Laser Skin Resurfacing

Laser resurfacing, also known as a laser peel or fractional laser resurfacing involves the removal of the outer layer of sun-damaged skin using Erbium laser. Subsequent healing results in smoother, softer, and more youthful looking skin. Laser resurfacing is another type of skin resurfacing alongside more traditional chemical peels and Morpheus8. Laser skin resurfacing is used to treat many skin concerns including fine lines and wrinkles, facial scarring, coarse skin texture, hyperpigmentation, age spots, acne scarring and discolouration. Laser resurfacing is most commonly performed in the face and neck region. Laser resurfacing especially when performed at higher treatment parameters allows patients to achieve results in just one treatment and the results can last for many years. The average recovery after laser resurfacing is about 7-14 days on average and during this time, patients should minimise sun exposure, wear protective clothing and wear high SPF sunscreen to minimise the risk of hyperpigmentation. Our practitioners will also prescribe medical grade skin care products to enhance the healing process, your recovery and ultimately the final results.

Laser Resurfacing Expected Results

• Reduce or eliminate fine lines and wrinkles
• Treatment of age spots, sun spots and solar lentigo
• Treatment of acne scarring
• Treatment of dyschromia
• Eliminate coarse skin texture
• Skin tightening
• Remove freckles

The effects of sun damage and environment pollutants gradually take their toll on human skin, causing wrinkles to be formed, age spot and sun spot formation and thickened unsightly blemishes.

Choosing the right specialist for your consultation and laser treatment is key to getting the very best results from your treatment. We don’t use ‘aesthetic grade’ lasers which are very often under-powered and actually carry greater risks of complications than their surgical grade equivalents.

Whether it is non-ablative or ablative laser, fractional or full field laser skin resurfacing, we have all the treatment options to suit every skin type. Our practitioners have a wealth of experience and perform hundreds of laser procedures annually. It is extremely important to select specialists who have the in-depth expertise with powerful surgical grade lasers as well as having access to the most advanced laser technology.

We also perform combination treatments with Morpheus8, anti wrinkle injections and dermal fillers.

All our doctors are on the GMC specialist register. Our London dermatology clinic at 106 Crawford Street was recently inspected and rated as good across all 5 domains.

10 REASONS TO CHOOSE US – CLICK HERE TO LEARN MORE

RealSelf Top Doctors

RealSelf top doctor status is awarded to less than 10% of the RealSelf doctor community.  This status is earned by achieving consistently high patient satisfaction (from RealSelf reviews), getting excellent feedback on expert answers to patient questions, and after investing significant time in Q&A and other doctor activity. RealSelf top doctors are rated among the very best surgeons in the United Kingdom and USA.

A laser dermatologist is trained to undertake aesthetic laser and surgical procedures in the face and neck region. They are dedicated sub-specialists. Compared with general dermatologists, laser surgeons are inherently better trained to perform delicate laser and facial procedures. The extra years of surgical training by facial laser specialists focused on the use of lasers in the facial region results in an exceptionally high degree of skill.

Our laser surgeons are full members of:

The laser surgeon will always take time to review all your options to give you an idea of how you may look after your procedure. Our high standard of ethics is reflected in our guidance to all patients to seek the opinions of several specialists so they can feel totally comfortable with their ultimate decision to undergo laser resurfacing as well the right choice of practitioner and clinic.

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, 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 or dermatologists 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

Who is not an ideal candidate for laser resurfacing?

Laser skin resurfacing delivers outstanding results and will significantly improve fine lines and wrinkles and smoothen out acne scars. However, it cannot completely remove very deep wrinkles or severe skin laxity with heavy jowl formation and saggy skin. In these cases, you will be referred to see one of our expert plastic surgeons for an assessment to determine if a surgical procedure such as a facelift would be more appropriate with your laser resurfacing procedure. For patients with darker skin types such as dark brown or black skin types (Fitzpatrick type 4-6), laser resurfacing may not be an ideal option. The risk of developing hyperpigmentation during the recovery process is higher in darker skin types. For all skin types, it is very important to commence a skin preconditioning regimen for at least 4-6 weeks prior to laser resurfacing. Preconditioning consists of prescription grade skin care products such as tretinoin and 4% hydroxyquinone. The preconditioning protocol prepares the skin for the effects of the ablative laser and optimises recovery and treatment outcomes.

Can laser resurfacing be combined with a facelift?

Fractional laser resurfacing can be combined with a facelift procedure in certain circumstances such as a mini facelift. There is, however, a potential risk of laser on the newly draped skin after a facelift.

At Centre for Surgery, we always recommend having laser resurfacing ideally after you have fully recovered from your facelift procedure for improved safety and better overall outcomes of treatment.

At Centre for Surgery, laser skin resurfacing in London is performed using state of the art VSP Erbium technology. This involves the use of a high power surgical grade laser to resurface the skin with extreme precision. Erbium:YAG lasers with a of wavelength 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 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 the thermal injury. Fractionation of the laser beam into lots of microcolumns lessens the impact of 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 imparting of energy to the dermis and therefore less risk.

There are numerous benefits for 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 main 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. It is these collateral thermal effects seen with the CO2 laser which are very often responsible for post inflammatory hyperpigmentation or PIH, persistent erythema (redness) and prolonger 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 tine 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 those patients with the lighter Fitzpatrick 1 and 2 skin types. As part of a skin preconditioning routine, all patients need to apply hydroquinone and topical tretinoin 2–3 times per week for 4–6 weeks and stop 7 days before laser treatment. A 1-week course of acyclovir 500 mg 4 times daily is started 1 day before the procedure.

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

The award-winning Fotona SP Dynamis at Centre for Surgery in London is our state of the art laser resurfacing system with dual Er:YAG and Nd:YAG capabilities. Er:YAG laser resurfacing is possible with both fully ablative and fractional modes for full treatment versatility.

We provide the most comprehensive range of anaesthesia options for laser skin resurfacing in the UK. Our dedicated outpatient surgical suite at 106 Crawford Street is fully equipped for all the methods below:

Non-invasive methods:

• Topical anaesthesia 
• Cryo anaesthesia (cold air skin cooling)
• Inhaled anaesthesia – inhaled anaesthesia is a real game changer for optimising patient comfort with laser skin resurfacing. There are no sedative effects and patients can control the amount of pain relief by simply inhaling the mouthpiece which delivers a controlled mixture of 50% nitrous oxide and 50% oxygen.

Invasive methods:

• Injected local anaesthesia – direct infiltration, nerve blocks and tumescent anaesthesia – where a procedure a requires local anaesthesia to be injected perhaps because a large treatment area will be addressed often requires the laser surgeon to utilise a combination of techniques. A commonly used combination is a regional nerve block combined with ‘horseshoe’ tumescent anaesthesia to allow pain-free full face laser skin resurfacing.
• Systemic anaesthesia – if you prefer to be asleep for your laser skin resurfacing procedure, our expert anaesthetists are trained to deliver TIVA general anaesthesia. This means you will not be able to see, hear or feel any part of the procedure. When you wake up you may feel a hot sensation to your face which is common to all anaesthesia methods is related to the laser itself. There are many excellent treatments to reduce this sensation to give a cooling effect to the skin.

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 lase scanners and precisely removes the superficial layers of the skin – micron by micron. During the healing phase, the old, aging and sun-damaged skin that was removed will be replaced with a fresh, healthy-looking layer. In terms of depth of penetration, 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 very much depends on your tolerance of downtime with some of the more deeper laser treatments.

In fractional resurfacing the laser creates tiny pinpoint columns of skin within each laser spot, leaving intact, unaffected tissue around each individual micro-spot. This promotes faster healing compared with fully ablative full field resurfacing, while the laser can be allowed to penetrate into 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 surface of the skin 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:

Will I need more than one laser resurfacing treatment?

For most patients, laser resurfacing is able to treat most skin issues in only one treatment. The final results may not become apparent until six months after treatment particularly after deep laser resurfacing. Some skin conditions such as acne scarring or more severe skin aging are notoriously difficult to treat and may require a number of treatments to get good results. In many cases, skin resurfacing options include milder chemical peels as a second treatment after a first laser resurfacing treatment to ‘fine-tune’ the result. Prescription-grade skin care products after laser resurfacing (Obagi Nu-Derm) will help to enhance the result further. A single light erbium micro-peel is equivalent to six microdermabrasion sessions.

Our surgeons preference is to pre-treat all patients for 4–6 weeks before laser resurfacing. This regimen includes topical tretinoin (0.05%–0.1%), hydroquinone (2%–4%), sunscreen with SPF greater than 30, and alpha hydroxy acid (4%–10%). 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 moisturising of the skin. Antiviral prophylaxis with Acyclovir is started 2 days before the laser resurfacing procedure and continued for 5 days after the laser skin resurfacing in patients with a prior history of herpes virus. Oral antibiotics may also be prescribed to be taken after the procedure to minimise the risk of bacterial infection.

Before laser resurfacing, it is important to remove all make-up and skin lotions from the face. You should avoid all forms of tanning including tanning beds and excessive sun exposure for at least 4 weeks before the procedure. The aftercare instructions are based on the type of laser treatment administered and should be followed to the letter to avoid complications. Intense physical activity should be avoided for at least one week. You should avoid exposure to the sun for at least 4 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 be irritating to the skin as the skin will be raw after treatment. Your doctor will be able to advise on the correct timing for sunscreen application.

Common side effects:

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 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 applying 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.

Case 1:

Fully ablative laser resurfacing with Erbium laser

Case 2:

Case 3:

Morpheus8 is the most exciting development in fractional radiofrequency microneedling. The Morpheus 8 device is the latest generation of fractional RF microneedling with full control over needle depth adjustment and the level of energy delivered through the 24 precision microneedles. Morpheus8 is a powerful technique for facial rejuvenation when combined with laser resurfacing. Morpheus 8 would be carried out first followed by erbium laser in the same treatment.

Unlike erbium laser, the tiny pins of the Morpheus 8 device are able to penetrate deep enough into the skin to impart controlled thermal energy via the micropins to induce contraction of collagen and elastin. The Morpheus 8 procedure does not require any incisions and there is no need for sutures. As with erbium laser skin resurfacing, the procedure can be performed effectively with the prior application of topical local anaesthetic cream to permit a pain-free procedure. Morpheus8 can be safely used on darker skin types unlike laser resurfacing although erbium laser is safer than CO2 laser in this regard.

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 with tretinoin, hydroxyquinone, sunscreen and alpha hydroxy acids to reduce  treatment risks and enhance treatment efficacy.

Our aftercare programme was recently described as ‘outstanding’ by our regulator, the Care Quality Commission. 

There are a number of a factors which will impact on the final cost of the laser resurfacing procedure:

Centre for Surgery is located at 106 Crawford Street in Marylebone. Crawford Street is just off Baker Street.

We are easily accessible by all major bus routes that pass through Baker Street as well as Baker Street underground station.

From the tube station, we are just a 5 minute walk southwards down Baker Street followed by a right turn onto Crawford Street. The clinic is about 200 yards on the left.

There is ample local pay & display parking in the surrounding area and an NCP car park is located further west along Crawford Street. Our local residential parking zone is the City of Westminster.

Address: 106 Crawford Street, Marylebone, London, W1H 2HY