What is Laser Skin Resurfacing?
Laser skin resurfacing utilises laser energy to achieve controlled ablation or coagulation of the epidermal and dermal layers. The primary purpose is to systematically correct structural cutaneous defects and reverse the signs of photoageing by inducing a controlled, predictable thermal injury to the skin. This clinical process achieves two main therapeutic objectives: the removal of compromised superficial tissue and the simultaneous stimulation of deep structural remodelling.
Depending on the patient’s specific clinical indications, skin phenotype, and acceptable recovery timeline, laser resurfacing can be customised using various types of lasers and delivery methods, such as full ablation or fractional ablative procedures.
what lasers are used?
By integrating both the Lumenis Acupulse carbon dioxide (CO2) and the Asclepion Dermablate Er:YAG platforms into our treatment repertoire, the clinic offers a highly sophisticated, dual-wavelength approach to epidermal resurfacing and dermal remodelling. Rather than relying on a single, compromised treatment modality, this dual-platform capability allows our clinicians to customise energy delivery to the exact pathology, skin phenotype, and lifestyle constraints of the individual patient.
Both systems feature modular delivery handpieces capable of executing both full-field ablation for uniform surface resurfacing and epidermal clearing, and fractional ablation for deep dermal remodelling with more rapid re-epithelialisation. This infrastructure enables three distinct treatment pathways.
The first is Lumenis Acupulse (CO2 laser) monotherapy, which is deployed when the clinical objective is maximum tissue contraction and deep neocollagenesis. The significant residual thermal zone created by carbon dioxide energy is ideal for addressing severe rhytids, structural laxity, and dense scar tissue.
The second pathway utilises Asclepion Dermablate monotherapy for high-precision, cold tissue ablation. Because its wavelength targets water ten times more efficiently than a CO2 laser, it vaporises tissue with minimal peripheral thermal damage, making it the choice for superficial dyschromia, delicate anatomical zones such as the periorbital and perioral regions, and patients requiring a tighter recovery window.
The third pathway involves combined dual-wavelength protocols. For complex cases, clinicians can employ both wavelengths sequentially during a single operative session, allowing deep, fractionated thermal stimulation via the CO2 laser to drive collagen synthesis, combined with precise erbium ablation to cleanly remove superficial epidermal irregularities and minimise excessive post-treatment erythema.
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what is the pathway of treatment?
Clinical Consultation and Initial Assessment.
A comprehensive assessment of your skin phenotype, medical history, and clinical indications is conducted. The clinician evaluates skin quality, laxity, and pathology while screening for strict contraindications, such as active infections, recent isotretinoin use, or a predisposition to keloid scarring. Expectation management regarding social downtime and treatment efficacy is established, and a bespoke treatment plan utilising either the Acupulse™ CO2 or Dermablate® (Er:YAG) system is proposed.
Pre-Treatment Conditioning: 2 to 4 Weeks Prior.
In some cases, you are placed on a targeted topical regimen to prime the skin barrier and minimise post-inflammatory hyperpigmentation (PIH). This protocol typically includes a broad-spectrum SPF, tyrosinase inhibitors for higher Fitzpatrick skin types, and occasionally a low-potency retinoid to accelerate epidermal turnover. If ablative full-field resurfacing is planned, prophylactic antiviral medication is prescribed to prevent herpes simplex virus (HSV) activation.
The Procedure Day.
Topical anaesthesia (and local infiltrative blocks if required) is applied 45 to 60 minutes before the procedure. The skin is meticulously cleansed with a non-alcoholic antiseptic. Clinicians calibrate the laser parameters, adjusting spot size, energy density and pulse duration based on the target depth. While the aim is for the procedure to be comfortable, invariably some discomfort will be experienced, which we can help with as required using further injectable analgesia or gas and air.
Acute Post-Operative Management: Days 1 to 7.
The side effects mentioned are those experienced with the more robust procedures.
The immediate healing phase focuses on maintaining an occlusive environment to promote re-epithelialisation. Patients apply prescribed emollient ointments to prevent crusting and use gentle, non-detergent cleansers. Erythema (redness), oedema (swelling), and mild exudate(leakiness) are expected physiological responses during the first 48 to 72 hours. Strict sun avoidance and cessation of active skincare ingredients are mandatory. Swelling gradually decreases along with the other normal side effects.
Subacute Healing and Re-Epithelialisation: Weeks 2 to 4.
As the epidermis seals, patients transition from heavy occlusives to non-comedogenic moisturisers and mineral-based broad-spectrum sunscreens. Transient erythema may persist, signalling ongoing vascular remodelling and neocollagenesis. Non-invasive, mineral makeup may be introduced once re-epithelialisation is clinically complete.
Clinical Review and Outcome Assessment: 6 to 12 Weeks Post-Procedure.
The patient returns to the clinic for formal evaluation and digital imaging. The clinician assesses the structural integrity of the remodelling collagen matrix, the resolution of dyschromia, and the overall improvement in skin architecture. This session serves to review long-term maintenance skincare, monitor for rare late-stage complications such as persistent erythema, and determine whether supplementary treatments are indicated.
What areas can be treated?
Wrinkle Reduction: CO2 and Er:YAG laser resurfacing is often used to reduce the appearance of fine lines and wrinkles, especially around the eyes, mouth, and forehead.
Scar Revision: It can improve the appearance of scars, including those from acne or surgery.
Skin Tone and Texture: The procedure can address uneven skin tone, texture irregularities, and sun damage.
Tightening: CO2 laser treatment can stimulate collagen production, leading to skin tightening
what is an ablative laser?
Unlike non-ablative lasers (which leave the surface intact and only heat the underlying tissue), ablative lasers vaporise the outer layer of skin (the epidermis) while heating the deeper layer (the dermis). This intense heat triggers a massive collagen remodelling process.
Your clinician can choose between full-field ablation (removing the entire surface layer) and fractional ablation (creating microscopic vertical columns of ablation, leaving a percentage of untreated skin between them to encourage and speed up healing).
What is the difference between co2 and er:yag?
Carbon Dioxide (CO2) – Penetrates deeper and generates more residual heat. It is incredibly effective for severe wrinkles, deep acne scars, and significant skin laxity, but requires a longer recovery.
Erbium (Er:YAG) – Absorbed much more efficiently by water in the skin, allowing for highly precise, superficial ablation with less residual thermal damage. This means faster healing and less risk of prolonged redness, making it ideal for mild-to-moderate wrinkles and finer skin textures.
The parameters of the Er:YAG laser can be tuned relatively more than the CO2 laser. This provides a greater range of procedures, from mild to robust, and an associated range of downtime from a day to weeks.
absolute and relative contraindications
Treatments will not be performed if any of the following factors are present:
- Active Cutaneous Pathology: Infections, open wounds, or active acne breakouts in the target treatment zone.
- Isotretinoin Use: Oral isotretinoin (Roaccutane) use within the preceding 6 to 12 months, as it severely impairs the skin’s adnexal structures and capacity for re-epithelialisation, drastically increasing the risk of hypertrophic scarring.
- Keloidal Tendencies: A documented history of keloid or severe hypertrophic scar formation.
- Healing Impairments: Uncontrolled diabetes, active autoimmune connective tissue diseases, or immunosuppression.
- Inability to Comply with Aftercare: Patients unable or unwilling to adhere to strict sun avoidance, regular emollient application, and social downtime are not candidates for this procedure.
risks, complications and side effects
Honesty and transparency are fundamental to our clinical practice. Every patient must fully understand that higher clinical efficacy and deeper tissue remodelling naturally carry an increased risk profile and a more intensive recovery pathway.
Expected (Normal) Side Effects
These are standard, anticipated biological responses to laser energy and should not be confused with complications:
- Transient Erythema and Oedema: Redness and significant swelling are universal. Swelling typically peaks at 48 to 72 hours. Redness can persist for weeks after fractional treatments and for up to several months after full-field CO2 ablation.
- Exudate, Maceration, and Crusting: As the vaporised epidermis heals, the skin will weep serous fluid and form crusts. This requires meticulous application of ointment to prevent premature peeling.
- Pruritus and Skin Tightness: Itching and a feeling of intense tightness are common during the re-epithelialisation phase (Days 3 to 10).
Potential Clinical Complications
While rigorous clinical protocols and precise parameter calibrations minimise these risks, the following complications can occur:
- Infection (Bacterial, Viral, or Fungal): The denuded skin barrier is highly vulnerable. The most common risk is the reactivation of the Herpes Simplex Virus (cold sores), which we mitigate with prophylactic antiviral prescriptions. Bacterial infections (e.g., Staphylococcus infections) can occur if postoperative hygiene is compromised.
- Post-Inflammatory Pigmentary Alterations:
- Hyperpigmentation (Darkening): More common in darker skin types or if the patient experiences early, unprotected UV exposure. It is usually transient and treatable with topical therapies.
- Hypopigmentation (Lightening): A rare, delayed complication typically associated with deep, full-field treatments, resulting from the permanent loss of functional melanocytes.
- Prolonged Erythema: Redness that persists beyond the expected healing window (greater than 3 months), indicating delayed vascular settling.
- Milium Formation: Small, benign keratin cysts can appear during the first few weeks of healing due to the heavy, occlusive ointments required.
- Scarring and Ectropion: Extremely rare in experienced hands. Excessive thermal energy delivery or secondary post-operative infections can lead to structural scarring. Treating the lower eyelid carries a remote risk of ectropion (outward turning of the eyelid) if skin contraction is over-engineered.