Skin is a living organ. Every day, thousands
of cells die, fall off, and are replaced by new cells from below. This is a haphazard process that
does not allow the skin to shed dark spots, sun
damage, or a dull lifeless complexion.
Laser resurfacing is a procedure in which a carbon dioxide laser is used to
remove the outer layers of skin. The purpose of laser resurfacing
is to cause the even, controlled removal of several layers of damaged
cells. This allows a new fresh layer of skin can grow, with a more even texture and
color.
Laser resurfacing is an outpatient procedure. If this procedure is
performed on only one segment of a patient's face (such as around the eyes),
then it is performed under light intravenous sedation in the minor procedure
room in the office. Otherwise the procedure is performed in the operating room
with an anesthesiologist providing sedation, or "twilight anesthesia."
Most patients have heard something about laser resurfacing but want to know
more. In this section, I intend to take you on a detailed tour through the
laser-resurfacing process, from start to finish.
Before the laser resurfacing procedure, we prescribe a skin cream
for the patient to begin at least 2 weeks before the procedure to prepare the
skin. At times, we may also prescribe a pigment lightening gel to begin 1-2
weeks prior, to help minimize pigmentary changes post-laser. All patients are
prescribed an antibiotic and an oral antiviral medication to begin prior to
surgery. This is to prevent the outbreak of bacterial infection or cold
sores/fever blisters during the healing phase.
The day of the procedure, patients are instructed to wear clothing that
fastens in front or back. Patients are asked to avoid slipover sweaters,
T-shirts, and turtlenecks and are instructed not to wear any earrings, makeup,
or facial creams. Men should be closely shaven.
The patient is brought into the procedure room & placed in a reclining
medical chair or table. Local anesthesia and intravenous sedation are utilized
as determined prior to the procedure. The patient's face is cleansed to
improve uniform uptake. The laser procedure is then performed. At the completion
of the procedure, ointment is applied.
Immediately after laser resurfacing, the resurfaced area will feel
swollen, numb, and look slightly pink. It is normal to have significant swelling
the night & morning after the procedure. This can be lessened by sleeping
with one's head elevated.
During days 7-30 after laser resurfacing, a patient's skin
will look like it had a sunburn. It may take up to 3 months for the redness to
completely disappear, but after 7 days a patient should look socially acceptable
with makeup. Patients may now resume their normal activities with the exception
of sun exposure.
Like all surgical procedures, there are potential side effects and
complications associated with laser resurfacing. Pigmentary changes after
laser resurfacing can cause areas of increased or decreased pigmentation. This
is more common in darker skinned individuals or those with a history of
pigmented scars. The use of sunscreens and lightening gels will decrease the
risk of these problems. Close follow-up & keeping all appointments with the
doctor is important so that these problems can be treated early when they occur.
Some redness may last for up to 3 months. This is managed with skin care
regimens and strict sun avoidance. Also, makeup can be used to camouflage any
redness during this time. Infection may be due to herpes simplex or bacterial
skin infections. Preventative medications are routinely prescribed for you to
take and are generally quite effective. Any signs of infection should be
recognized early and treated with additional therapy as indicated. Scarring is a
rare complication of the wound created by the laser resurfacing procedure, but
it remains a potential complication of any procedure that wounds the skin. Close
follow-up & keeping all appointments with your doctor is important so that
these problems can be treated early when they occur.
Patients may occasionally require more than one resurfacing procedure to
achieve their best improvement. For most skin types, one procedure is enough to
achieve the desired improvements, but some skin problems, such as excessive
pigmentation from pregnancy or birth control pills, may require multiple
procedures for maximum improvement. Everyone's skin is different, so each
person's program is tailored to his or her individual needs. When I examine
your skin I will tell you what I believe needs to be done for your skin to
accomplish what you desire.
Laser resurfacing is especially effective around the eyes:
