LASER RESURFACING

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Important facts about laser resurfacing:

• The beam of most physicians’ lasers is pulsed (or regulated) to prevent excess heat build-up in the surrounding tissues.
• This is crucial: the laser has a computer attached to it so the depth of the tissue removal can be precisely controlled.
• The fairer the skin, the fewer the pigmentation problems.
• The pulsed laser vaporizes the top few layers of skin and shrinks the underlying collagen tissue, resulting in a tightening of the skin.
• A laser works best on the fine lines around the eyes and mouth - vertical creases or "lipstick lines" are commonly treated with laser resurfacing.
• Some lines will reappear, but will be less obvious.

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Are There Any Alternatives to Surgery?

How Can I Prepare for Surgery?

How is the Procedure Done?

What Can I Expect Pre- and Postoperatively?

Tell Me About Recovery

What Kind of Risks / Complications Are There?

Still You…Only Better!

ALTERNATIVES TO SURGERY
There are alternatives to laser resurfacing. A good skin care specialist, such as a medical esthetician or a dermatologist should be consulted to begin a healthy skin regimen. Light chemical peels that can be done in the office can give your skin a healthy glow and maintain better skin elasticity. However, these methods will not be as long lasting or produce the dramatic changes that laser resurfacing will.

PREPARING FOR SURGERY
Your physician should discuss with you the areas you want to have laser resurfaced and should evaluate your skin type, the degree of sun damage, and the depth and location of wrinkles. The muscle tone of your lower eyelids should also be assessed to prevent the complication of an ectropion (droopy lower eyelid) that may occur from the tightening effect of the lower eyelid skin. Your doctor may recommend a canthopexy (eyelid tightening procedure) prior to the resurfacing.

All patients are at risk for hyperpigmentation, a darkening of the skin. Certain skin types are at higher risk than others. Many doctors prescribe skin lightening creams that inhibit the formation of melanin (pigment). The doctor should also strongly warn patients to avoid the sun after surgery for a minimum of three months. Even sunlight through a window must be strictly avoided.

If you will be undergoing any type of facial peel—chemical peel, dermabrasion, or laser resurfacing—it is imperative that you tell your doctor if you have a history of cold sores, shingles, or herpes infections because these procedures can reactivate the virus. Many doctors routinely prescribe an oral antiviral medication. It is also extremely important to tell your doctor if you have taken any acne medication (such as Accutane) in the past year, or if you have any connective tissue disease, e.g., lupus, scleroderma.

THE PROCEDURE
Many physicians who use lasers in their practice feel that there is greater control over the depth of the laser and therefore, better predictability of results compared to chemical peels or dermabrasion. However, many physicians have been getting favorable results with peels for years and see no reason to alter their method. Ultimately, your comfort level with your doctors training, skill and expertise will assist you in making an informed decision. The Erbium laser provides a lighter, less intensive resurfacing, whereas the CO2 laser will penetrate more deeply, taking care of deeper scarring or pitting. If you undergo laser resurfacing, here’s what you can expect:

CO2 Laser
The laser beam passes through a chamber filled with carbon dioxide, generating extremely high temperatures. For deep wrinkles, the result is similar to a deep chemical peel or dermabrasion. Pinkness usually lasts from one to six months, and the healing period can be lengthy and complex. Makeup can usually be applied between seven and ten days after treatment.

Erbium Laser
This laser produces a shallower laser area and less heat and has a light smoothing effect for fine lines and pigmentation. The procedure is similar to a light-to-medium peel, depending on how many passes are made over the surface. The Erbium laser has been used on the delicate neck area and the backs of the hands. It’s also been used successfully on darker skins (the ideal candidate has fair, healthy, non-oily skin). Blisters do not form, and the recuperation period is shorter and less complex.

Anesthesia
A local anesthetic may be used for deep laser resurfacing with the CO2 laser if the area to be treated is small, such as around the eyes or mouth. For more extensive, full-face resurfacing, intravenous sedation or general anesthesia is generally used. The type of anesthesia depends on the area(s) to be treated, the doctor’s choice and the patient’s medical history or desires. Erbium laser procedures many not require anesthetic although a topical anesthetic or injection may be necessary in delicate areas.

Length of Procedure
Laser resurfacing is a relatively quick procedure. Depending on the size of the area involved, it takes anywhere from a few minutes to one and one-half hours. When imperfections are especially deep, your surgeon may recommend that the procedure be performed in two or more stages.

Level of Pain or Discomfort
The treatment of localized areas of the face under local anesthesia with sedation produces minimal discomfort. Generally, most patients experience little discomfort during the postoperative period. However, the level of pain can be worse for patients failing to follow the doctor’s pre- and postoperative instructions. Most pain or discomfort can be controlled with prescribed or over-the-counter pain medications.

PRE- AND POSTOPERATIVE INSTRUCTIONS
Although your doctor may have different or additional instructions, the following recommendations are intended to make you feel more comfortable and help you heal:

• Stop smoking, discontinue the use of alcohol, and stop taking vitamin E and any medications containing aspirin or ibuprofen (two weeks pre- and preoperative is usually recommended). Check with your doctor regarding any other medications (including homeopathic/herbal products) that you are currently taking.
• Because you may experience postoperative itching, purchase cotton gloves to wear at night, especially if you’re prone to scratching yourself while sleeping.
• Have someone stay with you for at least the first night after surgery (the first twenty-four hours, optimally).
• If your procedure requires them, the doctor or nurse should apply dressings immediately after the procedure.
• Follow directions regarding the application of any ointments.
• Sunbathing and tanning beds must be avoided a minimum of six weeks prior to surgery and three to six months after surgery depending on your healing. Otherwise the pigmentation of your skin may change permanently. For optimal skin care and health, these should be avoided completely.

RECOVERY
Recovering from laser resurfacing requires strict adherence to a home care regimen to avoid any complications. You will probably not feel like going out until at least ten days after the procedure. You may be swollen and could be especially susceptible to infection for several weeks after your procedure. Within about twenty-four hours, your skin will begin to crust. Do not pick at the crusts, as they will dissipate within about a week. You may be given ointments to keep the resurfaced lubricated. The redness should turn to pink and can then take up to three months or longer to fade, depending on how quickly you heal. The same healing process applies for Dermabrasion patients.

RISKS/COMPLICATIONS
Although problems are unlikely, you need to be aware of what can happen and what action you should take. Most risks/complications will be avoided if you make an informed decision, choose a qualified physician, and follow your physician’s instructions.

The kinds of complications that can occur with laser resurfacing are infection, scarring, discoloration, changes in the texture of the skin, ectropian or scleral show (retraction of the lower lid if the skin under the lid tightens too much).

STILL YOU…ONLY BETTER
Laser resurfacing can make a dramatic difference in the texture and the feel of your facial skin. Healing and getting back to normal take a little longer with this procedure, but most patients report that the results are worth it.