We continue the coverage of the laser skin resurfacing as new data comes in and novel techniques are revealed in this rapidly growing field of cosmetic surgery.

Laser resurfacing, and in particular mild or gentle laser peel, is soaring in popularity as men and women seek quality clinics to get their wrinkles smoothed out. Over the past three years, the number of procedures has increased 456 percent among men and 215 percent among women, according to the statistical report recently published by the American Academy of Cosmetic Surgery. Publications by similar national groups confirm the dramatic growth in the number of procedures and physicians’ fees.

Laser resurfacing is performed by laser beam pulses from a carbon dioxide (CO2) or erbium (Er:YAG) laser to vaporize water molecules from the skin. The controlled damage stimulates the regrowth of new healthy skin tissue, which helps minimize wrinkles and lines. In the last couple of years fractional lasers, which produce microscopic beams in a pre-set pattern, have been upgraded by using the ablative CO2 or Er:YAG wavelengths to join the ranks of skin resurfacing lasers.

Laser peels produce very good aesthetic results at an affordable price, and seem to be more recession proof than most cosmetic surgery procedures.

Wrinkles and sagging skin are caused by a structural breakdown of connective tissue made up of proteins within the epidermis and dermis. These proteins, of which collagen is the main one, are produced from cells called fibroblasts. A fibroblast is a type of cell that synthesizes the extracellular matrix and collagen (and fibrin), the structural framework (stroma) for skin tissue.

Fibroblasts and fibrocytes are two states of the same cells, the former being the activated state, the latter the less active state, concerned with maintenance. Currently, there is a tendency to call both forms fibroblasts. The main function of fibroblasts is to maintain the structural integrity of connective tissues.

As skin ages, fibroblasts collapse and there is an increase in the production of collagenase, which breaks down collagen. For example, people in their 80s have four times more broken collagen than people in their 20s. This “dissolving” of the skin can be interrupted, or else the aging skin is just going downhill.

Our understanding of possible ways and means of the “interruption” is improving quite rapidly. Laser treatments effectively counteract the breakdown of fibroblasts by stimulating the growth of new collagen and subsequently the connective tissue.

Recent studies show that some cosmetic surgeries, such as silicone injections to the face and liposuction to remove fat (and lots of other stuff), may provide acceptable short-lived results but could be destructive and ultimately far less effective than most people expect. Bad side effects are not uncommon.

More and more studies suggest that laser skin resurfacing is the most effective, safe and long-term “interruption”. Voorhees and colleagues, in reviewing dozens of studies done since the early 1990s, found three types of treatments to be effective: topical retinoic acid, laser resurfacing and injections of cross-linked hyaluronic acid. “These treatments all improve the skin’s appearance — and its ability to resist bruises and tears — by stimulating new collagen,” the researchers wrote in the Archives of Dermatology. The work was funded by the university and the National Institutes of Health. “We have shown that if you make more collagen go in, it provides an environment in which fibroblasts recover and make more collagen,” Voorhees said.

Is it safe? Is it painful?

As it is the case with all aesthetic treatments, comfort, safety and effectiveness are determined by the provider, not the technology. Recent advances in aesthetic lasers have made them safe and very effective. The operator is ultimately responsible for the rest.

In conclusion, here is what the FDA has to say about laser resurfacing of wrinkles:

“Several manufacturers have received FDA clearance to claim treatment of wrinkles, while others may claim skin resurfacing. Patients have reported reddening of the skin, which lasted from one to four months. Pain was mild and could be treated with over-the-counter analgesics. Consumers should bear in mind that skin abrasion, whether achieved by lasers, chemicals or abrasive materials, means removing one or more layers of skin, which can be painful and could cause redness, swelling or scarring, depending on how each person heals.”