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Laser Skin Resurfacing
Overview
Laser skin
resurfacing uses a CO2 laser to selectively destroy the epidermis
and the superficial part of the dermis that makes up skin. This forces the dermis to make new collagen. The new collagen
that is formed is thicker, better vascularized, and is more
like collagen of youthful skin. It also dramatically tightens
the collagen which subsequently dramatically helps improve
wrinkles. This effectively rejuvenates the skin.
Because the dermis within the skin is
better vascularized, thicker, and has been tightened, the
skin has more of a youthful glow. Wrinkles and skin discolorations
are dramatically improved and sometimes removed altogether. Age spots can be eliminated or markedly improved.
Dr. Cruise has extensively studied the
process of facial aging. It involves all the layers of the
face. Laser skin resurfacing does a remarkable job of rejuvenating
the top layer otherwise known as the skin. It is able to
dramatically improve the fine wrinkles and excess skin around
the eyes. It does not do as well with the deeper wrinkles
but it will improve them. It does very little to improve
jowling or sagging of the face. This requires a face
lift.
There are several lasers available and
each has its own strengths and weaknesses. We will limit
this discussion to the CO2 laser which is the laser most widely
used for skin rejuvenation. Other lasers, while they have
their merit with skin rejuvenation, are more widely used in
other areas such as tattoo
removal.
 Dr. Cruise's philosophy regarding Laser Skin Resurfacing
 Laser skin resurfacing has gone through a cycle of popularity. It first came into the plastic surgery limelight in the 1980s. In the 1990s its popularity grew. In the 2000’s its role in the plastic surgeons armamentarium has become more clearly defined as we have discovered what it can and cannot do. Its popularity grew in the 1990s because it is very effective at tightening skin as well as rejuvenation. But it can cause redness for a long period of time. Other modalities, such as chemical peeling can produce equally effective results depending on the area. This is the art of plastic surgery; to determine what modalities are most effective at treating each individual problem.
I find laser skin resurfacing most effective around the eyes. This is an area where fine wrinkles are common. The CO2 laser has a tendency to lighten skin a little bit. This is often very useful for people with dark circles underneath their eyes. Also, there is often an excess of skin around the eyes which the laser does a wonderful job of tightening. Other areas of the face are also benefited from the CO2 laser but a chemical peel is often better and causes less prolonged redness and lightening of the skin.
When you come in for consultation, I will take digital photographs of your face in five different directions. Together we will look at the photographs as well as evaluate your face to decide what option is best for you.
Benefits
The CO2 laser when used correctly has
the ability to address many of the aging problems seen on
the skin. Most dramatically, compared to any other procedure,
the laser has the ability to tighten skin in addition to its
other qualities. Here is a list of some of its benefits.
- Has the ability to contract skin resulting
in tightening.
- Effectively treats fine wrinkles.
- Can help with treating deeper wrinkles.
- Improves dermis blood supply resulting
in a healthy glow appearance.
- Increases thickness of dermis which
has thinned out due to aging.
- Removes skin discoloration and age
spots.
- Creates a rejuvenated, youthful look.
Possible complications
Complications with the CO2 laser in Dr. Cruise's hands are rare but must be discussed. Possible complications include lightening of skin, hyper- or hypo pigmentation, scarring, prolonged redness, reactivation of herpes if you have had it in the past, and infection or wound healing problems.
Are
you a good candidate?
The best indication for using a CO2 laser
is to help remove the fine wrinkles around the eyes and face. It also does a good job in decreasing the dark circles underneath
the eyes. Other indications for having laser skin resurfacing
include
- Fine wrinkles around the eyes and
face.
- Dark pigmentation underneath the eyes.
- Stretched, lax skin.
- Skin discoloration and age spots.
People who are not good candidates are
those with very dark skin. These people have a higher risk
of skin discoloration and hyper pigmentation from laser skin
resurfacing. These persons may be better served with chemical
peeling which has less risk of causing this problem. Other people who are not good candidates are those who expect
laser skin resurfacing to do things that it is not capable
of doing. For example, the laser will not address the deeper
tissues of the face that result in facial sagging. Nor does
it help much with deep wrinkles, although it does improve
them. To decide what is best for you a consultation with
Dr. Cruise is necessary.
People who have been on the drug Accutane within the last 2 years should not have laser skin resurfacing
as it adversely affects skin healing capabilities and may
result in scarring.
Prior to surgery
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Medications. Certain medications thin blood and should not be taken
within 3 weeks of surgery. The most notable is aspirin
and aspirin containing products. Vitamin E and many herbal
products also thin the blood and should discontinued. Dr. Cruise will go over this more thoroughly prior to
the procedure.
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Sleep. It
is important to get a good night's rest prior to the procedure. If you think this may be a problem, please, do not hesitate
to ask your doctor for something to help you sleep.
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Smoking. You
must not smoke within 3 weeks before and after surgery. Smoking has a profound effect on reducing wound healing
capabilities. It significantly increases the likelihood
of infection, wound healing problems, and scar formation. It also affects your airway, what makes anesthesia much
more difficult.
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Eating. If you
are having general anesthesia do not eat within 8 hours
of surgery and do not drink within 6 hours of surgery. It is OK to take medications with a sip of water. Please
discuss all medications with Dr. Cruise and the anesthesiologist. If you are having laser skin resurfacing done under local
anesthesia it is best not to eat within 2 hours prior
to having the procedure.
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Washing. It is
a good idea to wash the surgical area thoroughly the night
before and the morning of surgery. Do not forget to wash
inside your ears just like your mother told you. Please
wash your hair the morning of surgery and comb it straight
back and hold in place. Do not apply any make up.
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Arrival. It
is important to arrive on time so everything goes as planned. Please be sure to have someone else drive you.
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State of mind. Remember, this should
be a happy and exciting time. A certain amount of nervousness
is normal but you should not be overly concerned. Our
specialists are professional, well trained and experienced. Excessive worrying can actually be detrimental and you
should discuss this with your doctor prior to surgery
so that something can be prescribed to make sure you remain
calm.
Anesthesia
ICRS uses only
board certified anesthesiologists to make sure you have the
best anesthesia possible. The anesthesiologist will discuss
with you what type of anesthesia is best for you. He/she will
take into consideration your medical history, the procedure,
and your personal wishes.
General anesthesia is necessary if the
entire face is being lasered. Local anesthesia is possible
if just the area around the eyes is being treated.
After
the procedure
The procedure itself will take about
1 to 2 hours.
Immediately. Immediately after the laser skin resurfacing Dr. Cruise will
apply ointment to your face. The local anesthesia, if used,
will still be effective and you will not have much pain. Dr. Cruise is a strong advocate of good pain relief so you
will be given as much pain medication as necessary both immediately
after the operation and for the next 4 to 5 days. Of course,
there will be swelling and bruising but there is surprisingly
little pain. You must lay with your head up for the first
week so that your face does not swell.
That evening. It is recommended that you take it easy. You can walk around,
eat, but not too much more. You must sit and lay with your
head up on at least 3 pillows. You should take as much pain
medication as necessary and try to go to sleep early. Apply
ice packs every 2 hours for the first 24 hours and reapply
the ointment as necessary. You will be given medication to
help keep the swelling down as well as to prevent infection. Your face will ooze somewhat.
First
48 hours. The next day you should take a shower and
let the cold water gently trickle over your face. This is
all that is necessary to clean it. Do not use hot water as
this will make the swelling worse. When you are done reapply
the ointment and keep your head elevated at all times. You
will look worse than you feel but the swelling will go down
markedly within a couple days.
First
week. After about 7 to 10 days your skin will heal. It should be completely healed by 14 days. It will be quite
pink for an additional two weeks and somewhat pink for probably
another 2 months. As soon as healing is complete you will
notice a marked improvement of your skin quality as well as
a marked tightening. Final improvement will not be seen until
about 6 months.
Recovery
time
The swelling will resolve in about 1
week. Some minor swelling will persist for as long as 3 months. As far as how you feel, you could return to work as early
as 3 or 4 days. But because your appearance may not be suitable,
it is more likely that it will take 2 weeks before returning
to work.
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