The Lumenis AcuPulse Laser is a fractionated CO2 laser. A fractionated CO2 laser is a laser that targets water in the skin to produce a light controlled superficial burn that in turn produces a healing response that tightens and smoothes the skin. Fractionated lasers are lasers that lay down a pattern of dots so that the skin can heal more quickly as opposed to simply treating the entire surface area of the skin.
Lumenis and other fractionated CO2 lasers will treat wrinkles, sun damage, pigmentary changes, and even reduce pore size. The laser works by producing a controlled burn as noted, which then produces a healing response, which results in an increase in collagen, elastin, hyaluronic acid, and other compounds within the skin that tightens and smoothes the skin.
Fractionated CO2 lasers are generally considered the gold standard in facial resurfacing (wrinkle and sun damage reduction). Unfortunately, there is significant downtime. Patients will have redness, swelling, light bleeding, and will be covering their face with Aquaphor or other creams or ointments. Most patients will return the public activities in five days, but some will wait longer. The face will generally be for the most part healed, but very red at five days. Redness generally persists for three to six weeks and in some patients, longer.
During the treatment, the patient is awake and using topical numbing cream. Many patients will take oral sedatives like Xanax and/or pain medicine like Norco prior to the procedure. The procedure generally is not performed with general anesthesia unless other concurrent procedures like a facelift are being performed at the same time.
No one has ever shown that lasers produce indefinite improvement, but most physicians feel that the laser benefit lasts for several years. The commonly cited number is 10 years. Of note, it is more common to repeat fractionated lasers even within this time period because recovery is quicker and easier than it was with the lasers that preceded fractionated lasers. Re-treatment is most common for wrinkles around the lips or the crow’s feet.
Porcelain skin refers to skin that was treated with older CO2 lasers (so-called confluent lasers that were not fractionated). These lasers could produce depigmentation of the skin leaving the skin looking a little bit pale and shiny. This is not generally considered aesthetic. Fractionated lasers are highly unlikely to depigment the skin.