LASER SKIN RESURFACING

If you’re considering skin resurfacing…

In laser resurfacing, sometimes called “laser peel” a carbon dioxide (CO2) laser is used to remove areas of damaged or wrinkled skin, layer by layer.  The procedure is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes.  However, it is also effective in treating facial scars or areas of uneven pigmentation.  Laser resurfacing may be performed on the whole face or in specific regions.  Often, the procedure is done in combination with another cosmetic operation, such as a facelift or eyelid surgery.

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A WORD ABOUT LASER

Laser resurfacing is performed using a beam of laser energy which vaporizes the upper layers of damaged skin at specific and controlled levels of penetration.  The CO2 laser has been in use over 20 years and continues to be the “Gold Standard” in facial resurfacing.

All resurfacing treatments work essentially the same way.  First, the outer layers of damaged skin are stripped away.  Then, as new cells form during the healing process, a smoother, tighter, younger looking skin surface appears.  Laser resurfacing is a method used by plastic surgeons to remove damaged skin.

For superficial or medium resurfacing, the laser can be limited to the epidermis and papillary dermis.  For deeper resurfacing, the upper levels of the reticular dermis can also be removed.  The CO2 laser allows varied penetration and the treatment of specific spots and wrinkles.

It is important to also consider the length of recovery when choosing laser among the skin-resurfacing alternatives.  In general, the more aggressive the resurfacing procedure is, the more prolonged the recovery is likely to be.  ‘Light” resurfacing procedures, such as superficial chemical peels or superficial laser resurfacing, offer shorter recovery times.  However, these lighter procedures may need to be repeated multiple times to achieve results comparable to those achieved with more aggressive techniques.

THE BEST CANDIDATES FOR LASER RESURFACING

In many cases, facial wrinkles form in localized areas, such as near the eyes or around the mouth.  The laser can be precisely controlled so that only specific areas are targeted.

Patients with olive skin or brown skin may not be candidates because of a risk for pigmentation changes no matter what type of resurfacing method is recommended.

Individuals who have taken Accutane in the past 12-18 months, or are prone to abnormal (keloid-like) scarring, or those with active skin infections on the treatment area may not be appropriate for this procedure.

Remember, having laser resurfacing won’t completely remove all facial flaws or prevent you from aging.  Lines that occur as a result of natural movements of the face – smiling, squinting, blinking, talking, chewing – will inevitably recur.  Your plastic surgeon can suggest ways to help you preserve your results by protecting yourself from sun exposure and using maintenance treatments, such as light chemical peels and Botox.  Before you decide to have laser resurfacing, think carefully about your expectations and discuss them with your surgeon.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

When laser resurfacing is performed by a qualified, experienced surgeon, complications are infrequent and usually minor.  However, because individuals vary greatly in their anatomy, their physical reactions and their healing abilities, the outcome is never completely predictable.

Risks associated with laser resurfacing include:  burns or other injuries from the heat of the laser energy; scarring; and obvious lightening or darkening of the treated skin.  Also, laser resurfacing can activate herpes virus infections (“cold sores”) and rarely, other types of infection.  Anti-viral medications are given before the procedure.

Additional corrective measures and treatment may be required if healing seems abnormal or delayed or if there is any evidence of abnormal pigmentation or scarring.

PLANNING YOUR SURGERY

Not every practitioner who offers laser surgery has the same level of experience and skill with laser use.  That is why it is especially important that you find a plastic surgeon who is adequately trained and experienced in the procedure.

One safety measure is to find out whether your surgeon has privileges to perform laser resurfacing with a CO2 laser in an accredited facility.  Even if the operation is to be conducted in your doctor’s private facility, the fact that he or she has privileges to use that same laser in a hospital ensures that the doctor has been reviewed by the institution’s experts.

In your initial consultation, be frank in discussing your expectations and don’t hesitate to ask any questions you may have.  Your surgeon should be equally frank with you, explaining the factors that could influence the procedure and the results, such as: any abnormal skin condition which has been diagnosed or previously treated; medications you are taking or have taken in the past; previous skin injuries; or previous operations.

PREPARING FOR THE LASER PROCEDURE

Depending on your individual needs, your surgeon may recommend that you begin a pre-treatment plan to prepare the skin for resurfacing, usually with Retin-A.

At the time of the procedure, you will be given specific instructions on how to care for your skin immediately following your laser treatment.  We will also instruct you to follow a specific maintenance regimen for long-term care of the skin to maximize the benefits of the procedure.

Be sure to make arrangements for someone to drive you home after laser skin resurfacing.

WHERE YOUR LASER TREATMENT WILL BE PERFORMED

Laser resurfacing is usually performed in an outpatient surgery center.

TYPES OF ANESTHESIA

Laser resurfacing is most commonly performed under general anesthesia, in which case you’ll sleep through the procedure.

THE PROCEDURE

Laser resurfacing is a relatively quick procedure and usually takes anywhere from a few minutes to 2 hours, depending on how large an area is involved.

If the imperfections are especially deep, you may need the resurfacing to be performed in two or more stages.

During the procedure, the activated laser is carefully passed back and forth over the skin until the surgeon reaches the level that will make the wrinkle or scar less visible.

When the procedure is over, the resurfaced skin is covered with an application of protective ointment.

AFTER YOUR TREATMENT

Your face may become quite swollen and your eyes may even be swollen shut temporarily. You will need someone to help care for you for a day or two. You may also be limited to a liquid diet and advised not to talk very much during the first few days of recovery. You will be given detailed postoperative instructions prior to your laser so that you can be prepared for the first week.

During this phase of healing, it is very important that you not pick any crusts off the treated area or scarring may result. Redness may persist for several weeks.

GETTING BACK TO NORMAL

Your new skin will usually remain bright pink to red in the weeks following the procedure. You will be prescribed medications to make this color subside more rapidly. After about 2 weeks or so, most patients can safely apply hypoallergenic makeup to conceal this temporary color change. Some pinkness, however may remain for up to six months.

Although it is rare, some patients may find that the new skin is unusually sensitive to the makeup that was regularly used prior to treatment. In such instances, makeup should be avoided until a substitute can be found or until healing progresses to a point at which your makeup no longer causes a reaction. Also try to initially use hypoallergenic products.

Above all, in the months following the treatment, it’s important to protect the treated area from the sun until all the color has returned to normal. Using sun protection regularly will help maintain your results and reduce the chance of any new sun damage to your skin.

If you must be in the sun, apply a strong waterproof sun block with an SPF 15 or higher and shade your face with a hat or visor. If resurfacing is performed around the eyes, it’s best to also wear good quality sunglasses with UVA and UVB 100 percent filters.

YOUR NEW LOOK

The final result from laser resurfacing may take several months to fully appear. However, once pinkness fades, patients usually notice a dramatic improvement in the surface of their skin-fewer fine wrinkles, fewer blemishes and a more even-toned skin. Your results will be long lasting, although not immune to the effects of aging and sun exposure. In the months and years following your laser treatment, your natural facial movements will eventually cause any “expression” lines to recur. Use Botox for any active facial muscles trying to create creases in your new skin.

Once skin rejuvenated with a CO2 laser treatment it usually does not need to be repeated. By protecting yourself from the sun and following a skincare regimen, you can help maintain your rejuvenated look.

Men and women of all ages can benefit from laser resurfacing. The ideal patient for laser resurfacing has fair, healthy, non-oily skin.
When healing is complete, the face has a more youthful appearance.
Fine, vertical creases or “lipstick lines” are commonly treated with laser resurfacing.
Within about five weeks after treatment, the upper lip is noticeably smoother.