Chemical peel is not suited to all skin types (i.e., people with light skin tones are better candidates), and surgeons are increasingly turning to the use of ultrapulsed carbon dioxide laser with excellent results. This 1990's technology produces very high-energy outputs in a short period of time minimizing damage to surrounding tissue and reducing healing time. While patients of all skin types can benefit from laser resurfacing, persons with a history of facial shingles, anti-acne medication, electrolysis, scleroderma, "sensitive skin" and prior skin resurfacing procedures may not be suitable candidates. These conditions may not support healing and may even contribute to permanent scarring. Smokers are also cautioned to cease smoking at least two weeks before and after the laser procedure to increase blood supply to the skin. Anyone may benefit from laser resurfacing. But the best candidate has fair, non-oily, infection-free skin. Prior to the procedure, a medical history is obtained to see if there are any factors that could negatively impact results. A physical examination is then performed, and the area to be treated is photographed.

Laser resurfacing is usually done on an outpatient basis and in nothing more than an intensely hot light causing controlled burns. Local anesthesia is used in most cases. As with the chemical peel, the process takes from a few minutes to an hour, depending on the size of the area and the depth of the involved tissue. When the lesions are particularly deep, your surgeon may recommend that the procedure be performed in stages.

Following laser treatment, the resurfaced area is covered with applications of protective/antibacterial ointments or creams, and some practitioners will apply a bandage over the affected area for the first four to five days. Once the bandage is removed, the patient will be advised to apply a thin layer of ointment to the facial skin and use special methods of washing and caring for the healing area. As in chemical peel, crusting will occur, and the same precaution should be taken in removing this dead tissue to prevent scarring. These patches should disappear within two weeks, but some pinkness will probably continue beyond that period, perhaps up to six months or more. Makeup may be applied about two weeks post-op, and medication may be prescribed to reduce the temporary color change. If the healing skin reacts negatively to normal makeup, further applications whould be avoided until a substitute is found or healing has progressed. Keeping the new skin protected from the UV rays of the sun is essential. Avoiding exposure to harmful sun rays, even beyond the healing period, is critical to prevent pigmentation problems and to delay the return of the wrinkles and fine lines the resurfacing removed. Visors and hats should be worn outdoors always and a strong sun-blocking agent applied to the face, even after the skin has healed.