Laser resurfacing is a term used to descried a procedure performed by Specialist in an operating theater—it is the ‘full house’ variant of fractional laser and is ideally suited to remove deep wrinkles, sun damage, and acne scars. Unlike fractional laser, all layers of the skin are removed. I use the CO2 and or the Erbium laser to perform this procedure. This form of laser resurfacing can also improve skin tone, and provide a ‘laser face lift’ by stimulation of collagen and elastin. Resurfacing can produce outstanding results often rejuvenating skin by over 10 years!

Facts on laser resurfacing with Erbium and CO2 lasers

  • Lasers can treat skin in small areas known as fractional skin resurfacing
  • Fully ablative laser resurfacing is referred to when the entire surface area of skin is treated
  • This page is dedicated to an in depth view of fully ablative laser resurfacing
  • This procedure is conducted using 2 types of lasers, Erbium and CO2
  • Healing time vary from 5-12 days depending on the condition
  • Most medical cases are partially covered by Medicare
  • Medical cases of laser resurfacing include acne scarring, surgical and traumatic scars, birthmark removal, sun damage treatments, and treatment of skin cancers
  • Cosmetic treatments such as laser face lifts are not covered under Medicare
  • I often combine both lasers in fully ablative and fractional modes for best outcomes- this is what I term ‘Hybrid’ resurfacing

How is laser resurfacing different from Fraxel and fractional lasers?

fractional vs ablative lasers

Fractional lasers treat only parts of the skin, fully ablative lasers treat ALL of the skin’s surface.

Fully ablative laser resurfacing is very different from fractional lasers. Fractional lasers only treat a ‘fraction’ of the skin’s surface – laser machines such as Fraxel, Pearl Fractional, and ProFractional are examples of fractional lasers.

Fully ablative lasers remove all of the skin. I manually control the depth of ‘ablation’ and how deep lasers go. Laser resurfacing is skill and experienced based, whilst fractional lasers rely on computers and the machine itself. Whilst fractional lasers have their use, the outcomes are limited by the machine. In contrast, ablative lasers are limited by the skill set of the specialist.

Fractional lasers will require multiple treatments, usually 3-5 sessions, whilst in most cases fully ablative lasers will only require one session to achieve better results.

What types of lasers do I use to perform laser resurfacing?

CO2 laser brisbane

In the majority of cases I use 2 lasers in different settings to achieve the end goal. The success of laser resurfacing is dependent on both the skill level of the Specialist and the equipment.

I combine fully ablative Erbium Sciton Laser, with fully ablative CO2 CORE laser. Depending on the end goal, I may only use Erbium as a fully ablative laser, then swap to CO2 as a fractional laser. In other cases I use CO2 fully ablative and then combine Erbium as my last pass.

Combinations are infinite, and each part of the face will require different techniques for optimal results. Watch my YouTube videos on laser resurfacing to gain some understanding of the complexity of choosing what lasers to use in particular locations. The complexity of this equation is further multiplied if darker skin races are treated.

What results can I expect from laser resurfacing?

Laser resurfacing can produce outstanding results that will transform your skin texture and tone, often reversing skin age by more than a decade. 

For more information on what laser resurfacing can do for cosmetic concerns such as poor skin texture and tone, review more on laser face lifts

For more information on acne scarring and how laser resurfacing can remove acne scars review the before and after gallery and more on acne scar treatments

laser dermatologist brisbane 9

Lasers can remove eye bags as well as tighten the skin around the eyes.

When is laser resurfacing better than a mini face-lift?

Laser resurfacing using a combination of erbium and CO2 lasers can achieve a significant improvement in skin texture, and in some cases volume and tone. Laser provides a better outcome than mini face lifts when skin laxity is moderate, and skin texture needs to be improved. Face-lifts do not address factors such as fine wrinkles, sun damage, loss collagen and volume, whilst laser resurfacing can address all these changes, in addition to ‘lifting’ key areas. Remember it is the balance between improving skin texture, tone and volume that gives the best, and most natural results. This is why it is important to see a specialist who is experienced in all 3 key skill sets- lasers, dermal fillers and surgical mini- face lifts. 

More on laser face lifts

How long will I take to recover following laser resurfacing?

5- 12 days. Recovery time is extremely variable, as all my laser treatments are tailored according to the skin condition and your goals.

  • Laser face lifting with erbium and CO2 will have a downtime of at least 10 days. You will be able to wear make up by day 12, however you will be red for at least 4-6 weeks.
  • Acne scar laser recovery will depend on the depth of your scars- shallow scaring will heal up within 6 days, deep scars will take 10 days before your skin reforms.
  • Laser blepharoplasty healing times range from 7- 9 days. For the first 2 days your lids will be extremely swollen and your activities will be limited. Day 3 will have less swelling, and day 4 even less. Redness around your eyes will persist for 3-5 weeks, but make up can hide this.
  • Surgical and traumatic scars will take 7- 10 days to heal up, once again this is depth dependent
  • Laser treatment of age warts, age spots, wrinkles, spots and dots will take 7-9 days to heal up.

laser resurfacing recovery brisbane

This is day 2 post fully ablative laser resurfacing.

Is the treatment painful?

Laser treatment is well tolerated as this is conducted under partial sedation.  We use the following combination to numb the skin and keep pain to an absolute minimum.

  1. 23/ 7 numbing gel one hour before the procedure
  2. Key local anaesthetic blocks to nerves
  3. Sedation with an injection or IV

How do I look after my skin after resurfacing?

Rest assured we will provide specific written instruction in regards to skin care to hasten skin reformation after resurfacing. Patients are seen by our laser nurses 24 and 72 hours after the procedure, and by myself one to two weeks post laser. During your visits your skin will be washed, and healing balm applied.

You need to –

  • Wash your skin twice a day with a bland cleanser
  • Moisturize 3-5 times per day for the first 3-5 days
  • Change moisturizer at day 5-6
  • You can use a special make up called Lycogel to hide the redness by day 5
  • Sunscreen and make up can be worn as soon as your skin heals, this maybe up to 12 days post laser

Sounds complex? Rest assured we make things easy with follow up checks and written instructions. Patients are never discharged until skin has completely healed.

skin after fraxel 1

This is day 8 following medium depth laser resurfacing- skin has completely healed.

What type of acne scaring responds best to laser resurfacing?

acne scar treatment laser brisbane

Most forms of acne scars respond to laser resurfacing, however box car scars and shallow rolling scars respond exceptionally well to fully ablative laser resurfacing with Erbium and CO2 combined. If scars reside within a certain depth of the skin, often one treatment of laser is needed.

If you have a mixture of scars, I will always tailor a regime based upon your scar type and skin type. For example I may elect to treat ice-pick scars and enlarged pores with TCA CROSS prior to laser resurfacing.

Atrophic scars respond best to dermal HA Fillers, whilst tethered scars are best treated with subcision. Not all acne scars are best treated with lasers. 

More on acne scar treatments

Can Asian and ethnic skin undertake laser resurfacing?

dark skin laser resurfacing

Yes. I have performed many skin resurfacing procedures on Asian and ethnic skin types. The risk with darker skin types is a condition known as PIH or post inflammatory hyperpigmentation. This means lasered skin can turn dark. PIH can be reduced by-

  1. The use of Erbium laser without CO2
  2. The use of sunscreen, hats, and UV avoidance for 6 weeks post laser
  3. The use of bleaching creams, and Vitamin A before, and 10 days after laser
  4. The passage of time
  5. Using a laser called Picosure FOCUS to decrease pigmentation 

In some cases of acne scarring, PIH is inevitable as scars lie so deep in the skin. All cases of PIH settle with time and sunprotection.

Risks will be discussed in detail according to the condition I am treating (eg. Acne scars, scars, wrinkles, skin rejuvenation, or medical conditions such as syringomas.)

What should I consider before undertaking laser resurfacing?

CO2 acne scars

Laser resurfacing in one of the most complex procedures I perform. Parameters must be exact, and skill levels exceptional. Recovery times for patients is the major issue, however my staff and I will guide you from the beginning to the end of this life changing journey.

Things to ask yourself before you consider laser resurfacing include-

  • Can I have downtime? Sick leave can be granted for patients
  • Do I have transport for the day of the laser and the day after? Patients undergo sedation and must have help to get home. Follow up the next day will require help as well.
  • Are you willing to comply with strict instructions regarding skin care? The use of moisturizers 4-5 times a day post laser is essential.
  • Are you willing to restrict UV – Sun exposure for 4-6 weeks after laser? If not, post laser darkening can occur.
  • Are you realistic with your expectations? I can achieve great results with laser and meet or even exceed your expectations. A detailed and written consent will give us a mutual understanding of the end result.
  • Finally are you in a financial position for laser resurfacing? This procedure is considered as ‘high end’ due to the technicality, logistics, theater use, laser use and after care. See pricing for full costs.

What are the potential side effects of laser resurfacing?

laser resurfacing co2

Side effects are very rare following laser resurfacing, however it is our duty to inform patients of potential complications and outcomes-

  • Infection- less than 2% of cases
  • Skin colour changes- more common in Ethnic skin
  • Patterning and de-markation lines- rare side effects, and reversible
  • Delayed healing- uncommon side effect
  • Scarring- extremely rare; less than 0.1% of my cases- my only case was a patient who I never saw post laser treatment, even to this day!
  • Dry eyes- very common after lower eyelid laser, resolves with ointment
  • Recurrence or partial improvement- for skin conditions such as syringomas and warts
  • Persistent redness- this can be a side effect to your benefit as more collagen stimulation occurs with increased blood flow. Easily treated with V Beam vascular laser

How much does laser resurfacing cost?

Cost will vary depending on the complexity and time taken for the procedure, as a guide-

  • Laser face lifts- $4990 upwards
  • Acne scar treatments- $2990 to $5500 depending on area*
  • Traumatic and surgical scar treatments – $2550-$5500 depending on area*
  • Upper and laser eyelid blepharoplasty- $2550-$5500
  • Medical conditions such as syringomas, sebaceous hyperplasia, angiofibromas – $ 2,800*

*Medical conditions such as acne scars, surgical and traumatic scars, as well as skin tumors are partially covered under Medicare. 

Laser lifts and laser eye surgery is considered as cosmetic and not covered by Medicare- Health Insurance. Price includes laser theatre fee, nursing fees, sedation and anaesthetic fees, and post laser recovery follow ups and dressings. 

Is this procedure covered by Medicare or Private Health Insurance?

skin needling medicare RF

In medical cases laser resurfacing is partially covered by Medicare. Examples include-

  • Treatment of acne scars
  • Treatment of scars caused by trauma, or surgery
  • Treatment of pre cancerous sun damage, such as solar keratosis
  • Treatment of skin cancers such as BCCs or Bowen’s disease
  • Treatment of dermatological conditions such as syringomas, adenexal tumors, angiofibromas
  • Treatment of rhinophyma from rosacea
  • Treatment of birthmarks such as epidermal and sebaceous naevi

Cosmetic cases such as laser face-lifts are not covered by Medicare nor Private Health Insurance, however in many cases there is an overlap between Medical and Cosmetic. Examples include full face resurfacing for a surgical scar and pre cancerous sun damage with the secondary advantage of laser face-lifting as a by product. A case to case basis applies in many cases.

What should I look for in a Specialist if I am considering laser resurfacing?

dr davin lim laser dermatologist

Experience, equipment and aftercare. Your GP will know who are the best fully ablative laser specialists in Australia. Always look at their own before and after pictures, as well as ask them about the procedure. Being comfortable in the skill set of your surgeon is very important.

A great unbiased website is called realself.com Take a note of the before and after photos and an explanation of what was performed. Base your decisions on feedback and the photos you see as well as unbiased patient testimonial who have had this procedure done before. 

My viewpoint on laser resurfacing using erbium and CO2 lasers

By Dr Davin Lim
Laser Dermatologist
Dr Davin S. Lim copy

Even with the event of fractional lasers, fully ablative laser resurfacing using combination CO2 and Erbium lasers can deliver far superior results with only one treatment. By using both lasers, I can choose the amount of collagen stimulation in key areas- such as under the eyes and in front of the ears. This gives a laser lift.

If the patient has darker skin, I would use more erbium and less CO2 as dark skin or ethinc skin patients have a higher chance of skin darkening with CO2 lasers. If I am treating lighter skin Caucasian patients, I opt for more CO2 as in most cases sun damage and collagen production needs to be optimized in this population of patients.

The same applies if I am using this combination of lasers for skin scars- including acne and surgical scars. In this situation I aim to get ‘under the scar’ with erbium, removing old collagen.

For conditions such as Rhinophyma, the CO2 is a must- this laser delivers heat as well as ablation to stop the bleeding associated with lasering this condition.

In summary, laser resurfacing can be conducted for all sorts of skin conditions including medical resurfacing- scars, benign skin tumors such as syringomas, skin cancers, rhinophyma, and sun damage. Conversely, laser resurfacing can also be used to treat cosmetic concerns such as sagging skin, loss of tone, wrinkles, upper lip lines and poor skin texture. The flexibility of using BOTH types of lasers for different applications, combined with the skill level of the operator can result in a remarkable transformation. See the before and after gallery for more information.