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Laser Skin Resurfacing

In laser resurfacing, sometimes called "laser peel," a carbon dioxide laser is used to remove areas of damaged or wrinkled skin, layer by layer.

Laser resurfacing is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes and to create a uniform skin color and texture. It is also effective in treating facial scars or areas of uneven pigmentation. Laser treatment will not correct deep furrows due to sagging jowls, for which a facelift remains the best option.

Laser resurfacing may be performed on the whole face or in specific regions. It has been shown that in some cases, this surgical method produces less bleeding, bruising and post-operative discomfort than is typically seen with other resurfacing methods.

Who are the best candidates?

The ideal patient for laser resurfacing has fair, healthy, non-oily skin. Patients with olive skin, brown skin or black skin may be at increased 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 candidates. Lines that occur as a result of natural movements of the face—smiling, squinting, blinking, talking, and chewing—will inevitably recur.

How does the laser work?

Laser resurfacing is a new method being used by plastic surgeons to remove damaged skin. It is performed using a beam of laser energy, which vaporizes the upper layers of damaged skin at specific and controlled levels of penetration. 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.

What is the recovery period?

It is important to consider the length of recovery when choosing among skin-resurfacing alternatives. The more aggressive the resurfacing procedure, 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.

What are the risks?

Risks of laser resurfacing are similar to those of chemical peeling and dermabrasion. The most common is increased pigmentation, a temporary brown discoloration after healing which is more common in patients with darker skin and often related to sun exposure while healing. Bleeding is minimal, and risk of infection can be minimized with diligent wound care and use of antibiotic ointment. Some scarring is possible after laser surgery, especially if infection develops. To minimize risk of scarring, it is preferable to treat conservatively and retreat persistent areas if necessary; deeper wrinkles occasionally require a second treatment for maximal improvement. Laser resurfacing can activate herpes virus infections ("cold sores") and other types of infections.

How do I prepare for surgery?

Your surgeon will discuss your medical history, perform a routine examination and photograph the area to be treated. He or she should explain the procedure in detail, along with its risks and benefits, the recovery period and the costs. Remember that cosmetic laser treatments can be expensive and are usually not covered by medical insurance. Your surgeon may recommend that you begin a pre-treatment plan to prepare the skin for resurfacing. At the time of the procedure, you will be given specific instructions on how to care for your skin immediately following your laser treatment. Your surgeon may also instruct you to follow a specific maintenance regimen for long-term care of the skin. Be sure to make arrangements for someone to drive you home if you will be given tranquilizers or sedation for your laser treatment.

Where will the surgery take place?

Laser resurfacing is usually done on an outpatient basis in our clinic.

What type of anesthesia is used?

Laser resurfacing is most commonly performed under local anesthesia with sedation. For more extensive resurfacing, your surgeon may prefer to use general anesthesia, in which case you'll sleep through the procedure.

What happens during the procedure?

Laser resurfacing is a relatively quick procedure. It usually takes anywhere from a few minutes to 1-½ hours, depending on how large an area is involved. 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, your surgeon may choose to treat the resurfaced skin with applications of protective ointments until healing is complete. Some surgeons choose to apply a bandage over the treated areas, which will cover and protect the healing skin for the first five to ten days.

What happens after the procedure?

You are likely to experience some mild swelling and discomfort after laser resurfacing. This can be controlled with ice packs and medications prescribed by your surgeon. If a bandage was applied after your procedure, it may be replaced with a fresh one after a day or two. After about a week or so, your bandage will be removed and a thin layer of ointment may be applied to the skin. Once this stage is reached, your surgeon will provide instructions on how to gently wash and care for your healing skin. During this phase of healing, it is very important that you not pick the crusts off the treated area or scarring may result. Most patients are free of crusts by about 10 days post-operatively. Redness may persist for several weeks.

How long before everything should be back to normal?

Your new skin will usually remain bright pink to red in the weeks following the procedure. Your surgeon may prescribe medications to make this color subside more rapidly. After about two weeks or so, most patients can safely apply makeup to conceal this temporary color change. Some pinkness may remain for up to six months. Some patients may find that their healing skin is unusually sensitive to the makeup that was regularly used prior to treatment. Makeup should be avoided until a substitute can be found or until the healing progresses to a point at which the makeup no longer causes a reaction. If you must be in the sun, apply a strong sunblock with an SPF of 15 or higher and shade your face with a hat or visor.

The final result from laser resurfacing may take several months to fully appear. It's important to understand that your results will be long-lasting, but not permanent.

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