Laser Peel FAQs

Dr. Hilinski is "Double Board Certified" in Facial Plastic & Reconstructive Surgery.

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Q - What is a laser peel?
The laser peel, also referred to as laser skin resurfacing, is a procedure which resurfaces the skin using sophisticated lasers. The laser peel minimizes the appearance of fine wrinkling, sun spots, brown spots, freckling, rough skin texture and large pores, providing a more vibrant and youthful look to the skin. The laser peel may be performed on its own, though it is commonly performed with other surgical facial rejuvenation procedures such as a face lift. There are a wide variety of laser devices available today, although those most frequently used in laser skin resurfacing include the carbon dioxide laser, the erbium laser and the fraxel laser.

Q - What is the carbon dioxide laser?
Carbon dioxide laser resurfacing (CO2 laser) is one of the most powerful skin resurfacing lasers available. CO2 lasers are used to rejuvenate aged and damaged skin by smoothing and tightening the skin while also improving skin discoloration. In general, CO2 lasers provide a deep peel similar to the highest settings on other laser systems. The CO2 laser may be performed as a ‘full face’ or ‘segmental’ treatment. Segmental treatment refers to laser resurfacing of only certain areas or segments of the face, such as around the eyes or around the mouth.

Q - What is the erbium laser?
Erbium lasers are another popular choice for skin rejuvenation and they can help to smooth and tighten the skin while also improving abnormal discoloration. Erbium lasers have the capability of being adjusted in terms of the power settings. If the settings are increased, dramatic skin changes can be seen that are very similar to those seen with a CO2 laser. With milder settings, modest to moderate skin changes can be made if desired. These milder forms of erbium laser resurfacing are commonly referred to as a ‘micro laser peel’ or ‘lunchtime peel’ due to their minimal downtime. The erbium laser may be performed as a ‘full face’ or ‘segmental’ treatment. Segmental treatment refers to laser resurfacing of only certain areas or segments of the face, such as around the eyes or around the mouth.

Q - What is the fraxel laser?
Fraxel laser skin resurfacing is a great option for patients with fine wrinkles/rhytids, unwanted brown spots and pitted acne scars who require less downtime from a laser procedure. The fraxel laser is actually an erbium laser with only a fraction of the laser rays allowed to penetrate thru to the skin (thus the term fractional skin resurfacing). On a microscopic level, this results in certain zones of skin that are affected by the laser being in immediate proximity to other zones that are left unaffected. This fraction of skin that is left unaffected by the fraxel laser helps to promote more rapid regeneration of the skin. This concept works particularly well when treating patients with pitted acne scarring of the skin. As opposed to the more intense CO2 and erbium lasers, fraxel resurfacing is done routinely in the office. The fraxel laser may be performed as a ‘full face’ or ‘segmental’ treatment. Segmental treatment refers to laser resurfacing of only certain areas or segments of the face, such as around the eyes or around the mouth.

Q - Who is a good candidate for a laser peel?
Most candidates for a laser peel present with undesirable skin changes as a result of aging, sun damage, hormone-induced discoloration or a prior skin/dermatologic disorder such as acne scarring. These unwanted changes include descriptions such as fine wrinkling (rhytids), sun spots, brown spots, freckling, rough skin texture and large pores. Laser peels will help to improve these types of skin changes and provide a more glowing, smoother skin complexion. Unlike surgical lifts that help with deep wrinkles and creases, laser peels are intended to address the finer wrinkles and lines covering the skin. In fact, laser skin resurfacing is commonly performed as part of a surgical facial rejuvenation procedure such as a face lift.

The best candidates for any type of skin resurfacing procedure are those who do not have a high propensity for developing dark or tanned skin. Patients who easily tan have a higher chance of developing post-procedure blotchy skin changes. These patients are still considered candidates for skin resurfacing, however more precautions need to be taken before, during and after the procedure in order to maximize the results. The ideal candidates who are less likely to develop post-procedure pigment abnormalities are those patients with fair skin which has a tendency to burn easily (due to less concentration of melanin in the skin). Candidates for chemical peels should not have a history of using Accutane within the past year and should not have any history of a collagen skin disorder that would impede the healing process.

Q - Where is the laser peel procedure performed?
Full face CO2 and erbium laser skin resurfacing procedures are commonly performed in the outpatient surgery setting while partial laser peels (for instance, eyes only) and fraxel laser peels are usually performed in the office setting.

Q - What type of anesthesia is used for the laser peel?
Deep sedation or general anesthesia can be used for full face CO2 or erbium laser treatments. Segmental peels can be performed with selective nerve blocks, and fraxel peels are performed with topical anesthesia with or without a nerve block.

Q - How is the laser peel procedure performed?
Patients scheduled to undergo any type of skin resurfacing procedure should be treated prior to the scheduled date with prescription hydroquinone cream to minimize the activity of pigment cells in the skin. They should also begin using a prescription antiviral medication two days prior to the date and continuing three days afterward. In some patients, Dr. Hilinski will recommend further preparation of the skin with a topical exfoliating agent to enhance the expected results of the peel.

Laser peels are performed by first cleansing the skin thoroughly to remove all residual oils and debris. The chosen laser is then used to treat the affected area. Usually at least two separate passes (repeat treatments) are made over the skin with the laser. More passes cause deeper penetration of the laser with the number of passes dictated by the patient’s skin type and desired changes. The laser passes essentially remove the outer layers of unwanted skin, leaving behind components of the skin that allow regeneration. Fraxel laser treatments are performed using many more passes over the skin. Once the treatment has been completed, the skin is covered thoroughly with a moisturizing ointment and are given explicit instructions on how to care for the skin as it heals.

Q - How long does the laser peel procedure take to perform?
Laser peels usually take less than one hour to complete.

Q - Is the laser peel a painful procedure?
Patients will experience some minimal to mild discomfort during the first several days after the laser peel. Discomfort is typically minimal provided that the skin is kept well moisturized.

Q - What is the recovery like after the laser peel?
Discomfort is minimal to mild during the first several days after treatment. Provided that the skin is kept well moisturized, discomfort is typically minimal. Patients will experience mild to moderate swelling for several days depending on how intense the treatment was. The new skin will begin to appear within two to seven days after a CO2 or erbium peel while fraxel laser patients have only one to two days of skin peeling. It is important that patients keep their skin well moisturized during this period to promote growth of the new, rejuvenated skin. Make-up can be applied by the end of the first week after CO2 and erbium laser treatment to help conceal some of the residual pinkness and redness. It is critical that skin resurfacing patients maintain strict sun precautions with regard to the treatment area. These precautions should be maintained for upwards of a year. Failure to do so may result in unwanted darkness or redness that will necessitate further corrective procedures.

Q - When will I be able to return to work after undergoing a laser peel?
Patients are usually able to return to work within two to seven days after the laser peel.

Q - When will I be able to exercise after my laser peel?
Aerobic exercise may be resumed within ten to fourteen days after the laser peel.

Q - Are there risks or complications with the laser peel?
As with most cosmetic surgery procedures, there are potential risks associated with the laser peel. Abnormal regeneration of the skin is a potential risk with any resurfacing procedure and this may lead to unwanted scarring within the treatment area. The development of abnormal pigmentation is also a potential complication of resurfacing procedures. If this occurs with the development of darker skin tones (hyperpigmentation), alternatives are available to help restore a more cosmetically pleasing appearance. The development of lighter areas of skin (hypopigmentation) is more difficult to treat but, fortunately, is not a frequently seen complication.

Q - Does insurance cover the laser peel?
Insurance typically does not cover laser peel procedures performed for cosmetic purposes, though some coverage may be available when treating pre-cancerous skin lesions. Patients should be sure to check with their own insurer.

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