CO2 laser for rejuvenation of aging skin

. Recent Articles, Skin — By Kate Marie on February 28, 2011

One of the things I’ve found most distressing about the aging process is the decline in integrity of my skin.  It has lost elasticity, become saggy and is thin and spotty in many places. Having nursed for several years when I was younger, I keep remembering the poor little old ladies with their papery skin and how it often got caught on things and so got ripped and bruised!  It wasn’t pretty, and I swore then as I do now, that I’d do anything I can to prevent this.

Maintaining youthful skin is not just about improving its appearance for cosmetic (read ‘shallow’ to some!) reasons.  As with any organ or body system it is important to keep it in as optimal condition as possible and to provide it all the support it needs to stay supple, intact and looking good (because good=healthy).  The use of products with active ingredients is a must, as is eating a diet low in sugar and full of fresh fruit and veges and lean, low fat protein such as that derived from fish and vegetables.  More interventionist treatments to remove dead skin layers and to stimulate collagen growth will also make a huge difference, and laser falls into this category.  There are many and varied lasers all with pros and cons. Cons relate to expense, pain and ‘down time’.  Newer lasers such as the fractionated CO2 laser take care of these key factors and provide fantastic results in typically 2 – 3 treatments.  Depending on the doctor you see (and you must go to a doctor as it is not without its risks), the cost per treatment will be from $700 per session upwards.

I’ve had several different treatments with various lasers but for facial skin rejuvenation found fractionated CO2 the most accessible for the reasons cited above. As well as smoothing fine lines and wrinkles, CO2 laser gives you a more even skin tone.  Unlike many other interventions, CO2 laser treatment can last for years and not just weeks or months.

The doctor I see for skin rejuvenation is Bruce Williamson and he is passionate about the field of cosmetic medicine so keeps abreast of new developments, is very gentle and doesn’t laugh at my fear of pain!  For me, the amount of pain attached is a key determinant of compliance with any intervention I undertake. As laser work is quite painful then the first thing to ask your doctor is how he or she manages this.  Bruce uses an anaesthetic cream comprised of Tetracaine 4%, Lignocaine 1.5% and (Prilocaine 1 5% Euxyl). You need to apply this at least an hour (or preferably longer) prior to the procedure.  Bruce also uses Nitrous Oxide while he is doing the procedure. Go to YouTube to see Bruce in action with the laser and me in action with the nitrous!

How does the CO2 laser work?

When the laser head is placed on your skin, the carbon laser beam that is channeled through the hand piece is broken into lots of evenly channeled, thin, microscopic beams that hit your skin and vaporize any sun damaged or scarred tissue. This causes tightening of the skin and during healing supports it to produce collagen (the protein responsible for skin structure and appearance).

This action effectively vaporizes small columns of tissue that take 2 – 3 days to seal back up again.  As the skin heals, the lost volume creates a tightening of the skin and around those columns of skin where the beam delivers heat, and the actual mechanism by which wound healing occurs, partly leads to the formation of new collagen in the skin.

Why CO2 laser?

Bruce uses a fractionated CO2 laser and more specifically a Smartxide DOT laser made by Deka.  Some doctors use Fraxel which is also a well-recognized brand.  Fraxel make two lasers:  the original Fraxel, now called the ‘Restore’, is a 1,550nm erbium glass laser that doesn’t cause ablation of the surface but penetrates deeply into the skin forming tiny zones of thermal coagulation thus initiating a tissue repair process that rejuvenates the skin.

The problem with this laser is that because you are not really ablating the epidermis the external surface of the skin, still looks much the same even though you may be treating the deeper layers of the skin to improve the structure. It works reasonably well for acne scarring but apparently the results have been disappointing with most people needing between 4-6 treatments to see any reasonable results. Also because that wavelength penetrates deeply into the skin there is also a lot of pain. More recently Fraxel have released the ‘Fraxel Repair’ laser which is a fractionated CO2 laser very similar to Bruce’s.

The wavelength of a CO2 laser is 10,600nm and is absorbed strongly by water ablating from the top down. This produces true fractional ablation of the epidermis with the depth of the thermal injury depending on the power of the laser and the dwell time on each dot. Because you ablate the epidermis you get a new, smoother surface of the skin with less treatments and a potentially less deeply penetrating treatment and less discomfort.

With regards to discomfort however, the CO2 laser can drill very deep holes into the skin if you want it to, such as if you were trying to treat deep wrinkles with a single treatment, and then there will be a lot of pain and discomfort and local unaesthetic blocks are usually necessary along with oral analgesics. Less pain, less gain!!

Recovery and results

Think ‘red puffer fish’!!  The immediate effects includes redness, swelling and sometimes oozing of clear fluid (serum). This is only temporary and initial healing occurs within 3 – 5 days. The first day or so you’ll be red and swollen and then the skin will start to peel off (think dandruff of the face!). Unless you want to be noticed it is best to stay out of the public eye until day 3 at least. By day 5, apart from looking pink you’ll be ready for public viewing.

There’s really not much required in the way of wound care. To keep swelling under control be sure to apply ice to your face for at least an hour after the procedure.  For the first day or so use an intensive tissue repair cream (Bruce uses Complex Cu3) and then use a thick moisturizer (I use a shea butter cream).  Don’t use moisturizer with active ingredients as this might cause stinging and damage the rejuvenated skin surface.

Dr Bruce Williamson operates from Balgowlah Skin Cancer Clinic and Face Today.

Tags: rejuvenation, skin, treatments