Fractional CO2 laser skin resurfacing is one of most preferred treatments for skin rejuvenation and treating the signs of ageing. It is the best skin rejuvenation treatment in Chandigarh for laser toning and skin tightening. Fractional CO2 laser or laser facial skin rejuvenation is one of the latest advances in the anti ageing treatments. The CO2 laser is the laser with the longest wavelength. It can be used safely for people with darker skin tone with appropriate settings. It gives optimum results when performed by an expert dermatologist.

Mechanism

a. Laser energy in ablative fractional lasers like Fractional CO2 Laser is fractionated either optically (by subdividing the conventional bulk laser beam into many microscopic beams) or through scanner.

b.. This pixelated form of energy passes vertically downward into the skin as microscopic channels and is absorbed by target chromophore water in the tissue (epidermis and dermis), to generate heat which then thermally damages or destroys it.

c.. Multiple vertical microscopic three-dimensional small columns of coagulated and necrotic tissue are created and are referred to as microthermal/microscopic treatment zones (MTZs).

d. Each MTZ is substantially surrounded by undamaged skin. Thus, only fraction of the skin (fractional) is exposed to light (photo) to thermally damage or destroy (thermolysis) small treatment zone and hence named Fractional Photothermolysis (FP).

e. The MTZs induce a wound healing response consisting of rapid eipthelialization, tissue repair through neocollagenesis, and dermal remodelling from the surrounding viable tissue.

Indications:

  • Photo ageing
  • Ageing skin
  • Fine/moderate/severe wrinkles
  • Skin laxity (tightening)
  • Laser toning and tightening
  • Ageing neck
  • Ageing hands

Contraindications:

Keloidal tendency
Infection
Connective tissue disorders

Patient selection:

1. The fairer the patient, the better the results. Though it gives great results for people with darker skin tone using appropriate laser settings, required skin care & precautions.
2. Emotionally balanced with realistic expectation.

Patient information:

Patient should be well informed about the following facts -

  • Realistic expectation of the outcome: 50-95% improvement (depending on the condition being treated & results vary from patient to patient) and there’s no complete elimination. Multiple (2 to 6) sittings may be required at 1 month gap.
  • Postoperative sequelae, side effects, and complications.
  • Postoperative sun protection for 3 to 6 months.
  • Younger the patient, lesser the number of sessions required for skin rejuvenation.

Preoperative work:

  1. Medical Tests: CBC, blood sugar etc.
  2. Ancillary preoperative procedures: These are done 6-8 weeks before laser ablation.
  3. Consent and photographs.
  4. Preoperative preparation (cream programme) to prevent or reduce postoperative adverse reactions. It is advised to use sunscreens, topical creams 4-6 weeks before the surgery.
  5. Preoperative medications (Oral & Topical): To be started 15 days before the procedure and to be continued for the next 7-10 days post the surgery.
  6. Stop shaving and removal of excess hair etc. just before laser skin rejuvenation treatment.

Procedure:

  1. Gloves and goggles
  2. Topical anesthesia (TA) - Cream is applied under occlusion for 1-2 hours before the procedure.
  3. Preparation for the laser
  4. The parameters of the laser are set.

Technique for Laser Resurfacing for Ageing Skin:

The laser is set in the desired mode and its parameters are set to moderate-to-high density of MTZ/cm2 along with high energy in a small circular or square geometrical shape. Skin surface is laser impacted once or twice depending on the indication to be treated.

Postoperative Management:

Total sun avoidance for 7-10 days and sun restriction for further 1-2 weeks.
Patient is instructed to use broad-spectrum sunscreens every 2 hours once the crust falls and reepithelialization is completed (7-10 days).

Proper skin care:

Antibiotic creams & other serums are prescribed by our dermatologist to be used immediately post the surgery at home for the first 7 -10 days till flakes or crusts are gone. Patient is encouraged to wash the face repeatedly followed by the application of antibacterial ointment. Reepithelialization process starts and is usually completed in 7-10 days.

Postoperative programme consisting of sunscreens, emollients etc. is usually started after 2-3 weeks when skin is no more irritable and continued for next 2-4 weeks. The postoperative skin care regimen advised by our dermatologist further enhances our final laser results; thus further reduces the number of laser sessions required for the treatment.

Oral medications are prescribed to reduce post laser discomfort and to enhance the final laser outcome giving highly satisfactory results for our patients.
Face is not covered with any dressing; only topical preparations as guided by our dermatologist are applied all over.

SEQUELAE OF FRACTIONAL LASERS:

Usual events: Transient edema, erythema, localised urticarial, punctuate bleeding, discomfort, flaking, crusting, and bronzing.

Side effects: Persistent erythema and post inflammatory hypo/hyper-pigmentation can happen only if the patient doesn’t follow post laser skin care properly including the use of a good sunscreen, frequently and religiously.

Advantages:

  1. Good to excellent aesthetic results.
  2. Simple office procedure.
  3. All signs of Photo ageing, aging skin, fine/moderate/severe wrinkles, skin laxity (skin toning & tightening) can be treated at one time.
  4. Can be combined with scar revision, face lift etc.