Skin rejuvenation or resurfacing with the fractioned CO2 laser

Skin rejuvenation or resurfacing

Laser resurfacing is a laser technique in which the skin is provided with a new surface, making the skin look younger. For that reason, this technique is also sometimes referred to as skin rejuvenation. The resurfacing technique is usually used to make the skin firmer, to smooth wrinkles, fade scars and stretch marks or to improve the texture and skin pore structure. CO2 lasers are the most suitable laser devices for this.

Classic CO2 lasers versus fractioned CO2 lasers

The traditional CO2 lasers are the ultimate agent for the treatment of skin aging and wrinkles. These laser devices give a powerful light beam of a single wavelength which is absorbed by the water in the skin. The skin, which consists of a large proportion of water, is heated to enable the water to evaporate. The intense heat of the superficial skin layer (epidermis) results in an abrasion. The light rays are so precise that they hardly damage the underlying tissues. The heat radiation in the underlying corium (dermis) causes a contraction effect of the protein structures in the skin (collagen), which results in the creation of a permanent more solid structure over which the epidermis will grow back. The skin will tighten, look younger and fresher.

The traditional unfractionated laser technique has been used with a CPG-scanner for the face since 1995. However, this is very burdensome because recovery takes a long time and intensive local care is necessary for 7 to 10 days. Therefore, a new method has been sought.

In early 2005, the fractional laser technique was developed, whereby first with fine hand-pieces and also since 2008, with FX scanners, evaporation is performed in micro-spots and checkerboard patterns. The fractioned CO2 laser only irradiates a portion (20 to 50%) of the skin. The irradiated sections are performed via small cylinders situated at regular intervals from one another in a grid pattern. The surrounding, intact skin particles ensure a smooth recovery. This fractional laser treatment makes it possible to effect the skin much deeper with a negligible risk of scarring or pigment damage compared to conventional resurfacing. An additional advantage of fractional laser treatment is the faster healing process of the intermediate epidermis particles which are not influenced by the laser. Also, discomfort and risk of infection are a lot lower.

Fractioned resurfacing using different methods

  • With FX scanners
  • With the 0.2 mm handpiece

Fractioned UltraPulse CO2 with FX scanners

The UltraPulse is the most powerful CO2 laser on the market and ensures fewer repeat treatments than other laser types. Due to its short pulse duration, complications are rare and some of the best results are achieved. With the FX scanners, we can treat entire skin surfaces, including the face, neck, décolleté, the back of hands, arms, and so on. Which scanner we will eventually choose (FX 1300, FX 120 or a combination of both) and with which parameters (energy, density of the spots, etc.) depends on the condition we will be treating: sagging skin, depth of the wrinkles, skin type, pigmentation, depth of the acne scars, and so on.

Is fractioned CO2 skin rejuvenation painful?

  • Fractioned UltraPulse CO2 laser treatment with an FX scanner feels like fine pinpricks.
  • Most patients tolerate this without anaesthesia.
  • In patients with a lower pain threshold, possibly a local anaesthesia may be considered. 
  • The burning feeling occurring during the treatment is perceived as the most difficult. However, we cannot reduce this feeling by a local anaesthetic. The burning feeling takes at the most a couple of hours and diminishes quickly when we apply a cooling ointment, like Flamigel during the treatment.

What to expect after the fractioned CO2 treatment?

  • The wound healing phase is limited with fractioned CO2 treatment.
  • For 2 to 4 days, you can suffer from a mild to moderate swelling and redness, which can be compared to a superficial abrasion, followed by a tanned look caused by very fine micro scabs in the skin. Usually, this condition is completely healed after a week.

Aftercare at home following fractioned skin rejuvenation

  • The first day or the first two days
    According to the feel and necessity, apply Flamigel on the treated area up to 5x daily. Additionally to refresh or to moisten the drying gel, you can use Avene thermal water. Remove the gel at least 2 times a day with thermal water and apply a new layer.
  • From the second day or the third day
    When the Flamigel starts to feel too drying, you can start using a hydrating, restorative cream from the pharmacy, such as Avene Tolerance Extreme cream or Toleriane Ultra RochPosay. Depending the feel these creams can be applied several times per day.
  • From the fourth day
    Once the skin is dry and only has a tanned look due to the micro scabs, you can also use a concealing cream or foundation if desired.
  • The first month after the treatment
    During the first month after the fractioned CO2 treatment, you should avoid exposure to UV radiation (sun or sunbed) as much as possible. If it is not possible, for example, if you are leaving on vacation or a skiing holiday, a total sunscreen cream with a SPF50+ is recommended. This ointment needs to be applied half an hour before the first exposure to the sun and repeated every 2 hours.
  • Additional advice
    During the first week, you should not use any personal care products. During the first month, you should definitely not use care products containing vitamin A acid derivatives, such as retinol, retinoids, and so on.

Fractioned resurfacing treatment for scars and stretch marks

  • For the treatment of stretch marks and scars, we usually use the fractioned CO2 resurfacing laser with the 0.2 mm handpiece.
  • The inconveniences, the healing phase and aftercare are very similar to those of the CO2 laser with FX scanner described above.

Fractioned resurfacing of the lower eyelids

  • Blepharoplasty is the treatment of sagging skin on the eyelids (blepharochalasis). It is recommended to apply the fractioned resurfacing technique, especially for the lower eyelids because scarring does not occur.
  • For the upper eyelids, a surgical blepharoplasty is often preferred. The interfering overhanging upper eyelids can be cut away in the time of a single session and the scars coincide with the eyelid fold.
  • The shrinking effect of the fractioned laser technique is not unlimited. In more pronounced blepharochalasis, the fractional laser treatment will have to be repeated a couple of times. However, it is not a problem to repeat the treatment with an interval of at least 6 months until the result is optimally satisfactory.

The advantage of fractioned laser treatment for eyelids

  • No lasting scars
  • No risk of pigment damage
  • Limited postoperative discomfort
  • Healing within a week
  • The shrinking effect of collagen occurs in the natural direction of the collagen thus, the eye shape will never change.
  • Also, the quality of the remaining skin improves; for example, firming of the surrounding skin, fresher texture, a reduction of dark circles under the eyes, and so on.
  • The fractioned laser treatment of the eyelids is performed without anaesthesia.
  • The cosmetic look during the healing phase is not repulsive.
  • If you do not work in a polluting environment, you can continue your normal activities at work, as well as your household and sports activities. 

The expected results of fractioned resurfacing

  • In general, fractioned resurfacing gives a remarkable improvement in the areas of the skin texture and skin tightening. However, this does not mean that the sagging skin, wrinkles, stretch marks or scars will be completely gone.
  • With fractioned resurfacing, we do not expect complications, such as scarring, pigment damage and / or the inability to connect the eyelid to the eyeball (ectropion).

What you also need to know

  • During the treatment, closing the eyes is sufficient to protect your eyes. Alternatively, we can also place protective metal eye-shells on the eyes.
  • As a precaution for patients who are sensitive to fever blisters (herpes simplex), we can prescribe preventative medication. 
  • During the preliminary consultation, we explain what you can expect from the fractional laser resurfacing treatment. Of course, after treatment, the skin undergoes the natural evolution of the aging process. Optimal protection from the sun, possibly combined with an adapted skin care cream can help to maintain the achieved result as long as possible. If desired, you can opt for annual maintenance treatment to maintain the best possible rejuvenation. 
  • Although fractioned laser treatment is effective in most cases, we can never predict, nor guarantee, the degree of improvement.
  • Often multiple treatments are necessary to achieve an optimal satisfactory result.
  • Although in theory, you can drive a car after treatment, we recommend that you organise transportation in the case of fractioned CO2 laser treatment to the face or eyelids.

If you have any question about skin rejuvenation by means of fractioned CO2 laser treatment, do not hesitate to contact us.

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