Sometimes deep acne scars are tethered to the underlying skin by scar tissue and this can make the results of laser treatment less effective. An injection with a wide bore needle, of normal saline solution, mixed with a local anaesthetic can be swept underneath the tethered scar to disrupt and break down the scar tissue, before a laser skin resurfacing procedure is carried out.
Laser Skin Resurfacing
Lasers restructure the skin by applying very high laser power in very short bursts to the affected area. The laser removes a very precise layer of superficial skin (the epidermis) and stimulates the production of new collagen, resulting in a more youthful texture and feel to the skin. It has been claimed that the increase in skin collagen, following this type of laser therapy is much more permanent than other treatment methods. However, in cases of severe acne scarring there may often be a need for more than one treatment to achieve the best possible results.
Immediately before the laser procedure you will need to thoroughly cleanse the areas to be treated with soap and water. Female patients should remove all make-up and male patients should have a close shave prior to treatment.
Treatment may only require a local anaesthetic, which is injected into the areas that are going to be treated. Sometimes an anaesthetic called a “field block” will be used to freeze one of the main nerves to the fact to reduce any discomfort. Some patients may wish to have a general anaesthetic or deep sedation for the whole procedure and this will be discussed at the consultation. Paracetamol tablets taken one hour before the procedure, and at six hourly intervals afterwards, can be helpful also.
Once the anaesthetic has worked, the eyes are protected with moist gauze and special goggles. The procedure itself may take from thirty minutes to two hours depending on the number of laser passes that are necessary. After each pass with the laser, the treated skin has to be cleansed before a further pass is carried out.
Treatment usually only requires the application of a local anaesthetic cream or gel, one or two hours before the procedure. However, if extensive areas of the face are to be treated, a field block may also be carried out, or again a general anaesthetic.
Many patients prefer to take a couple of weeks out of their daily routine, as the normal immediately response to treatment is a temporary reddening and weeping of the skin, which will take a few days to heal.
If patients have had problems in the past with cold sores on the face, the consultant may advise taking Acyclovir, an anti-viral medication, to prevent the laser procedure being complicated by further infection by cold sores.
In cases where the patient has had active acne, there is a risk of acne developing in the treated area, so you may be advised to take some long term low dose antibiotics for two or three months after the procedure.
It is very unusual to develop scarring following the use of resurfacing lasers. The lasers have been designed to very exacting technological standards, to try and ensure as far as possible that scarring is not a possibility. However, very rarely a minor degree of scarring has been reported in a small minority of patients, but this can usually be controlled with a steroid injection, into the scar tissue itself.
The commonest post-operative complication is post-laser therapy hyperpigmentation. This increased pigmentation in the skin is much more common in people who tan easily. Hypopigmentation can also occur after laser skin resurfacing. In this condition the skin has less pigment and will look paler than previously. This is usually mild and best treated with sun blocking creams.
Following a skin resurfacing procedure, the treated area will look red, sore and swollen. This is because the top layers of the skin (epidermis) have been removed. It is normal for the treated area to leak a serous fluid. This is the healing process beginning to work.
The swelling will subside within four to five days, but patients may experience some crusting, as the skin begins to heal. If crusting is experienced, then the affected area may, very carefully be cleansed with a solution of hydrogen peroxide (3% strength) and water. DO NOT attempt to dislodge or pick off any of these crusts, as the delicate new skin underneath will become scarred (full aftercare instructions will be given on the day of the procedure).
It is quite usual for the treated area to remain red for several weeks after the procedure. This is absolutely normal and is one of the positive signs that the treatment has worked. The redness is due to an increased number of blood vessels in the skin, which will help to keep it healthy in the future. Eventually the redness will fade.
To minimise the risk of pigmentation, it is extremely important that you use a sunscreen of SPF30 for at least six months following treatment to protect the skin from harmful ultraviolet rays.
Please remember the best results are seen ten to twelve months after the procedure and patients with severe acne scarring will need more than one and sometimes up to three resurfacing procedures. If necessary, laser treatment can be repeated six to twelve months after the first procedure.