Facial Laser Treatment Side Effects: Scabs, Redness and Recovery

• Expected reactions: redness, swelling, tingling, itching, scabs, peeling and small white bumps are possible after laser resurfacing.
• Depending on the treatment: ablative CO2 laser and fractional CO2 laser leave skin that has to repair itself; non-ablative intense pulsed light mostly leaves skin that is pink and sensitive.
• Duration: it varies with the depth of the treatment, the type of laser and your skin; there is no day-by-day timetable, and no worst day that is the same for everyone.
• Care: follow your written instructions for gentle cleansing, skin protection, makeup and your usual products; sun exposure is limited until the skin has healed completely.
• Seek care right away: pain, redness or swelling that is getting worse, fever, suspicious greenish or yellowish discharge, yellowish scabs accompanied by worsening symptoms, blisters or a wound that does not heal.

Your skin is red, tight, sometimes covered in small scabs after a laser. You wonder whether it is recovering normally. Before treatment as well, knowing what to expect from CO2 laser recovery, or from any other facial laser treatment, helps you plan your care and the days after treatment. The side effects of a facial laser range from expected redness and swelling to rarer complications such as infection or a change in skin colour. At CARE MD, in Sainte-Thérèse, recovery instructions take into account the treatment received: fractional CO2 laser, ablative CO2 laser resurfacing and intense pulsed light.

Recovery time varies from one person to the next and from one treatment to the next. Care is planned according to your skin and the treatment received. No day-by-day timetable applies to everyone: a reaction that is settling is not monitored in the same way as pain that is getting worse.

An ablative treatment removes layers of skin. It therefore leaves a surface that has to repair itself, and it is that repair that explains the scabs, the peeling and the importance of care. “Fractional” describes something different: how the energy is delivered, in small areas rather than across one continuous area. A fractional laser can be ablative, and that is the case with the fractional CO2 laser: it disrupts the barrier that protects the skin from infection. Care protects this surface while it heals. Ablative CO2 laser resurfacing removes the outer layer of the skin.

Intense pulsed light is non-ablative: it does not remove layers of skin. Its after-effects are more like skin irritation, pinkness or redness than a healing wound, although scabs, infection or a change in colour remain possible. Instructions are tailored to the treatment received: those for skin that is healing after a CO2 laser do not apply to an intense pulsed light session, and vice versa.

Fractional CO2 laser, ablative CO2 laser resurfacing and intense pulsed light do not have the same after-effects. Recovery is one of the things to discuss before a facial laser treatment, though it is not enough to choose a procedure: your skin and what you want to change also matter.

After laser resurfacing, the skin is red and swollen, with tingling or itching for a few days. These reactions can accompany a normal recovery; what matters is how they progress. Redness can persist after the skin surface has healed over. While the skin surface is healing over, the skin is red and sensitive; once the surface has healed over and peeling has stopped, the new skin stays pink and gradually lightens. The skin surface healing over therefore does not mean the redness has disappeared, and skin that is still pink does not, on its own, indicate the result.

After intense pulsed light, the treated area turns pink or red, with tingling that feels like a mild sunburn and slight swelling. The redness generally lasts a few hours, sometimes longer; the tingling often settles within a few hours and the slight swelling within a few days. The instructions given at the session may suggest cool compresses or damp cloths for the tingling sensation.

If your face swells after a CO2 laser, follow only the care instructions you were given: temperature, compression, medications or applied products are not something to improvise. Watch whether these reactions are decreasing or increasing. Swelling, redness or pain that increases from one day to the next instead of settling is not an expected after-effect, and means you should contact the professional who treated you right away.

Healing time varies with the depth of the resurfacing and the type of laser. There is therefore no worst day that applies to everyone. Another person's timeline, even after a treatment with the same name, cannot predict your recovery. Three distinct processes unfold: the skin surface heals over, the redness disappears and the aesthetic result develops. The result is assessed later and cannot be determined from scabs or redness.

The device settings and the colour of your skin also influence the type and severity of the risks. Before the session, discuss with the doctor the reactions to expect for your skin and the planned treatment.

After resurfacing, a yellow fluid may ooze from the treated skin and dry into a scab, and then the skin peels. This can be part of normal healing. Do not scratch or pick the scabs: it can leave a scar. A scab that falls off on its own does not mean the skin has healed, nor that you can resume using all your products.

Small white bumps, called milia, can appear during healing, and an acne flare-up is also possible. You and the doctor decide what to do, including whether a treatment should be prescribed. A white bump cannot be identified with certainty in a photograph: on examination, the doctor can tell it apart from another reaction, and a bump that is red, painful or oozing must be examined right away.

After a CO2 laser, ablative or fractional, the barrier that protects the skin from infection is disrupted while the skin heals. Care therefore has two goals: gently cleansing and protecting the skin while its surface heals over. The specific cleanser, protective ointment or dressing depends on your skin and the treatment; follow the written instructions you were given for your treatment. Apply only what you are told to apply, even a natural product or one reputed to be soothing: a product not included in your instructions can slow healing. A prescribed treatment, for example to prevent infection, sometimes accompanies this care. Follow the prescription instructions.

After a fractional CO2 laser, wait until the area has healed completely before applying makeup; neither the number of days nor the scabs falling off tells you whether it has healed. Before resuming exfoliants, products containing active ingredients or your usual cream, ask for written instructions stating which products are appropriate for your skin and when to use them. After intense pulsed light, avoid perfumes and irritating products, and wait until the redness and tingling have subsided before applying makeup.

Until the skin has healed completely, avoid exposing the treated area to the sun. If you have to go out, cover it with clothing or a hat, or a mineral sunscreen if the doctor allows it for your skin. Once the skin surface has healed over, continue daily sun protection with a sunscreen chosen for sensitive skin; the disappearance of redness does not, on its own, mean you can expose your skin to the sun.

After a fractional CO2 laser, hot baths, saunas and swimming pools are limited during healing, for a length of time set by your instructions. Going home after the session does not mean the skin has healed. Returning to work, sports and outings depends on the treatment and your skin; ask for instructions that clarify when you can resume these activities.

As for driving, sedation may be used for extensive resurfacing. Under sedation, reflexes and judgment remain impaired even if you feel well, and you must not drive. Before the treatment, ask what you will be given and how you will get home.

Even when well performed, a laser can cause temporary pain, redness, bruising and swelling. Other effects are possible: blisters, burns, infection. After an ablative fractional CO2 laser, the skin barrier is disrupted. An area that is slow to heal may be a sign of infection, and an infection can leave a scar. It can be hard to tell apart from normal healing: the doctor examines the skin to determine the cause.

Facial resurfacing can also trigger a cold sore flare-up, especially around the mouth; mention before treatment whether you have ever had cold sores. Also mention any past poor healing, keloids or thick scars, which may lead to avoiding aggressive resurfacing.

The treated skin can become darker than before, more rarely lighter. If a change in colour persists or becomes more pronounced, have it evaluated rather than waiting for it to fade. It is not a spot to treat yourself: the doctor looks for its cause.

Contact the professional who treated you right away if you notice:

• pain that increases instead of settling;
• redness or swelling that is increasing;
• fever or chills;
• suspicious greenish or yellowish discharge, or yellowish scabs along with pain, redness or swelling that is increasing;
• blisters or new sores, including cold sores;
• a wound or area that does not heal;
• skin whose colour changes and does not return to normal;
• any other change that worries you.

An isolated yellow scab can form during healing; its colour alone does not establish that there is an infection. Redness, swelling, tingling, peeling and small white bumps can also accompany recovery. However, seek advice right away for increasing pain, redness or swelling, or suspicious discharge. Worsening symptoms must not automatically be attributed to normal recovery. After intense pulsed light, pain, infection, bleeding and colour change are also risks, to be reported in the same way.

Use the contact details and the instructions given at discharge to reach the professional who treated you. The CARE MD contact form is for routine questions; it must never be used to report these warning signs.

To get instructions suited to your skin, bring the name of the treatment you received or are considering, along with any instructions you have already been given. Describe what you have noticed and when it started. Mention the skin care and products you use, your current treatments and your history of cold sores or poor healing. Ask how to reach the professional after the treatment. This conversation takes place during a Global Aesthetic consultation at CARE MD.