
• Take pre-treatment photographs.
• Pre-treatment with bleaching cream (e.g., hydroquinone) or chemical peel may be necessary for patients with darker skin or pigmentation problems.
• Consider aciclovir or valaciclovir prophylaxis against herpes simplex infections (cold sores)
• The patient needs to remove all jewellery and makeup. Wash face with soap and water before treatment.
• An anesthetic cream is applied to the treatment area. It takes about 45-60 minutes for the anaesthetic to take full effect.
• The anesthetic cream is removed, and a gliding gel is then applied to the treatment area, which helps the laser to lay down an even microthermal treatment zone spot pattern.

Application of fractional laser

• The gliding gel acts as the contact lubricant for the robotic handpiece that glides across the skin surface.
• Treatment time will depend on the areas being treated, but a full face will take around 30 minutes.
• The pain associated with the procedure is dependent on the energy delivered to the treatment site. It is essential that the strong anaesthetic cream provided with the Fraxel laser is used.
• A cooling device, called a Zimmer™ machine, is used to reduce the discomfort during the procedure.

Fractional laser recovery

• The gliding gel is washed off after the treatment.
• Patients may experience a mild sunburn sensation for about an hour after the procedure.
• Swelling is usually minimal and should resolve in 2–3 days.
• The skin will have a pinkish tone for 3–5 days.
• Within 24 hours new epidermal skin develops and the skin will have a bronze appearance that can last 3–14 days. Flaking of the skin may also occur as new skin replaces dead skin tissue, which can be treated with a moisturising cream.
• Skin peeling can be pronounced after ablative therapy when the skin should be gently removed with tap water, petrolatum and gauze once or twice daily.
• During the healing phase and for several months after treatment, it is recommended that the treatment area is protected using a moisturizing sunscreen with an SPF of at least 50+. Protective clothing and wide-brimmed hats should also be used to protect the skin from sun exposure.

Four to five treatments with fractional laser (Fraxel®) are required, depending on the energy level used and the condition of the treated skin. These are spaced one month apart. The results are not immediate and are slowly progressive, with optimal improvement visible over a three to four month period. This timeframe and treatment regimen allows for complete healing and replacement of damaged tissue with new collagen and elastin, and viable, healthy skin cell growth.

Ablative fractional resurfacing lasers are more aggressive than non-ablative devices, so recovery takes a little longer.

Fractional laser treatment side effects and complications

Fractional laser treatment appears to be well tolerated by most patients. Shaving or application of mineral make-up can be done soon after treatment. In most cases, patients can return to work directly after treatments or the following day, depending upon their skin condition and treatment.

Some of the side effects and complications that may occur after aggressive or ablative fractional laser treatments, particularly on neck skin, include:

• Excessive desquamation (scaling, peeling) and some crusting
• Swelling for up to one week after treatment – this can be helped by applying an ice pack at 10-minute intervals for the first 24 hours.
• Postinflammatory pigmentation – occurs more commonly in patients with a history of melasma or postinflammatory hyperpigmentation (more common in patients of darker skin types)
• Acneform eruptions, herpes simplex, bacterial and candida infections
• Contact dermatitis

Laser skin resurfacing preparation

Before you have laser resurfacing, your doctor will likely:

• Review your medical history. Be prepared to answer questions about current and past medical conditions and any medications you’re taking or you’ve taken recently, as well as any cosmetic procedures you’ve had in the past.
• Do a physical exam. Your doctor will inspect your skin and the area that will be treated. This will help him or her determine what changes can be made and how your physical features — for example, the tone and thickness of your skin — might affect your results.
• Discuss your expectations. Talk with your doctor about your motivations and expectations, as well as the potential risks. Make sure you understand how long it’ll take to heal and what your results might be.

Before laser resurfacing, you might also need to:

• Take medication to prevent complications. If you’re having ablative laser resurfacing — or nonablative laser resurfacing and you have a history of herpes infections around your mouth — your doctor will prescribe an antiviral medication before and after treatment to prevent a viral infection. Your doctor might recommend taking an oral antibiotic medication around the time of the procedure to help prevent a bacterial infection. In addition, your doctor might recommend using a topical retinoid on your skin for four weeks before having ablative laser resurfacing.
• Avoid unprotected sun exposure. Too much sun up to two months before the procedure can cause permanent irregular pigmentation in treated areas. Discuss sun protection and acceptable sun exposure with your doctor.
• Arrange for a ride home. If you’re going to be sedated during laser resurfacing, you’ll need help getting home after the procedure.

During the laser skin resurfacing procedure

Ablative laser resurfacing is an outpatient procedure. Your doctor will numb your skin with local anesthetics. For extensive resurfacing, such as treatment to your whole face, you might be sedated.

During ablative laser resurfacing, an intense beam of light energy (laser) is directed at your skin. The laser beam destroys the outer layer of skin (epidermis). At the same time, the laser heats the underlying skin (dermis), which causes collagen fibers to shrink. As the wound heals, new skin forms that’s smoother and tighter. Ablative laser resurfacing typically takes between 30 minutes and two hours, depending on the technique used and the size of the area treated.

Nonablative laser resurfacing can be done in your doctor’s office. Your doctor will protect your eyes and numb your skin with a topical anesthetic one hour before treatment. If you’re having fractional photothermolysis, you might need additional pain relief. To protect the outer layer of your skin, your doctor will apply a water-based gel. The laser damages collagen beneath your skin and stimulates the growth of new collagen, tightening underlying skin and improving skin tone and appearance. No skin is removed.

Nonablative laser resurfacing typically takes between 15 minutes and 1 1/2 hours, depending on the technique used and size of the area treated. A series of treatments is typically scheduled over the course of weeks or months.

Laser resurfacing recovery time

After ablative laser resurfacing, the treated skin will be raw, swollen and itchy. Your doctor will apply a thick ointment to the treated skin and might cover the area with an airtight and watertight dressing. To relieve pain, take an over-the-counter pain reliever and apply ice packs. Your doctor will explain how to care for your skin. You might prefer to remain home while you heal. Once new skin completely covers the treated area — usually after one or two weeks depending on the depth of resurfacing and type of laser — you can use cosmetics to conceal any redness.

After nonablative laser resurfacing, your skin might be temporarily red or swollen. Use ice packs as needed. You can apply makeup and resume your normal activities immediately.

Self-Care Guidelines

Ablative laser total skin resurfacing requires 7–14 days of intense skin care with the patient usually unable to work or socialize during that time. A typical regimen is a combination of skin dressings, ointments, and diluted vinegar compresses applied around the clock. Antibiotic and antiviral pills are usually taken for 7–10 days. After 7–14 days, a moisturizing sunblock should be used for several months.

Ablative fractional laser treatment requires moderately intense skin care (often ointments and diluted vinegar compresses) for 2–3 days, as microscopic areas of bleeding can be seen. Afterwards, a moisturizing sunblock is recommended.

Non-ablative fractional laser treatment is much easier to care for. Typically, cold compresses should be used as needed. It is important to use sunblock on a daily basis. Swelling may be improved by elevating the head at nighttime.

Laser skin resurfacing results

In most cases the results are a moderate to marked reduction in facial lines and wrinkles, a more even skin tone and texture, and fresher, healthier-looking skin.

After ablative laser resurfacing, your skin might stay red or pink for up to several months. However, once the treatment area begins to heal, you’ll notice an immediate difference in your skin quality and appearance. The effects can last for years.

Results after nonablative laser resurfacing tend to be gradual and progressive, rather than immediate and dramatic. You’re more likely to notice improvements in skin texture and pigment than in wrinkles.

After laser resurfacing, avoid unprotected sun exposure for one year to prevent irregular pigmentation. Keep in mind that your results might not be permanent, since as you age you’ll continue to acquire lines by squinting and smiling. New sun damage also can reverse your results.

Laser skin resurfacing risks

Ablative laser resurfacing can cause various side effects, including:

• Redness, swelling and itching. After ablative laser resurfacing, treated skin will be itchy, swollen and red. Redness — the degree of which is related to the depth of resurfacing done — can be intense and might last for several months. The aggravation of a previously existing skin condition, such as rosacea, can contribute to redness.
• Acne. Applying thick creams and bandages to your face after treatment can worsen acne or cause you to temporarily develop tiny white bumps (milia) on treated skin.
• Infection. Ablative laser resurfacing can lead to a bacterial, viral or fungal infection. The most common infection is a flare-up of the herpes virus — the virus that causes cold sores. In most cases, the herpes virus is already present but dormant in the skin.
• Changes in skin color. Ablative laser resurfacing can cause treated skin to become darker than normal (hyperpigmentation) or lighter than normal (hypopigmentation). Hyperpigmentation is more common in people who have darker skin. Topical retinoic acid or glycolic acid can help treat hyperpigmentation after the treated area has healed. Use of sunscreen during the healing process also is important. Nonablative fractional photothermolysis might help improve hypopigmentation.
• Scarring. Ablative laser resurfacing poses a slight risk of scarring.
• Turning of the eyelid (ectropion). Rarely, ablative laser resurfacing near the lower eyelid can cause the eyelid to turn out and expose the inner surface. Surgery is needed to correct the problem.

Nonablative laser resurfacing also can cause side effects, including:

• Infection. Nonablative laser resurfacing can cause a flare-up of the herpes virus.
• Changes in skin color. If you have tanned or darker skin, nonablative laser resurfacing can cause your skin to become temporarily darker (hyperpigmentation).
• Mild swelling and redness. Swelling and redness typically last only hours or days.
• Blistering and scarring. Rarely, nonablative laser resurfacing can cause blistering and scarring.

Laser resurfacing isn’t for everyone. Your doctor might caution against laser resurfacing if you:

• Have active acne
• Have taken the acne medication isotretinoin (Amnesteem, Claravis) during the previous year
• Have an autoimmune disease or a weak immune system
• Have a tendency to form scars
• Have very dark skin
• Have unrealistic expectations