LASER SKIN RESURFACING

Laser skin resurfacing has become one of the hottest topics in plastic surgery today. I hope this material will help answer some of your questions and give you a thorough overview of this popular procedure.

What is the skin resurfacing laser?
Lasers have been used in medicine for decades. Over the past few years, lasers have been modified and perfected for use in the treatment of wrinkles, the improvement of scars, and in the general rejuvenation of skin. The laser works by selectively removing a thin layer of outermost skin.

Until recently, chemical peels and dermabrasion have been widely used to improve the appearance of aged, sun damaged skin. Unfortunately, these two modalities have certain drawbacks compared to the newer laser technology. Nevertheless, they may still be indicated for some patients.

Laser resurfacing can be done on the entire face or on segments, such as the forehead, cheeks, upper lip or chin. The results, while long lasting, are not permanent. Time, sun, and life eventually will take their toll on the treated areas, as they will on all of the skin. The laser resurfacing technique works on the principle that as old or damaged skin is removed, new and younger looking skin grows in its place.

What conditions are treatable with laser resurfacing?

Facial wrinkles
Lip lines, crows feet, and wrinkles around the eyes
Acne scarring and post surgical scarring
Sun damaged skin
Laugh lines and frown creases
Skin irregularities and blemishes

How is the procedure performed?
Laser resurfacing generally takes place in the office or surgicenter setting. Depending on the number of areas to be treated, laser resurfacing takes between thirty to ninety minutes. Anesthesia ranges from local to general anesthesia. Once you are adequately anesthetized, the surgeon uses the laser much like a wand or a paintbrush, tailoring the procedure to your individual needs.

Who are the best candidates for laser skin resurfacing?
Ideal patients are people who have light colored skin with fine wrinkling. People with olive, brown or black skin have a higher risk of change in pigmentation. It is particularly effective for fine wrinkling around the eyes and vertical lip lines. In addition, sun damaged skin responds extremely well to laser therapy. The surgeon may recommend that you see the aesthetician for pre-treatment skin care with hydroquinones and Retin A.

Laser resurfacing is frequently used in conjunction with other facial cosmetic procedures such as a face lift or eye lift. You can compare a face to a custom made suit. To make the suit fit, you cut away any extra material, and then iron away the wrinkles. The laser takes care of the wrinkles, but does not treat the extra skin.

Many of my patients are women in their forties who would like a tightening, but are not yet ready for a facelift. I also see patients who have had previous facelifts, but now have some recurrent laxity that is treatable without repeat surgery. Although the results of treatment with laser therapy alone are not equivalent to a facelift, most patients are extremely pleased with the outcome.

What are the preoperative considerations?
My patients are generally enrolled in a regular skin care program with my aesthetician. We use the latest and most effective skin care regimens to prepare your skin for resurfacing. Agents such as Retin A, glycolic acids and pigment stabilizing creams are used several weeks before your laser resurfacing. By pre-treating your skin well in advance of your resurfacing, a more predictable and pleasing result can be achieved. This program is individualized to your particular skin type.

What are the postoperative considerations?
The challenging aspect of laser surgery is the healing process. Because a thin layer of skin is removed by the laser treatment, you can expect some “weeping” of the face with areas of crusting. This is normal. The weeping can last for 5-10 days after treatment. During this time you will be cleansing your skin 5-6 times a day with a mild vinegar and water solution to help remove some of the crusting. The solution also acts as a mild antiseptic. The most important things to do after laser is to keep your skin clean, moist and out of the sun. Moist skin heals better and faster, and feels better.

You will be applying an occlusive petroleum jelly based ointment to your face after each cleansing. We like Aquaphor because it is very mild and causes the least number of skin reactions. You can expect your face to be red for several weeks and occasionally for months. This is usually not a significant problem as you can start using a concealer and foundation once the weeping and crusting stops.

Swelling can occur but is typically minor. Swelling around the eyes can be significant but usually resolves after a few days. Mild to moderate pain is common. The discomfort can be alleviated with Tylenol or prescription pain medication. Patients must alter their lifestyle for a brief time to perform the required cleansing and lubrication; many people find this bothersome. After three or four weeks you can resume your normal skin care routine.

What are the side effects and possible complications of laser resurfacing?

Pain. Most people feel some pain during the treatment if only local anesthetic is used. Utilizing general or IV sedation makes the patient more comfortable and reduces anxiety.
Wound Healing. Because a superficial wound is created with the technique, you can expect swelling, weeping and crusting. Once the surface has healed, the skin will take on a pink color that can last for weeks or even months. You must avoid sun exposure to the treated areas for six months after your procedure.
Pigment Changes. The treated area may heal with increased or decreased pigmentation. This means that your skin can be darker or lighter than before surgery. These skin color changes vary by skin type and generally resolve with time. In rare circumstances, the pigment change can be permanent.
Scarring. This is uncommon, but it does happen. When you are in the healing phase, you may notice a small area, which seems to heal more slowly than the rest of your face. These areas are sometimes prone to scars and are treated aggressively with topical steroid therapy. To minimize the chances of scarring, it is very important that you follow all pre- and post-operative instructions.

Overall, I have been very pleased with the results of the laser for skin resurfacing. It won’t take 20 years off your face, but it certainly improves the overall appearance and texture of your skin. Laser resurfacing will tighten your face and smooth wrinkles significantly. It is ideal for use in younger individuals looking for a safe and simple procedure that can dramatically improve the appearance of their face without surgery.

Robert C. Caridi M.D.

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