Fractional laser results

A patient sits down in the chair and says: "I would like to look the way I did ten years ago. Preferably starting tomorrow."

I understand that. I really do. But then I have to say something nobody wants to hear: for the first week after a laser treatment you will look worse than you did before it.

Not because something went wrong. Because that is exactly how it works.

Why the skin has to suffer first

The principle behind lasers is surprisingly brutal: they stimulate the skin to rebuild itself by damaging it in a controlled way.

Everything else follows from that. The face will be red, it may be slightly swollen, and after a few days the epidermis will start to peel intensively. How long this lasts depends on how deeply the skin was damaged — the stronger the treatment, the longer the recovery.

The result? It only becomes visible once the skin has healed, remodelled and regenerated. Which means after four weeks at the earliest.

So it is worth simply putting a week of recovery into your calendar. A few days of working remotely is usually entirely enough.

Four weeks is the point at which the skin has healed — but not the point at which everything is visible. The remodelling of collagen takes longer and the full effect is usually assessed at around the third month. The good news is that it does not disappear quickly: in follow-up of patients after a fractional CO₂ laser, the improvement in the appearance of the skin was still significant a year and five years after the treatment. That is why it is not worth judging the result either after a week or after a month.

What "fractional" means

It is the word that comes up most often with lasers, and it is worth knowing what it means.

The beam of a fractional laser penetrates deep into the skin over 15–20% of its area. It acts point by point, on selected areas, without disturbing the tissue in between. The continuity of the epidermis is broken at intervals — the rest remains untouched.

And it is precisely those untouched islands that are the key. It is from them that the skin rebuilds itself, which is why regeneration proceeds much faster than if the entire surface were damaged at once.

Ablative or non-ablative — two completely different deals

Fractional lasers fall into two families. The difference comes down to whether the skin is going to peel.

Ablative — the beam reaches the deeper layers of the skin, where it is absorbed by the water inside the cells. The water heats up instantly and evaporates. The result is ablation of the epidermis and of the superficial layer of the dermis. A regular network of microdamage forms, which prompts the cells to regenerate and triggers the production of new collagen and elastin fibres. More collagen means firmer, more elastic and better toned skin. The price: the damaged cells have to peel off first.

Non-ablative — no peeling. It acts more gently, healing takes less time, but the result is also weaker. To achieve what an ablative laser does in one go, three to five non-ablative treatments have to be performed. Nor does the skin look as fresh and radiant afterwards as it does after an ablative treatment.

Choosing between them is usually a choice between the strength of the result and the amount of free time.

What the laser actually works on

The list of indications is long:

• wrinkles on the face, around the eyes, on the neck and décolletage
• sagging and lack of skin firmness
• scars of various origins, including acne scars and post-surgical scars
• discoloration and pigmented lesions
• stretch marks
• uneven skin and enlarged pores

The aim of laser treatments is to improve the overall condition of the skin and to stimulate collagen production. The therapy clearly rejuvenates, improves the complexion, makes fine wrinkles shallower, reduces scars and even stretch marks. It copes excellently with irregular skin texture.

The results can last for as long as two years. On two conditions: a series of treatments and following the doctor's recommendations. One treatment is not enough — the minimum is three repetitions.

Not all lasers are equal — what we do at our clinics

There is no single universal laser. Each type of device works at a different wavelength, and that determines what in the skin will absorb the energy: water, melanin or haemoglobin. Hence the different applications.

• CO₂ fractional laser — Ablative. The deepest skin remodelling, the energy is absorbed by the water in the cells · Advanced wrinkles, scars, sagging, uneven skin texture.
• 2940 nm fractional laser (Er:YAG) — Ablative resurfacing, shallower and more precise than CO₂ · Scars, stretch marks, wrinkles, smoothing the surface of the skin.
• 1927 nm thulium laser — A non-ablative fractional treatment, without peeling · Uneven complexion, discoloration, general skin renewal.
• Laser wrinkle reduction — A non-ablative Nd:YAG laser in Q-Switch mode · Rejuvenation and shallower wrinkles with no recovery time.
• Laser treatment of discoloration and redness — Energy absorbed by melanin and haemoglobin · Discoloration, pigmented lesions, skin redness.
• Laser closure of broken capillaries — A 1064 nm Nd:YAG laser closes the lumen of the vessel · Dilated capillaries, redness, vascular skin.
• Laser removal of scars and stretch marks — A fractional laser smooths the skin and stimulates it to rebuild · Acne scars, post-surgical scars, stretch marks.
• Laser hair removal — An 810 nm diode laser, the energy is absorbed by melanin in the hair follicle · Permanent hair removal.

As you can see, a "laser treatment" is not one single procedure but a whole family of completely different treatments.

Autumn and winter are no coincidence

This is one of the most practical pieces of information in this whole text.

Laser treatments are best performed in the autumn and winter period, when the strength of solar radiation is weaker and cloud cover is far greater than in summer.

The reason is simple: after a laser the skin is stripped of its natural protective mechanisms. For about four weeks after the treatment it absolutely must not be exposed to the sun, and a high-protection sunscreen, SPF 50+, has to be used every day.

Even indoors — that is not a mistake. UVA radiation, responsible for the formation of discoloration, passes through clouds and window panes. Protection indoors makes sense above all when you work by a window — because it is the sun behind the glass, not a computer screen, that really affects the skin after a treatment.

Planning a holiday in the sun? Postpone the treatment.

How to get through the first few days

Healing can be made easier for yourself. For skincare it is worth using regenerating and moisturising products of the "Cica" type, which soothe and calm the skin.

A laser treatment can also be combined with platelet-rich plasma. The plasma stimulates regeneration and rebuilding, shortens the recovery and strengthens the rejuvenating effect of the laser.

Apart from that: skincare exactly according to the doctor's instructions. This is not the stage at which it pays to improvise.

Redness and peeling are not a complication

It is worth saying this clearly, because it can be a source of unnecessary panic.

Since lasers work by damaging the skin in a controlled way, healing is naturally part of that process. Redness, inflammation, itching, swelling, hypersensitivity, browning and peeling of the skin are not complications but physiological processes — proof that the damaged tissue is regenerating.

Real complications occur extremely rarely. They include, among others, a recurrence of herpes. The virus stays in the body in most adults, also in people who have never had symptoms — which is why, in treatments involving the area around the mouth, it is the doctor who decides about antiviral prophylaxis, regardless of what the interview shows.

The most common of the rare complications are acne-like lesions — they appear in just under two per cent of people and resolve on their own. Less frequently there are erosions, prolonged redness and swelling, and post-inflammatory discoloration. The latter is influenced not only by aftercare, but above all by the skin tone: the darker the skin, the higher the risk. That is why with a darker phototype we choose more cautious settings and prepare the skin in advance.

If you want a specific figure: in a large analysis of almost a thousand fractional laser treatments, complications occurred in 7.6 per cent of patients in total, and post-inflammatory discoloration in less than one per cent, lasting on average about seven weeks. That is the real scale of the risk — small, but worth knowing when you are planning a treatment.

You have to tell your doctor about this

Complications after a treatment can stem from medications you take every day. These are photosensitising products, and the list of common ones is surprisingly long:

• diuretics and heart medications
• antidepressants and psychotropic medications
• antifungal and antiemetic medications
• isotretinoin — if it was taken within the last 6–9 months
• vitamins A and D
• ointments containing retinoid derivatives

Medications are not everything the doctor needs to know about. The treatment has to be postponed if you have an active skin infection — a cold sore, pus-filled lesions — or a fresh tan. Tell us as well about pregnancy and breastfeeding, about a tendency to keloids, about connective tissue diseases, about treatment that lowers immunity and about radiotherapy in the area that is to be treated. Your phototype matters too: the darker the skin tone, the higher the risk of temporary discoloration — this is not a contraindication, but a reason to choose more cautious settings.

Do you use any of them? Be sure to tell your doctor before the laser treatment. This is a question there are no good reasons to answer evasively.

Is it worth it

In my judgement, the fractional laser is one of the most effective methods of rejuvenating the skin and evening out its imperfections. At the initial visit, however, I always warn that it involves a certain amount of discomfort — resulting simply from the natural healing processes.

A few days of working from home and you go back to your everyday activities with healthy, noticeably smoother and radiant skin.

Which laser to choose — you will not settle that on the internet. The depth of the damage, the wavelength, the number of treatments in the series and the intervals between them are selected by the doctor after looking at and assessing your skin, after an interview about medications and past courses of treatment. The same wrinkle in two patients may require two different devices.

That is why the first step is not choosing a laser. It is a consultation.

You will find full descriptions of the treatments on the pages for the CO₂ fractional laser and laser removal of scars and stretch marks.

This article was prepared by Aneta Bembenek, MD — specialist ophthalmologist, aesthetic medicine physician.