smartxidedotLaser Resurfacing

Laser resurfacing is the name given to a procedure that dramatically improves skin texture (wrinkles, scars rough spots, coarse pores).

You would be forgiven for thinking that laser resurfacing was the equivalent of using sandpaper to plane down the uneven surface of the skin. That was the principle behind full ablative CO2 resurfacing, the entire top layer of the skin was removed (usually under a general anaesthetic) and allowed to regrow, resulting in flattening of the surface wrinkles.

Although results were spectacular, there were significant drawbacks as the raw surface required surgical dressings for about 2 weeks. There was a significant risk of infection during this open phase and the new skin was often paler than the surrounding skin.

What’s the difference between Fractional vs. Full resurfacing?

The Difference Between Fractional vs. Full Resurfacing

Chennels in Skin

Channels in Skin

About 6-7 years ago, fractional ablative resurfacing was developed: as the name implies, the skin is only partially removed. The laser creates a series of microscopic channels into the mid and deep layers of the dermis, leaving bridges of normal skin in between.

With this process, up to 50% of the skin surface can be removed at one time, healing in as little as 48hrs with no permanent marks or scarring, this resulted in a far lower risk of infections, with no need for dressings. The resurfaced area could simply be covered with an occlusive ointment such as Vaseline or Aquaphor.

What’s more, the thousands of microscopic wounds in the skin stimulate the production of collagen, leading to thickening of the dermis, or mid-layer of the skin a smoothing of the wrinkles occurs from the inside-out, vs. the outside-in.

What about “non-ablative resurfacing” - how does this work?

Non-Ablative Resurfacing

Ablative means open, or having a connection with the surface; non-ablative resurfacing occurs with lasers that work on the middle layer of the skin, leaving the outside layer (the epidermis), intact (e.g. the Affirm Multiplex 1320/1440 nm laser -an example of a fractional non-ablative laser used for acne scars, stretch marks and fine lines and the Fraxel Dual 1550 Erb/Glass laser, used for melasma, surgical and acne scars, fine- moderate lines. The Fraxel 1550 can be safely used for all skin types, but can be associated with significant downtime).

Difference between fractional ablative resurfacing lasers

Difference Between Fractional Ablative Resurfacing Lasers

CO2 and Erbium lasers can both be used for fractional ablative resurfacing. The CO2 laser exhibits superior tissue tightening and shrinkage, vaporises treated cells and coagulates blood vessels, resulting in no bleeding, no crusting, faster healing time and a lifting effect.


* Individual Results May Vary

The Smartxide DOT Fractional CO2 Resurfacing Laser

The Smartxide DOT fractional CO2 resurfacing laser is used for treating:

  • Deep Lines & Wrinkles (face, neck, chest)
  • Smoker’s Lines (vertical lines above and below the lips).
  • Loose, Sagging Skin (bags under the eyes, loose skin of the neck).
  • Droopy Eyelids (the non-surgical Madonna Eyelift).
  • Stretch Marks resulting from post pregnancy, weight loss*.
  • Severe Acne Scarring**.
  • Traumatic and surgical Scars.
  • Poor Skin Texture (fine lines, pores, pigmentation*).

* Pigment – e.g. brown spots – may require additional IPL treatments

** Caution is advised with keloid scars – they may not respond, improve, or even get worse, as the problem is with the healing characteristics of the skin.

Explain (again) how this laser works?
skin-resurfacingThe laser creates a series of microscopic channels into the mid-layer of the skin – stimulating the formation of collagen as a healing response. The new collagen causes thickening of the dermis, or mid-layer of the skin, thus smoothing out wrinkles /remodelling scars from the inside-out. The CO2 laser, additionally, causes immediate tissue shrinkage, which is of benefit for loose or saggy skin.

Healing occurs in  the following distinct phases:

  • The first phase: Tissue shrinkage is seen almost immediately
  • The second phase: Closing of the holes in the skin occurs over the next 48-72 hours
  • The third phase: Involves flaking or shedding of the old skin, over a 5-7 day period
  • The fourth and final phase: Remodelling of the wrinkles and scars occurs from 1-3 months after the treatment, as new layers of collagen are deposited in the dermis.
What are the risks / side-effects of treatment with the Smartxide DOT laser?
Potential side effects include

Potential Side Effects Include:


  • Small risk of infection
  • Swelling, redness and peeling post treatment.
  • Downtime which may last from 4-7 days depending on the depth of the resurfacing and the healing characteristics of the patient.
  • Post-inflammatory hyperpigmentation, darker skin tones may be at risk of transient darkening of the treated area known as hypopigmentation (lighter colouring of the treated skin) although, extremely unusual.

see day-by-day account of healing post Smartxide laser at this link.

How many treatments are required?

How Many Treatments Are Required?

Depending on the depth of the wrinkles, more than 1 treatment may be required (eg. deep lines above the lip or crow’s feet may require 2 or in rare cases  3 treatments).

The Madonna eyelift, which consists of light resurfacing of the upper lid, under the eye and crow’s feet area, typically takes 3-5 treatments, as progressively more tightening occurs in the loose tissue with each treatment.

How long will my results last?

How Long Will My Results Last?

That depends on a number of factors:

  • Age at treatment
  • smoker vs. non-smoker
  • Depth of wrinkles
  • Genetic factors
  • Quality of skin care products used afterwards
  • Whether you continue to damage the skin by sun tanning etc.

A touch-up treatment with the non-ablative Affirm Multiplex laser in 18 months to 2 years, if needed, can prolong the results.

The Madonna EyeLift

LazerRoom Patient - The Madonna EyeLift

LazerRoom Patient – The Madonna EyeLift * Individual Results May Vary

This non-surgical approach to droopy eyelids was developed by renowned Manhattan dermatologist, Dr. Bruce Katz.

The Smartxide laser is used to lightly resurface the upper eyelids, under the eyes, under and above the brows as well as the crow’s feet area. As discussed previously, one of the chief characteristics of the CO2 laser is to cause tissue shrinkage, hence a series of light treatments of the above-noted areas will progressively shrink loose baggy tissue while smoothing out wrinkles (crow’s feet) and improve the appearance of dark circles under the eyes.

What To Expect

  •  3-5 treatments are required at 2-4 week intervals
  • Downtime consists of 1-2 days of swelling around the eye area
  • followed by another 2-3 days of redness and mild flakiness (which can be covered with make-up).

Patients who have their treatment done on Friday, are usually back to work by Monday.

Steel contact lenses (corneal shields) are inserted below the upper lid prior to treatment to ensure proper protection of the eye. The entire treatment takes approximately 10 minutes and is done under topical anaesthesia.

Prior consultation is required, as some patients may not be suited to this procedure (eg. if they have excess skin or extreme ptosis of the upper lid, very low brows, or fat deposits under the eyes known as infraorbital fat pads), and would be better suited to surgical procedures.