Facial resurfacing at Oxford, The Manor Hospital

What is facial resurfacing?

Facial resurfacing removes the outer layers of your skin to reveal smoother skin underneath and encourage your body to produce new collagen. It's most often carried out with a laser, though older methods, such as dermabrasion, use a mechanical tool instead.

What conditions can facial resurfacing treat?

Facial resurfacing may be used for:

• fine lines and wrinkles, including around the eyes, mouth and forehead
• scars from acne, chickenpox, surgery or other causes
• uneven skin colouring, such as age spots, liver spots and sun-damaged skin
• actinic keratoses (rough, scaly patches caused by sun damage)
• seborrhoeic keratoses (raised, waxy growths) and sebaceous hyperplasia (small bumps caused by enlarged oil glands)
• birthmarks and warts
• some skin tumours
• skin that hasn't responded well to a facelift

What are the benefits of facial resurfacing?

Facial resurfacing can smooth fine lines and wrinkles, even out skin tone, tighten your skin, and leave it looking fresher and softer.

Your skin may keep improving for up to a year afterwards, and the results can last for several years, although normal ageing means fresh wrinkles will form eventually, and these too can be treated whenever you're ready.

Are there different types of facial resurfacing?

There are several approaches, and your doctor will recommend one based on your skin and what you want to achieve:

• CO2 laser resurfacing: treats wrinkles, scars and other skin growths, with healing taking up to 2 weeks
• erbium laser resurfacing: treats finer, more surface-level lines and wrinkles, causes fewer side effects, and tends to suit darker skin better; healing takes around a week
• fractional laser resurfacing: treats your skin in narrow columns rather than all at once, so healing is quicker, though the deeper reach of the laser carries a somewhat higher risk of complications; healing takes around a week
• dermabrasion: an older technique that uses a rotating mechanical tool to physically remove the outer layers of skin, rather than a laser

What happens before facial resurfacing?

In the 4 weeks before treatment, you'll usually be asked to:

• stay away from sunbathing or tanning beds, and wear a broad-spectrum sunscreen daily
• avoid other deep skin treatments, such as chemical peels or dermabrasion
• apply a vitamin-A cream (retinoid) to help prepare your skin, if recommended

You'll usually need to stop any medicines that increase skin sensitivity to sunlight at least 72 hours beforehand. If cold sores or shingles have ever affected the area being treated, mention this to your doctor, since you may be given antiviral medicine to take beforehand and for a few days afterwards.

What happens during facial resurfacing?

1. The area to be treated is thoroughly cleaned.
2. It's numbed with a local anaesthetic; a general anaesthetic may be used if your whole face is being treated.
3. Your doctor directs the laser at your skin in short, concentrated pulses, removing damaged skin one precise layer at a time.
4. A single feature, such as around the eyes or mouth, is usually dealt with inside 30 to 45 minutes, whereas covering the entire face takes roughly 1.5 to 2 hours.
5. A non-stick dressing is placed over the treated area for the first 24 hours.

What does recovery look like?

Straight after treatment, you'll clean the area several times a day with a saline or diluted vinegar rinse, then apply a protective ointment to stop scabs forming, which can increase the chance of scarring.

Your skin will feel red, tender and sunburnt at first, and may weep or blister for a few days. Around 5 to 7 days later, it starts to dry out and peel, uncovering new pink skin underneath. This pink colour tends to fade over 2 to 3 months, though it can take as long as a year for some people, particularly those with blonde or red hair.

To help your skin heal:

• prop yourself up on an additional pillow while sleeping for the first 4 days, which helps keep swelling down
• hold a cool compress against the area for 15 minutes every 1 to 2 hours across the first two days
• apply a thin layer of petroleum jelly or antibiotic ointment twice a day until your skin has healed
• avoid strong skincare products, such as retinoids or glycolic acid, for 4 weeks, and anything that may irritate your skin for 6 weeks
• avoid activities that make you flush for 2 weeks
• don't smoke, since this slows healing

Once your skin has healed, a broad-spectrum sunscreen of at least SPF 30, applied every day, helps protect your results going forward.

What are the risks and complications?

Possible risks of facial resurfacing include:

• small white bumps (milia) in the treated area, which usually settle with gentle cleansing
• skin becoming darker (hyperpigmentation) or, less often, lighter (hypopigmentation)
• a cold sore flaring up, particularly after treatment around the mouth
• infection
• swelling, which can be more noticeable around the eyes
• scarring, though this is rare

Facial resurfacing is considered an elective cosmetic procedure, so it isn't usually covered by health insurance.