Lasers

Laser Skin Treatments — Overview

Lasers and energy-based devices use precisely controlled light or electromagnetic energy to remodel, resurface, and rejuvenate skin. Oculoplastic surgeons use these modalities to treat periorbital and facial skin concerns including wrinkles, sun damage, pigmented lesions, vascular lesions, and acne scars. Laser treatments are often combined with surgical procedures for comprehensive periorbital rejuvenation.

Ablative Laser Resurfacing

Ablative lasers vaporize the outer layers of skin — the epidermis and superficial dermis — allowing new skin to regenerate with improved texture, tone, and reduced wrinkles. Significant collagen remodeling occurs as the skin heals, producing skin-tightening effects that continue for months after the procedure. Ablative resurfacing provides the most dramatic improvement of any energy-based treatment.

Fractional Laser Resurfacing

Fractional technology revolutionized ablative resurfacing by treating only a fraction of the skin in a grid pattern — creating microscopic columns of treated tissue (microthermal zones) surrounded by untreated skin. The intact surrounding tissue acts as a reservoir for rapid healing, dramatically reducing downtime compared to full-field ablation while still producing meaningful results.

Fractional Ablative

• Fraxel Re:pair® (fractional CO₂), Lumenis ActiveFX/DeepFX
• Creates microscopic ablated columns surrounded by untreated bridges of skin
• Recovery: 3–7 days (vs. 10–14 for full-field CO₂)
• Results: Moderate improvement in one treatment; can be repeated for progressive improvement
• Multiple treatment sessions over months can substantially improve results—often approaching, though not always fully matching, single full-field treatment—with significantly less downtime
• Lower risk of hypopigmentation and scarring than full-field ablation — better suited to Fitzpatrick types III–IV

Fractional Non-Ablative

• Fraxel Restore® (1550 nm / 1927 nm), Palomar Icon, Clear + Brilliant
• Heats dermal tissue creating controlled micro-injuries without ablating the surface — epidermis remains intact
• Minimal downtime: 1–3 days of swelling, mild redness, and bronzed appearance as treated columns slough
• Best for: Fine lines, textural irregularities, melasma, acne scarring, mild pigmentation — not significant wrinkles or laxity
• Requires a series of 3–5 sessions for meaningful improvement
• Suitable for all Fitzpatrick skin types, including V–VI with proper technique and parameters

Before & After — Laser Skin Rejuvenation

Vascular & Pigment Lasers

Selective photothermolysis — the principle of using wavelengths specifically absorbed by target chromophores (melanin or oxyhemoglobin) — allows targeted treatment of vascular and pigmented lesions with minimal surrounding skin damage:

Pulsed Dye Laser (PDL) — 595 nm

Selectively absorbed by oxyhemoglobin in vessels. First-line treatment for:

• Facial telangiectasias and spider veins
• Port wine stains and superficial or residual hemangiomas (note: oral propranolol is first-line for proliferative infantile hemangiomas)
• Rosacea-associated redness
• Erythematous (red) surgical scars

Characteristic post-treatment purpura (bruising) resolves in 7–14 days. Newer "V-beam Perfecta" settings allow treatment without purpura at the cost of some efficacy.

KTP Laser (532 nm) & Nd:YAG (1064 nm)

• KTP (532 nm): Excellent for superficial facial redness and fine telangiectasias; less purpura than PDL
• Long-pulsed Nd:YAG (1064 nm): Penetrates deeper; treats larger vessels, leg veins, and darker-skin vascular lesions with minimal melanin absorption — safer for Fitzpatrick V–VI

Q-Switched / Picosecond Lasers (Pigment)

• Ultra-short pulse durations shatter melanin particles into micro-fragments for elimination
• Q-switched Nd:YAG (1064/532 nm), Alexandrite (755 nm), Ruby (694 nm)
• Picosecond lasers (PicoSure, PicoWay, Enlighten) — shorter pulses (picoseconds vs. nanoseconds) reduce thermal injury, improve efficacy for resistant pigmentation and tattoo removal
• Indications: Lentigines (age spots), ephelides (freckles), melasma (second-line, adjunctive to topical therapy and strict photoprotection; recurrence-prone and can rebound), tattoo removal, nevus of Ota

Intense Pulsed Light (IPL)

IPL uses filtered broadband light (not a laser) to target both melanin and oxyhemoglobin simultaneously, treating mixed vascular and pigmented changes from photoaging in a single session. It does not resurface skin but provides significant improvement in overall facial tone, redness, and pigmentation.

• Best for: Diffuse facial redness (rosacea), age spots, freckles, overall photodamage, periocular telangiectasias, meibomian gland dysfunction (emerging off-label adjunctive benefit for evaporative dry eye; evidence still developing)
• Protocol: Series of 3–5 treatments spaced 3–4 weeks apart; annual maintenance
• Downtime: Minimal — pigmented lesions darken and flake off over 7–14 days; redness resolves in 1–2 days
• Limitations: Not safe for Fitzpatrick types V–VI due to melanin competition; not suitable for deeply pigmented lesions

Skin Type & Treatment Selection

The Fitzpatrick phototyping scale guides laser treatment selection. Darker skin types have more melanin in the epidermis that competes with target chromophores and is at risk for post-inflammatory hyperpigmentation (PIH) or hypopigmentation:

• Types I–II (fair skin): Full range available including full-field CO₂ and deep chemical peels
• Types III–IV (olive, Asian skin): Prefer fractional techniques (ablative and non-ablative), Er:YAG, medium TCA peels; pre-treat with hydroquinone; avoid high fluences
• Types V–VI (dark brown, Black skin): Non-ablative fractional lasers, long-pulsed Nd:YAG, Q-switched/picosecond lasers with lower fluences; avoid IPL, full-field CO₂, and superficial wavelengths; aggressive pre-treatment and post-treatment hyperpigmentation protocols essential

Combining Lasers with Surgery

Laser resurfacing is frequently combined with surgical procedures performed at the same operative session:

• CO₂ laser + upper blepharoplasty: Resurfacing periorbital skin simultaneously with upper blepharoplasty can improve the rejuvenation result in one recovery period; however, simultaneous full-field resurfacing of the lower-eyelid skin—particularly when combined with a transcutaneous lower-lid procedure—increases the risk of delayed healing and cicatricial ectropion, so many surgeons limit fluence, use fractional treatment on the lower lid, or stage the resurfacing. Full-field lower lid resurfacing should be performed cautiously — cicatricial ectropion is a risk if too much skin is treated near the lid margin.
• Fractionated laser + facelift or brow lift: Skin resurfacing addresses textural changes and fine lines that lifting alone cannot correct.
• Staged treatment: Many physicians prefer to stage laser resurfacing 3–6 months after surgery once swelling has resolved and the surgeon can accurately assess residual skin quality.

Continue Reading — Complete Laser & Energy-Treatment Guide

• CO2 Laser Resurfacing
• Fractional Laser Resurfacing
• RF Microneedling
• Skin Rejuvenation