Laser Skin Resurfacing

New fractional Laser technology has modified the difficult recovery process historically associated with this laser resurfacing. The fractional CO2 laser is a valuable addition to existing laser resurfacing techniques. Because of the reduced heat of the fractional CO2 laser, healing is much faster and recovery much shorter with the same end result. Patients treated with the fractional CO2 laser can often have the procedure performed with only topical anesthesia.

How the Laser Works

Unlike natural sunlight, which is comprised of light wavelengths of many colors, the laser produces only specific wavelengths of light at specific energy levels. The laser light energy is translated into heat when the skin absorbs it. It is this energy which produces the effect of the laser on the skin, in this instance, destruction of skin cells in a very precise manner. The older technology CO2 laser produces a lot of heat damage while the fractional CO2 laser does not. The fractional CO2 laser generates pinpoint dots of laser energy in a precise, computer controlled process that leaves normal skin islands intact inside a pattern of laser treatment. This allows the skin to heal rapidly, reduce wrinkles, reduce pigmentation and tighten skin. Normal healing is 95% complete in 4-5 days.

Before Surgery

Prior to surgery, a complete medical history and examination is performed in order to evaluate the general health of the patient. Photographs are taken before and after surgery to evaluate the amount of improvement. Patients who have a history of cold sores are sometimes placed on a cold sore prevention medication such as Zovirax or Valtrex before and after the procedure. It is recommended that patients use the Obagi skin care program for at least two weeks before the procedure and following healing to promote healing and to help control pigment changes after the surgery.

The Procedure

The procedure is usually performed in Dr. Galoob's office laser treatment room. An oral sedative and local anesthetic injections may be used in some cases. If more sedation is needed or requested by the patient, IV anesthesia in the office consists of IV Sedation and local anesthetic injections. A licensed nurse is specifically assigned to constantly monitor vital signs and give medications under the Doctor's direction. Patients are kept at a twilight level of consciousness that allows them to relax and rest and the treatment to be easily performed. The face is thoroughly cleansed with an antiseptic cleansing agent. Protective contact lenses are placed against the cornea of the eye for protection against stray laser light. The lasers are then used to treat the facial and neck skin. The procedure lasts from thirty to sixty minutes, depending upon the condition of the skin and extent of the area involved.

Following Surgery

For a few days, the skin feels as though it has been severely sunburned. The raw skin weeps and crusts until healing occurs. Antibiotics and antiviral drugs are often prescribed to prevent bacterial or cold sore infection. Some swelling is to be expected 24 to 48 hours after surgery. Swelling can be reduced by keeping the head in a slightly elevated position when reclining. Medication alleviates any discomfort the patient may have. Patients may use cool soaks, a fan, or warm Epsom salt soaks to improve comfort depending on their needs.
The crust which loosens and falls off in several days begins to form a few days after fractional CO2 laser skin resurfacing. At this time, the treated area is moist and weepy. The patient is instructed to wash the crust with a mild soap and tap water and apply Vaseline or antibiotic ointment. The patient is cautioned not to pull off crusts that tightly adhere to the skin as this can result in scarring.

After the crusts fall off, the skin may have a lighter or pink appearance. This coloration normally fades in two to three weeks. During this period, special soaps and cosmetics may be recommended and men are allowed to shave with mild shaving creams. Patients are instructed to avoid medicated or scented cosmetics and hair sprays that might be harmful to the skin.

For several weeks following fractional CO2 laser skin resurfacing, pimples resembling acne may appear. These disappear in time. Direct and reflected sunlight must be avoided for several weeks, and sunscreen should always be worn when out of doors. Strenuous activities should be avoided for ten days to two weeks following surgery. The physician advises when normal activities can be resumed. The amount of improvement from laser skin resurfacing varies, depending on the initial condition of the patient and the extent of surgery. In most cases, a single procedure achieves the desired results while in some cases, additional procedures may be indicated. Most patients who have had this procedure are delighted with their more attractive, smoother appearance.

Occasionally, hyperpigmentation (darkening of skin color) may occur, but this is easily treated with bleaching creams. Hypopigmentation (lightening of skin color) is a late effect and is only treatable by lightening the surrounding skin. Using the fractional CO2 laser for skin resurfacing reduces the risk of hypopigmentation. Infection of the treated area is rare as is scarring. Additional treatments may be necessary.

If you are interested in learning more about fractional CO2 laser contact our office and we will be happy to answer your questions.

What can the Laser Skin Resurfacing do for me?

Laser Skin Resurfacing will remove or noticeably decrease wrinkles, improve skin texture and tighten skin. Occasionally, additional treatments may be recommended to further enhance your results. Although treatment results will vary depending on various considerations, with few exceptions, you can expect an improvement in the texture and quality of your skin.

How does laser skin resurfacing work?

The laser light is absorbed by the water in your skin cells. The absorption in turn causes the instantaneous vaporization or destruction of the cell. As your physician passes the laser light over your skin, a mere 30 millionths of an inch of tissue is removed at a time. This incredible control allows your physician to treat only as deeply as needed, from removing wrinkles to merely refreshing your overall skin appearance. After the damaged skin is removed, new skin quickly regrows in it's place.

Does it hurt?

The level of discomfort is different for every person and also varies by the location and area to be treated. A combination of topical and sedative anesthesia is usually given. Your physician will discuss your options with you based upon your own tolerance and the specific areas to be treated. Laser resurfacing may cause the skin to become raw, red or pink with mild to moderate discomfort for several days following the procedure. Although over the counter medication is usually sufficient, your physician may recommend alternative pain relief options to keep you comfortable.

How long will the healing process take?

Everyone will heal at various rates depending on the depth of the treatment, the particular areas treated and your own healing rate. Noticeable results are typically seen in a few days, with complete healing in only a few weeks. Light resurfacing around the eyes and lips in general takes only a few days for healing to occur. A deep full facial resurfacing may take up to 2-3 weeks before you feel aesthetically comfortable to return to your normal activities.

How do I take care of my skin?

Depending on your specific treatment, your physician will prescribe detailed skin care instructions before and after treatment. To avoid the risk of infection and to ensure a positive result, please follow these instructions carefully. Before treatment, the patient is placed on the Obagi Skin Care Program to prepare the skin and provide better healing. After you have healed, you will need to continually protect your new skin. In the early weeks and months following treatment, your skin will be very susceptible to sun damage. If at all possible, avoid prolonged exposure to the sun. If you must be in the sun for a short time, please use sunscreens recommended by your physician. Remember, one of the reasons you are probably considering laser resurfacing is because of the long-term damaging effects the sun has had on your skin.

Are there any complications with fractional CO2 laser resurfacing?

Although the fractional CO2 laser has substantially reduced many of the risks associated with laser procedures, infection, temporary or permanent pigment changes, even scarring or other unsatisfactory results can occur. As with any medical procedure, be certain to thoroughly discuss any questions or concerns you my have with your physician.

Treatment

Special precautions are taken to protect your eyes and personnel who will be in the room. Everyone wears special glasses or eye shields. (Our practice meets the standards of the AAAHC (www.aaahc.org) for laser safety). Lasers are maintained and calibrated on a regular basis and a technician is available at all times during the procedure.

The procedure will either be performed by Dr. Galoob or one of his experienced staff. Initial laser settings are verified by Dr. Galoob prior to each treatment. It is common for him to apply a test pulse to himself as a last safety check before treatment. The laser is pulsed in multiple spots over the area for complete coverage (like turning a flashlight off and on each time). Each pulse feels like being snapped with a rubber band. Cold air is applied over the skin during the treatment to provide comfort and to protect the skin from heat produced when the laser light contacts the hair root. Afterwards, the skin may be slightly red. Occasionally irritation and blistering may occur. A soothing cream will be placed on the skin after treatment. Irritation may last for several days.