Laser Treatments and Resurfacing
Some of the most modern techniques for dealing with unsightly blemishes and wrinkles involve the use of lasers. There are a wide variety of lasers available. Some lasers are excellent for reducing wrinkles, such as the CO2 and Erbium YAG lasers. Some lasers, such as the Argon and Pulsed Dye lasers, are good at eliminating spider veins, birthmarks, and pigmented or vascular lesions. Q-Switched lasers are especially suited for fading unwanted tattoos. And there is a whole new breed of lasers that are designed to help remove unwanted hair.
Laser Skin Resurfacing
As our skin ages it loses elasticity and begins to form permanent wrinkles and etchings. With increasing age the skin loosens and begins to sag into folds. Surgical procedures like facelifts and browlifts can eliminate the deep folds and have a “smooth the bed sheets” effect on larger wrinkles. However, finer wrinkles can be more difficult to eliminate with surgery, especially around places on the face less affected by lifting procedures, such as the lips and “crows feet” areas. In younger faces, where skin laxity is not even an issue, lifting procedures have no role in improving skin wrinkling and texture problems. These problems require “resurfacing” technology.
Resurfacing the skin to make it look more youthful can be done in several ways, including “dermabrasion” and “deep” chemical peels. The more modern method of skin resurfacing involves the use of certain lasers—particularly the CO2 laser.
 At Heartland Cosmetic Surgery we currently rely almost exclusively on the CO2 laser for resurfacing the face. Although other lasers and devices have been developed to perform this procedure, to date, nothing has been able to improve upon the dramatic long-term results achievable with the CO2 laser. This tried and true technology not only resurfaces the skin, it also literally tightens the skin as well! Unlike other lasers or devices, the CO2 laser is able to do this because it exerts such a deep penetrating effect on the skin. This is the beauty of the procedure.
Laser resurfacing is an outpatient procedure. Full face treatments require sedation anesthesia while area treatments, such as around the eyelids or lips, can be done with local anesthesia only. Recovery requires about a week of healing. After laser resurfacing the skin is smoother, softer, and more youthful looking.
FAQ
How long do I need to be off work?
Most patients will plan to take 1 to 2 weeks off from work. The skin resurfaces within 5 to 7 days and makeup can be used to hide any residual redness at that time.
How long will I have redness?
This varies from patient to patient and is very dependant on your skin type and genetics. Most redness fades after 2 to 6 weeks, but in some individuals can persist as long as 6 months. We have an excellent line of cosmetics that can be matched to most skin tones and will hide any pinkness completely.
Will my skin be lighter in color after resurfacing?
Yes, for most people, the new skin will be faintly lighter in color than adjacent, untreated skin. With time this color difference disappears.
I have very dark skin - can I still have laser resurfacing?
Generally speaking, black and very brown skin are not good candidates for laser resurfacing. The risk of healing with patches of “hypopigmentation” (loss of pigmentation) is too great. Hypopigmentation is an uncommon complication of any resurfacing procedure, but is more common in dark skin individuals. Once it occurs it is permanent and irreversible.
Post-op Instructions
The Recovery Period
Laser resurfacing is essentially a precise, superficial burn of the skin. You should therefore expect the skin of your face to react appropriately. At the very least, expect to experience a mild burning sensation in your face, to undergo significant swelling in the treated areas (especially around the eyes) and to exude significant amounts of clear straw-colored fluid while the reddened skin attempts to crust.
This initial phase of healing is alarming to most patients. These reactions are normal, expected and last for 3 to 7 days. You will be given a prescription for pain medication to help control any discomfort during this period. You may also use ice packs (packages of frozen peas work very well) on your face for additional soothing if you desire. You should sleep with your head elevated to help minimize swelling. You should obviously avoid strenuous activity and sweating during this phase as well.
New skin will resurface in anywhere from 7 to 10 days, depending on the size of the area being resurfaced. Wound care, outlined below, should continue until this resurfacing is complete. For these reasons, most patients will stay at home for 7 to 10 days to recover.
During this later phase of healing, itching is a common complaint. Although diligent wound care will help minimize this symptom, you may take over-the-counter Benadryl (25 mg tablet every 6 hours) to help control this common symptom. Of course, you should avoid scratching or rubbing your face as it continues to heal.
The amount of redness that your face experiences is variable, depending on your skin type and numerous other factors. How long the redness persists is also variable. CO2 laser tends to impart redness that persists longer (1 to 3 months) than the Erbium YAG laser (2 to 4 weeks). Prolonged redness lasting up to 6 months is possible with any laser procedure, however. I will monitor this redness closely for you.
Wound Care
Skin treated by the laser resurfaces itself most smoothly in a peaceful, moist environment. Crusting and scabbing are to be avoided since these tend to cause irregularities in the healing. With these principles in mind, you should adhere to the following instructions to optimize the healing of your laser-resurfacing wound.
Keep the Vigilon or Second Skin dressing applied following surgery on your wound overnight. This gel dressing should then be changed one to two times a day, typically after you shower, for five days. Any areas of treated skin not covered by the gel dressing should be covered by a new layer of Vaseline each day. Although some of the gel dressing will stick to the treated skin unsupported, most of the dressing will require support in the form of elastic netting or bandages.
For the remainder of the 1 to 2 week resurfacing phase, you will simply cover the healing area with a thin layer of Vaseline 2 to 3 times a day. Again, this helps prevent scab or crust formation, which tends to make scars. The smoothest wound healing occurs beneath a cover of moist gel or ointment.
To change your gel dressing, use the following procedure:
1. Carefully remove the bandage or netting holding the gel dressing in place.
2. Gently peel away the gel layer coating the wound.
3. Shower your face, as described below.
4. Cut the new sections of gel dressing needed to cover the wound.
5. Using a pair of tweezers, remove the clear blue plastic from one side of the gel.
6. Apply the gel dressing, exposed side down, against the wound.
7. Leave the remaining layer of plain clear plastic on the outside surface of the gel.
8. Cover the gel dressing with elastic netting (or with gauze and tape) to keep the dressing in place.
If any scabs or crusts do form, do not pick or peel them off, as this also tends to make scars. Whatever crusts do not loosen by themselves with gentle cleaning below should be soaked off or left alone.
At least once a day, you should shower your face with clean water and mild soap in the shower. This will help loosen and remove crusting. However, try not to rub or scrub the wound in any way during the first 5 days as it tries to resurface itself with new cells. Simply “pat” on a lather of mild soap and shower it off. Replace the gel dressings after this cleaning.
After the first 5 days of healing, you may begin cleaning your wound gently with a light fingertip action using the running water. Gentle cleansing is the key. Be sure to promptly recover the wound with Vaseline after each cleaning.
Crusts that are resistant to shower cleaning can usually be “soaked” off using gauze pads or a clean washcloth soaked in ½ strength hydrogen peroxide or ½ strength vinegar. Apply the wet cloth or gauze to your face and allow it to soak the crust thoroughly. Then shower the face again. Do not use the soaking gauze or washcloth in a scrubbing manner. Simply soak with it.
Precautions
Don’t apply makeup over the treated sites until after 10 days. A cover-up makeup to hide the initial color disparity with surrounding tissues is best and should contain a sunscreen to help protect the new tissues.
Don’t apply any skin care products to your skin, such as glycolic acid, alpha hydroxy acid or skin bleaching creams until at least 2 to 3 weeks postoperatively (I will let you know when you may restart any of these products).
Freshly healed tissues are susceptible to sunlight or UV light exposure, which tends to turn new tissue red or pink. This redness may persist for months and can be noticeable. Therefore, protect your wound from sunlight and UV light as much as practical for at least 6 months. Since complete avoidance of these rays is not practical, coverage with clothing or hats is the next best option. At the very least, use sunscreens (or makeup with sunscreens) on the wound whenever outdoors.
Follow Up
I will typically see patients in follow up at 2 to 3 days after treatment and thereafter as necessary to ensure optimal healing and results (typically 1 week later and at 1, 3 and 6 months).
Side Effects and Possible Complications
Swelling can be dramatic and typically resolves within 3 to 5 days.
Redness is expected and typically resolves within 1 month for the CO2 laser and 2 weeks for the Erbium YAG laser. Prolonged redness lasting up to 6 months is possible, however. Cover-up makeup is the mainstay of treatment.
Itching is common during the second week of healing and usually responds to antihistamines, such as Benadryl.
Infection from bacteria is always possible but uncommon. We will attempt to prevent any bacterial infection with antibiotics during the resurfacing period. If, despite this preventive medication, your wound should become increasingly red, swollen and tender, please call my office immediately.
Viral breakout (herpes, cold sores, shingles) can occur following laser resurfacing even in people who were unaware they carry such viruses and have never had a breakout. In patients with a known history of such breakouts, we start preventive treatment before laser resurfacing. All patients are treated with preventive antiviral medication after laser resurfacing. Should an outbreak occur despite this preventive medication, call my office immediately to change antiviral medications.
Pigmentary changes are always possible following any type of resurfacing procedure. This can be as simple as the kind of skin lightening often experienced following a sunburn peel or more involved changes, such as the skin darkening experienced by some darker complexions. Most pigmentary changes, if they occur, are temporary and treatable. I will monitor you closely for any such pigmentation changes and initiate therapy with a skin bleaching cream if indicated.
Acne breakout can sometimes occur following resurfacing, especially in patients prone to this condition to begin with. If acne seems to be a problem after your procedure, call my office for treatment.
Scarring is a rare complication and due to a variety of factors, including a patient’s own healing characteristics. If scar tissue formation seems to be occurring, call my office immediately.
Petechiae, finely distributed blood-colored “speckles” in the skin, is sometimes seen just after the skin resurfaces at 7 to 10 days. This is a temporary condition and will clear in time without treatment.
Lower eyelid “ectropion”, or sagging down of the lower eyelid margin, is rarely seen after resurfacing the skin of the lower eyelid. This condition, when it occurs, is usually treatable by simply “massaging” the eyelid to keep it soft and pliable while healing continues. I will show you how to do this should the need arise.
Questions or Concerns
Careful compliance with these instructions will ensure an optimal, smooth and cosmetically appealing result from your laser resurfacing treatment. If you should have any questions not answered above, call my office at 785-309-0900 or 1-866-760-0900 and ask to speak to my office nurse.
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