Laser resurfacing is a significant surgical process. Layers of skin are removed with this technique and healing requires the regrowth of new skin. Removal of deeper wrinkles requires more intensive treatment. Very fine wrinkles can be removed with a light treatment and healing may be complete in less than a week. Most people require more intensive treatment that may take 10-14 days to heal. For the first few days after surgery, there is a great deal of oozing tissue fluid while the skin is denuded. Frequent compresses with cool water help absorb this excess fluid. Most surgeons will apply dressings over the treated areas. The dressings speed healing and protect the new skin. There is surprisingly little pain.
Acne scars are much more difficult to treat than are wrinkles. Because scar tissue has to be removed, many more "passes" of the laser over the skin are usually needed. Such aggressive laser treatment is only possible in areas with thicker skin. Scars in thinner-skinned areas will probably require soft tissue augmentation in addition to laser resurfacing.
The most significant landmark of healing is when the epidermis (top skin layer) has completely regrown and the skin is no longer raw and moist but is smooth and dry. The skin is invariably red and usually requires the use of make-up. Redness fades over a period of several weeks.
Scar formation as a result of laser resurfacing is very uncommon. A scar has abnormal texture, either thicker or thinner than the skin around it. Skin pigment (color) changes are much more common, especially in people whose natural skin tones are darker. Hyperpigmentation (darkening) of the skin after resurfacing is generally temporary and responds to treatments such as bleaching creams. Of greater concern is hypopigmentation (lightening), which is much more difficult to treat but tends to gradually improve. Pigmentary alterations of treated skin are always relative to untreated skin and are one reason why treating the entire face is recommended for those people with darker skin types.
The results of laser resurfacing are greatly dependent on the skills of the surgeon. There are endless variations to how an instrument like the UltraPulse laser can be used. Every treatment should be individualized because the features of facial skin vary widely from patient to patient. Different areas of the face have different types of skin and require different intensities of treatment for optimal results. An inexperienced surgeon is likely to undertreat some of the facial areas, resulting in a disappointing outcome with only minimal improvement. It is also possible for an inexperienced surgeon to overtreat the more sensitive areas such as the skin around the eyes, which can result in delayed healing, prolonged redness and even scarring.
The most experienced laser surgeons own their own equipment. Physicians who lease a laser once a month or use a laser only in a hospital operating room are very unlikely to have the experience needed to obtain optimal results. The best cosmetic laser surgeons use their own laser very frequently and have accumulated a large number of cases. Be sure to ask your surgeon if they own their lasers. Also request to see "before and after" photographs of patients that they have treated. The experienced laser surgeon should have many examples of cases that he or she has done and should be eager to show them to you.