The newer generation of physically conscious youngsters (both girls & boys) besides young moms refuse to live with a physical appearance, which demotivates them to wear the clothing of their taste. CO2 facial resurfacing is one of the treatments of choice in stretch marks with excellent laser toning and tightening effect. Fractional CO2 laser skin resurfacing in Chandigarh or fractional CO2 laser treatment in Chandigarh is one of the latest advances in the stretch marks reduction treatments. The CO2 laser is the laser with the longest wavelength. CO2 face treatment can be used safely for darker skin type with appropriate settings. It gives optimum results in the hands of an expert dermatologist.

Mechanism

  • 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.
  • This pixilated 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 thermally damages or destroys it.
  • Multiple vertical microscopic three-dimensional small columns of coagulated and necrotic tissue are created and are referred to as microthermal/microscopic treatment zones (MTZs).
  • 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).
  • The MTZs induce a wound healing response consisting of rapid eipthelialization, tissue repair through neocollagenesis, and dermal remodelling from the surrounding viable tissue.

Indications:

  • Stretch marks
  • Skin laxity (tightening)
  • Laser toning and tightening

Contraindications:

  • Keloidal tendency
  • Infection
  • Connective tissue disorders

Patient Selection:

  1. The fairer the patient, the better the results. Though it gives great results in darker skin too with appropriate laser settings and required skin care & precautions by the patient.
  2. Emotionally balanced with realistic expectation.

Patient Information:

Patient should be well informed about the following facts -

  1. Realistic expectation of the outcome - 40-70% improvement (Results vary from patient to patient) and not complete elimination. Multiple (3 to 6) sittings may be required at 1 month gap.
  2. Postoperative sequelae, side effects, and complications.
  3. Postoperative sun protection for 3 to 6 months if striae are present on sun exposed areas.
  4. Younger the patient, lesser the number of sessions required.

Preoperative work:

  1. Complete work: CBC, blood sugar etc.
  2. Consent and photographs.
  3. Preoperative preparation (cream programme) to prevent or reduce postoperative adverse reactions (sunscreens, topical creams for 4-6 weeks before the surgery).
  4. Preoperative medications (Oral & Topical) to be started 15 days before the procedure and to be continued for 7-10 days postoperatively.
  5. Close shave, removal of excess hair just before the procedure in case of thigh and lower abdomen.
  6. Procedure :
    1. Gloves and goggles
    2. Topical anesthesia (TA) - cream applied under occlusion for 1-2 hours before the procedure.
    3. Preparation for the laser
    4. The parameters of the laser are set.
    5. Technique for Laser resurfacing for Stretch marks: The laser is set in 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 and site to be treated.
    Postoperative Management:
    1. In case of stretch marks on sun exposed area, 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 hourly, once the crust falls and reepithelialization is completed (7-10 days).
    2. Proper skin care

      a.Antibiotic creams, other adjuvant creams & serums are prescribed by our dermatologist to be used immediate post operatively and at home for first 7-10 days till flakes or crusts are gradually gone. Patient is encouraged to wash the area repeatedly followed by application of antibacterial ointment. Reepithelialization process starts and is usually completed in 7-10 days.
      b.Postoperative programme consisting of sunscreens, emollients etc. is usually started after 2-3 weeks when the 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.

    3. Oral medications are prescribed to reduce the post laser discomfort and to enhance the final result giving highly satisfactory results for our patients. Area is not covered with any dressings; only topical preparations as guided by our dermatologist are applied all over.
    SEQUELAE OF FRACTIONAL LASERS:
    1. Usual events: Transient edema, erythema, localised urticarial, punctuate bleeding, discomfort, flaking, crusting, and bronzing.
    2. Side effects: Persistent erythema and post inflammatory hypo/hyperpigmentation can happen only if the patient doesn’t follow post laser skin care properly including the use of a good sunscreen frequently & religiously.
      1. Advantages:
        1. Good to excellent aesthetic results.
        2. Simple office procedure.
        3. All signs of stretch marks and skin laxity (skin toning & tightening) can be treated at one time.
        Can be combined with scar revision