Erbium Laser Skin Resurfacing

Er:YAG Laser Resurfacing for Skin Rejuvenation and Youthful Complexion

Laser resurfacing, also referred to as laser peel or fractional laser resurfacing, harnesses the power of the Erbium laser to rejuvenate sun-damaged skin. This advanced technique effectively removes the outer layer of damaged skin, resulting in a smoother, softer, and more youthful appearance. Laser resurfacing is a groundbreaking alternative to traditional methods like chemical peels and Morpheus8, addressing a myriad of skin concerns, including fine lines, wrinkles, facial scarring, rough skin texture, hyperpigmentation, age spots, acne scarring, and discolouration. Typically performed on the face and neck, laser resurfacing offers remarkable results in just a single treatment, with long-lasting effects that can endure for years.

The Recovery Process

Following laser resurfacing, patients can anticipate an average recovery period of 7-14 days. During this time, it is imperative to minimize sun exposure, wear protective clothing, and use high-SPF sunscreen to reduce the risk of hyperpigmentation. Our dedicated practitioners will also prescribe top-tier medical-grade skincare products, facilitating the healing process and optimising both your recovery and final results.

Expected Outcomes

• Reduction or elimination of fine lines and wrinkles
• Treatment of age spots, sun spots, and solar lentigo
• Treatment of acne scarring
• Treatment of dyschromia
• Elimination of coarse skin texture
• Skin tightening
• Removal of freckles

Over time, the effects of sun damage and environmental pollutants accumulate, leading to the formation of wrinkles, age spots, sun spots, and unsightly blemishes.

Choosing the Right Specialist

Selecting the right specialist for your laser treatment is paramount in achieving exceptional results. At Centre for Surgery, we prioritise surgical-grade lasers over ‘aesthetic grade’ alternatives, which often carry higher risks of complications. Our practitioners possess extensive experience, performing numerous laser procedures annually. Entrust your skin to specialists with profound expertise in powerful surgical-grade lasers and access to cutting-edge laser technology.

The Power of Fotona Lasers

Fotona lasers are renowned worldwide for their exceptional quality and precision. Er:YAG laser resurfacing using the Fotona SP Dynamis is a superb treatment option for a wide range of common skin concerns. From localised treatment of benign pigmented lesions such as seborrhoeic keratosis or senile warts to full-field resurfacing of the entire face, this laser emits light at a peak wavelength of 2940nm. This wavelength targets water absorption in the superficial skin layers (epidermis and dermis). It enables epidermal ablation and subsequent skin healing, effectively addressing sun-induced damage, dyschromia, and rough skin texture.

Stimulating Collagen and Elastin Production

Moreover, the added thermal injury in the dermis below the ablation zone stimulates collagen and elastin production. This leads to a reduction in skin laxity and an improvement in the appearance of static wrinkles, also known as wrinkles at rest. With careful patient selection and Er:YAG laser treatment, you can achieve a significantly enhanced overall skin appearance.

Suitability for Different Skin Types

While Erbium laser skin resurfacing is most effective for lighter skin types (Fitzpatrick skin types I-II), it can also be adapted for darker skin types (Fitzpatrick skin types III-IV) by adjusting the laser settings to more conservative levels.

Comprehensive Treatment Approach

At the Centre for Surgery, we offer a holistic approach to skin rejuvenation. In addition to Er:YAG laser resurfacing, we provide combination treatments involving Morpheus8, anti-wrinkle injections, and dermal fillers, tailored to your unique needs. Trust us for a radiant, youthful complexion that stands the test of time.

Laser skin resurfacing is a cosmetic procedure that utilises laser technology to enhance the appearance of the skin. This innovative technique involves directing concentrated, pulsating beams of light at irregular skin, meticulously removing skin layer by layer. This process is also known as lasabrasion, laser peel, or laser vaporisation.

At the heart of this procedure is the precision with which the laser operates, allowing for targeted treatment of specific skin issues. Laser skin resurfacing primarily aims to reduce facial wrinkles, scars, and blemishes. Additionally, it’s remarkably effective in improving overall skin tone and texture.

The procedure involves two types of lasers: ablative and non-ablative. Ablative lasers, which include erbium lasers, work by vaporising the top layers of damaged skin. This intense treatment leads to more significant downtime but dramatically improves skin quality.

Non-ablative lasers, on the other hand, don’t remove any skin layers. Instead, they aim to stimulate collagen growth and tighten the underlying skin. This approach is less invasive and typically requires less recovery time, making it a preferred choice for individuals seeking a less intensive treatment.

During the procedure, the practitioner focuses the laser device on the desired area, emitting short, concentrated beams of light. This light removes the outer layer of the skin (epidermis) while heating the underlying skin (dermis). This dual action removes damaged surface skin and stimulates the growth of new collagen fibres. As the treated area heals, the new skin forms smoother and firmer.

Candidates for laser skin resurfacing typically have fine lines or wrinkles around their eyes, forehead, or mouth, scars from acne or other causes, or skin that needs repairing due to sun damage or ageing effects. It’s a highly tailored procedure, so a consultation with a skincare professional is essential to determine the best approach based on individual skin type and cosmetic goals.

Recovery times vary depending on the type of laser used and the extent of the treatment. Ablative treatments might require two to three weeks of healing, whereas non-ablative treatments generally have a shorter recovery period.

Like any cosmetic procedure, laser skin resurfacing has potential risks, such as infection, scarring, and changes in skin pigmentation.

At Centre for Surgery, laser skin resurfacing in London is performed using state-of-the-art VSP Erbium technology. This involves high-power surgical-grade laser resurfacing the skin with extreme precision. Erbium: YAG lasers with a wavelength of 2940nm create less injury to the deeper lying dermis and have less risk of inducing hyperpigmentation skin changes compared with the CO2 laser when the Erbium laser is used in a pure ablation mode, which leads to quicker healing.

In recent years, the fractional CO2 laser has been developed to reduce the impact of thermal injury. Fractionation of the laser beam into lots of microcolumns lessens the impact on the skin. The disadvantage of fractional CO2 lasers is their effect of leaving areas of untreated and aged skin. The fully ablative Erbium laser allows for complete ablative skin resurfacing with much less energy being imparted to the dermis and, therefore, less risk.

There are numerous benefits to undertaking laser skin resurfacing, including:

• Able to rejuvenate the skin without surgery or the use of chemicals
• Suitable for any skin type
• Reduced downtime
• Allows for precise and accurate control during treatment, giving you the best results

Ablation and coagulation – how do these matter?

Er:YAG laser is very well absorbed in water. Water is the primary chromophore for ablative lasers like the older CO2 lasers and the newer Er:YAG lasers. CO2 lasers have less ablation efficiency due to their lower absorption in water. Er:YAG laser is much more efficiently absorbed in water than CO2 lasers. This allows our lasers to vaporise the target tissue of skin with extreme micron-level accuracy without undesired thermal coagulation effects. These collateral thermal effects seen with the CO2 laser are very often responsible for post-inflammatory hyperpigmentation or PIH, persistent erythema (redness), and prolonged recovery times. Coagulation will always accompany ablation with CO2 lasers – not so with Er:YAG technology.

The dual mode Erbium allows the operator to fine-tune the ratios between Er:YAG ablation and coagulation all the way from ‘cold’ ablation to non-ablative coagulation. The versatile nature of dual-mode Erbium laser technology is now the standard of care for laser skin resurfacing.

Erbium laser resurfacing is best suited for patients with lighter Fitzpatrick 1 and 2 skin types. As part of a skin preconditioning routine, all patients must apply topical skin products 2–3 times per week for 4–6 weeks and stop seven days before laser treatment. A one-week course of 500 mg of antivirals four times daily is started one day before the procedure.

Non-ablative laser resurfacing using Erbium Glass laser is better suited for patients with Fitzpatrick skin types 3-5.

Fractional erbium laser skin resurfacing is a suitable procedure for those who are concerned about fine lines, wrinkles, skin texture or acne scars. It is suitable for those who do not wish to undergo a surgical procedure and do not want to use any chemicals . You will need to be at least 18 years old to undergo the laser resurfacing procedure.

You will need to attend a consultation with one of our aesthetic practitioners, who will be able to assess whether or not you are a suitable candidate for laser resurfacing.

Good candidates for laser resurfacing

• Patients with lighter skin types – Fitzpatrick types 1-3
• Those who would like to reduce fine lines around the periocular or perioral region
• Tightening of loose skin of the upper and lower eyelids as an alternative to a blepharoplasty
• Those wanting to reduce hyperpigmentation, age spots or freckles
• Treatment of facial scars, including all types of acne scars
• Are in good overall health with realistic expectations of what laser resurfacing can achieve
• Non-smokers

Our practitioner’s preference is to pre-treat all patients for 4–6 weeks before laser resurfacing. This regimen includes topical skin-lightening agents and sunscreen with an SPF greater than 30. The pretreatment protocol improves skin tolerance, regulates fibroblast and melanocyte function, improves dermal circulation, and allows for the treated skin to heal 3–4 days faster due to increased cellular division and new collagen formation. Modifications to this pre-procedure regimen (dosages and application intervals) are made as needed based on tolerance and skin types. A week before the laser resurfacing procedure, patients are started on a cleansing and toning protocol and encouraged to maintain adequate hydration and regular skin moisturising. Antiviral prophylaxis is started two days before the laser resurfacing procedure and continued for five days after the laser skin resurfacing in patients with a prior history of herpes virus. Oral antibiotics may also be prescribed after the procedure to minimise the risk of bacterial infection.

Before laser resurfacing, removing all makeup and skin lotions from the face is important. You should avoid all forms of tanning, including tanning beds and excessive sun exposure, for at least four weeks before the procedure. The aftercare instructions are based on the type of laser treatment administered and should be followed to avoid complications. Intense physical activity should be avoided for at least one week. You should avoid exposure to the sun for at least four weeks after the laser resurfacing procedure and up to 6-8 weeks for fully ablative laser resurfacing. Check with your doctor before applying sunscreen, as it can irritate the skin and will be raw after treatment. Your practitioner can advise on the correct timing for sunscreen application.

There are two approaches to laser skin resurfacing: fully ablative and fractional.

In fully ablative resurfacing, the entire surface area of the skin within the laser spot is treated by the laser beam. The laser beam is scanned across the treatment area using specialist laser scanners and precisely removes the superficial layers of the skin – micron by micron. During the healing phase, the old, ageing, and sun-damaged skin that is removed will be replaced with a fresh, healthy-looking layer. Regarding penetration depth, treatments can range from superficial light peels to deep peels reaching beyond 100 microns. Light peels are indicated to remove fine lines, sun spots and aged-looking skin; deep peels are applied to improve skin tone and texture and eliminate deep wrinkles, even notoriously hard-to-treat smoker’s lines and crow’s feet. Light peels have a shorter downtime, but deeper peels have more dramatic treatment effects. It depends on your downtime tolerance with some of the deeper laser treatments.

In fractional resurfacing, the laser creates tiny pinpoint columns of skin within each laser spot, leaving intact, unaffected tissue around each micro-spot. This promotes faster healing compared with fully ablative full-field resurfacing, while the laser can be allowed to penetrate the deeper skin layers to initiate collagen and elastin remodelling. This also works very well for acne scarring.

The laser skin resurfacing involves three steps:

• Conditioning: an Ng: YAG laser is passed along the skin’s surface twice, penetrating the tissue and conditioning the skin.
• Fractional therapy: the fractional Er: YAG laser is used to ablate old skin, allowing for new, tighter tissue to form.
• Peeling: the full light Er: YAG laser ablates the skin, removing any superficial imperfections on the skin.

Types of laser resurfacing:

A burning sensation of the face with associated swelling develops over the first 24 hours and takes about 24-48 hours to resolve. This is a non-invasive procedure, so there is very little recovery time. You will be able to return home on the same day as the procedure. You may experience redness on the skin that may feel similar to a mild sunburn. This may last for around 48 hours. After around 36 hours, the skin will begin to peel. After seven days, you may wish to do a light exfoliation to remove any peeling skin.

You should avoid any exercise for the first 24 hours. Avoid any sun exposure and apply any makeup for the first 48 hours. Avoiding makeup will help reduce the possibility of any acne breakouts. During this period, make sure to keep the skin moisturised and hydrated.

Laser resurfacing is a safe procedure when performed by appropriately trained practitioners. At Centre for Surgery, risks are minimised by meticulous patient selection and thorough pre-procedure preparation. It is very important to undertake skin preconditioning to enhance treatment efficacy.

There are several factors which will impact the final cost of the laser resurfacing procedure: