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Laser Skin Resurfacing
 
As we age, the effects of sun damage and environmental pollutants begin to take their toll on our skin, creating lines and wrinkles on our faces. Laser resurfacing can help minimize fine lines as they begin to occur, particularly those that form around the mouth and eyes. Laser treatments can be tailored to a variety of other skin problems as well.

Laser resurfacing is a relatively new method of improving skin texture and appearance. In many situations, it can provide the doctor with more control over the penetration of the skin than other resurfacing treatments, such as chemical peels and dermabrasion. In addition to skin resurfacing, lasers can sometimes be used to remove facial scars, acne scars, and unwanted hair.

If you're considering laser resurfacing, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a board-certified physicians with experience in laser resurfacing.
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What are some of the most common benefits of this surgery?
The laser is used to remove layers of damaged and wrinkled skin so that new, smoother, and more vibrant looking skin can form. Depending on the type of laser and amount of surface skin removed, you may also see a significant improvement in the tightness and firmness of the skin.
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What will happen at the initial consultation?

During the consultation, your doctor will advise you on the changes that you would like to make in your appearance. He/she will explain the different options available to you, the procedure itself, its risks and limitations, and costs.

Your doctor will begin with a complete medical history and will examine your face, both the skin and underlying bone. He/she may also take photos, give you specific instructions to follow, that may include instructions for pre-treating your skin before the operation.

Your doctor will determine if laser resurfacing – or another form of skin resurfacing – is right for you. This decision may depend largely on your skin type and color, since laser resurfacing can cause uneven skin tone formation on people with darker skin tones.

Be sure to tell your doctor about any allergies you have (to foods, drugs, environmental elements), if you have been exposed to significant amounts of radiation, if you have a history of unusual scarring, or if you have had cold sores around the mouth (like herpes or shingles). Also tell your doctor if you have had previous facial surgery, if you smoke, or if you take any drugs or medications, including aspirin.

Take this opportunity to ask all the questions you have about the procedure, and ask to see photos of the doctor’s recent patients, before and after the procedure. Also ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision. See Questions to ask your doctor below.
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How is laser resurfacing performed?
Brief, high intensity emissions of light from the laser remove layers of damaged or wrinkled skin at precisely controlled levels of penetration.

The surgery will follow these steps. First, the doctor, or an assistant, will cleanse your face to remove oils from the skin. Antibiotic is then applied to kill bacteria. A beam of light from a microphone-shaped instrument is passed over the skin to vaporize the outer layers of damaged skin. The laser can be can be programmed for varied levels of penetration. The doctor may choose to penetrate more deeply in some areas, in order to remove deep scars, stubborn spots, and wrinkles. As the laser works, you may hear it zapping, and smell smoke. Finally, your doctor, or a medical assistant, may apply a protective ointment or bandage to the treated area.
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Will I be awake or asleep?
To treat small areas of the skins surface, your physician will most likely use a local anesthetic with or without an oral sedative. For complete facial resurfacing, physicians most commonly use intravenous sedation or a general anesthesia with monitoring of your ECG, breathing and other vitals signs. Check with your physician to see which method applies to the procedure that you have selected.
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Which is better, the CO2 laser or the erbium laser?
The CO2 laser has been in use for several more years than the erbium laser. It seems to tighten the skin more effectively, but it also leaves the patient’s skin red for a longer time after surgery. It is also much more suited to patients with lighter skin tones. Often African-Americans, Asians and Latinos are better candidates for the erbium laser, which has a lower chance of prolonged redness and irregular pigmentation. However, the results may not last as long as results from the erbium laser. Examine this issue thoroughly with your physician to determine which laser is best for you.
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How long does the procedure take?

The amount of time that the procedure takes varies, depending on the size of the area being treated, as well as the severity of the skin condition. It can last from just a few minutes to an hour and a half. The procedure may later be repeated to achieve desired results.
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Will I need to stay in a hospital?

Laser resurfacing procedures may be performed in a hospital, an outpatient surgical facility, or physician’s office. Extensive laser resurfacing, or resurfacing performed in conjunction with another surgery, such as a facelift, is generally performed in an outpatient surgical facility or hospital.
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How much pain is there?
Even patients who remain awake during the procedure report feeling only minimal discomfort. Many doctors use a local anesthesia or a local anesthesia with a sedative. This is similar to the anesthesia used by dentists. After the surgery, the pain is mild to moderate.
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What can I expect afterward?
After the procedure, you may experience some swelling and discomfort. Cold packs are usually recommended to reduce the swelling.

If a bandage was applied after the surgery, it may be changed in a few days, but it will be completely removed after approximately one week, at which time an ointment is applied. Some physician’s use a tape that retains moisture to bandage the treated area. Because this bandage must remain dry, you will not be able to shower normally until the bandages are removed.

If the treated area is not bandaged, you will need to wash your face several times daily. You will need to use caution in caring for the treated area. After each washing, you will need to apply an ointment, such as petroleum jelly, to the treated area. Scabs may form, and last for about 10 days. You must not pick at the scabs. If you experience pain, an over-the-counter pain medication can be taken.
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What is the recovery period like?
The amount of time needed for recovery depends on the depth of the resurfacing and the individual’s capacity to heal. Redness may persist for several weeks, or longer. The redness gradually lightens to pink, and then to a lighter, more natural color.

Make-up can be applied approximately two weeks after the procedure to cover-up the redness.
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What is the long-term outcome like for most people?
Laser resurfacing generally removes most of the fine wrinkles and imperfections in the treated area, but natural facial movements and expressions eventually cause some of the lines to reappear. Like most other methods of skin resurfacing, laser treatments may be repeated to maintain the desired results.

After laser resurfacing, daily sunscreen is highly recommended to protect the sensitive new skin from sun exposure. Ask your doctor to recommend a sun block with both UVA and UVB protection, and apply it daily. If resurfacing was done around your eyes, you should use sunglasses.
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Ideal candidate:
In general, the best candidates for laser resurfacing are:
  • Physically healthy
  • Psychologically stable
  • Non-smoker
  • Wanting to look younger and more refreshed
  • Unhappy with the appearance of wrinkles or brown spots, especially around mouth or eyes
  • Free of active skin infections, including acne
  • Possessing the appropriate skin tone for the type of laser used
  • Not taking Accutane, nor having taken it in the previous 18 months
  • Without any unusual scar formations, such as keloids
  • Well informed in regard to the procedure’s outcome
  • Realistic in their expectations
  • Willing to accept the limitations involved in the healing process
The above is only a partial list of the criteria that your physician will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your physician if he/she considers you an ideal candidate for laser resurfacing.
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Other important information:
Sometimes laser resurfacing is performed in conjunction with a facelift. Loose, sagging skin can be tightened and firmed by a facelift, while the texture of the skin can be improved by laser resurfacing.

Other resurfacing options include chemical peels and dermabrasion. In general, laser resurfacing allows the doctor to more precisely control the depth of penetration than these other two methods. In addition, the controlled vaporization of the laser produces less bleeding, bruising, and post-operative discomfort. The speed of the emissions of the laser also lessens the risk of burns. However, peels and dermabrasion have advantages in certain situations.

Your doctor will consider your expectations, the size of the area to be treated, and other factors in deciding which method, or combination of methods, is best for you.
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Risks and limitations:

Though the majority of procedures are successful, you should be aware of the following risks:

Semi-permanent or permanent skin lightening may occur in the treated areas. This is unpredictable and hard to treat without permanent tattooing of the skin. The skin may also become hyperpigmented (darker) immediately following the surgery. Often this darkening treats itself, lightening on its own or responding to various skin care regimens that include hydroquinone (a bleaching crème) and alpha hydroxy (fruit) acids.

Laser skin resurfacing may not sufficiently tighten the skin, and surgical excision may be necessary to achieve the results desired. It is most often worthwhile the try to perform laser procedure first to avoid the possibility of scarring, so do not be dismayed if a secondary procedure is necessary.

Heat from the laser may cause burns or injuries. To reduce the risks involved in this procedure, carefully follow all of your surgeon’s instructions, both before and after surgery.
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Costs:
The national average of 2007 for cost of laser skin resurfacing was $2,484 (Source: American Society of Plastic Surgeons). Regional averages: New England states: $2,378 Middle Atlantic states: $2,250 North central states: $2,500 South Central states: $2,250 and Mountain/Pacific states: $2,875. These are physician fees only, and do not include related expenses.
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Choosing a doctor:
We strongly recommend that you consider choosing a doctor who is board certified by the American Board of Medical Specialties. See our Physician Locator feature to find a doctor in your area, including detailed profile information for many of the listed doctors. Also read How to Select a Dermatologist for a more detailed discussion.
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Questions to ask your doctor:

The following questions should help you to select your doctor, and better understand the procedure.
  1. Are the desired results I described realistic?
  2. How should I prepare my skin for the treatment?
  3. Where is the procedure performed? How long will the procedure take?
  4. Are there other procedures that I should consider to enhance the affects of laser resurfacing?
  5. What kind of anesthesia is used?
  6. How much does the procedure cost?
  7. What is your experience in performing this procedure? (How long has he/she performed this procedure, and how many he/she has performed in the past year?)
  8. What percentage of patients have had significant complications? (The physician should disclose this information to you.)
  9. Will you repeat or correct procedures if it does not meet agreed upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
  10. May I see "before and after" photos of recent patients? The physician should provide many photos of recent patients.
  11. May I have the names and contact information for several recent laser resurfacing patients? (Follow up to get first-hand information on the procedure and the physician.)
  12. Could I observe the exact procedure I am considering before I decide to have the procedure? (Either on videotape or ask to view one in real life.)
  13. What should I expect post-operatively, in terms of soreness, what to watch for, medication, bathing, and level of activity? Ask if your doctor has a list of activities that you should avoid.
  14. Who will be assisting during the procedure? What are their qualifications? (Does the dermatologist perform the entire procedure?)
  15. Have you ever had your malpractice insurance coverage denied, revoked, suspended?
  16. Do you have privileges to perform laser resurfacing with a CO2 laser at an accredited hospital?
  17. Do you offer patient financing?
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Be sure to:
  • Tell your doctor about any allergies you have (to foods, drugs, environmental elements).
  • Tell your doctor about all medications, herbal supplements or natural supplements that you are taking (both prescription and non-prescription), including such natural remedies as Echinacea and St. John’s Wort.
  • Be sure to tell your doctor if you smoke. Smoking can lead to complications and poor healing.
  • Tell your doctor if you have been exposed to significant amounts of radiation, have a history of unusual or poor scarring, or cold sores– like herpes or shingles.
  • Let your doctor know if you have taken Acutane any time during the year and half before the surgery. This medication can affect your skin’s ability to heal after laser resurfacing.
  • Tell your doctor if you have any serious medical conditions
  • Carefully follow any instructions your doctor gives you regarding eating and drinking, smoking, and vitamins.
  • Avoid aspirin and all medicines that contain aspirin for two weeks prior to the procedure.
  • Tell your doctor if you have had previous facial surgery.
  • Arrange for someone to drive you home after the procedure.
The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.
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Related Articles
Please review the following articles for more information on this procedure.
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How do I finance this procedure?
Did you know that 29% of all Americans have considered having an elective procedure? Of those, 60% would schedule a procedure immediately if financing was available. With iEnchance's patient financing options, money no longer has to be the barrier between you and your new image. By filling out our on-line application you can qualify for a loan in as little as 30 seconds.
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At iEnhance, find information on top plastic surgery procedures such as breast augmentation, liposuction, facelift, tummy tuck, BOTOX ® Cosmetic, eyelid surgery, thermage, rhinoplasty; as well as teeth whitening, porcelain veneers, and other cosmetic dentistry procedures. Locate a plastic surgeon, cosmetic surgeon, cosmetic dentist, or specialist today!
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Articles:
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Facts:

*Top 5 Surgical Cosmetic Procedures in 2008:

1. Breast Augmentation: 356,000
2. Liposuction: 341,000
3. Blepharoplasty: 195,000
4. Rhinoplasty: 152,000
5. Abdominoplasty: 147,000

*Top 5 Non-Surgical Cosmetic Procedures in 2008:

1. Botox: 2,464,000
2. Laser Hair Removal: 1,281,000
3. Juvederm/Restylane: 1,263,000
4. Chemical Peel: 592,000
5. Laser Skin Resurfacing: 571,000

* Data collected from the American Society of Plastic Surgeons (ASPS)
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