LASERS

What are Lasers?

The laser is a space-age technology that has finally made its way to the plastic surgeon's office. Widespread interest in getting rid of wrinkles by use of laser treatment has resulted in thousands of laser procedures scheduled every year across the United States and worldwide. Simply put, laser surgery has taken off like wildfire!

This procedure was initially presented by Coherent Laser Corporation at a March 1995 conference of the Aesthetic Society of Plastic and Reconstructive Surgeons in San Francisco. At that time, very few people were using lasers. Since then, however, more and more plastic surgeons, dermatologists, and general surgeons have begun to use the Ultra Pulse CO2 laser and now have begun to use another laser called the erbium laser.

The main benefit of these lasers is to help obliterate fine wrinkling of the face; specifically, the areas around the eyes and the lips as well as some of the deeper wrinkles of the forehead and areas of the cheek. In addition, lasers can help tighten the entire skin in an almost lifting procedure to help the jowl region. It is currently now being used to laser-resurface the area of the neck and chest in some centres.

What can lasers treat?

Lasers can treat the following:

·               fine wrinkles around the mouth and around the eyes and cheeks

·               tattoos

·               spider veins on the legs, face, nose, cheeks

·               some stretch marks on the legs

·               age spots

·               birthmarks

Lasers work the best around the eyes and around the mouth. The "lipstick bleed" is, for the most part, eliminated with the laser. Fine wrinkling and "crepe paper" skin around and below the eyes can also be eliminated nicely with the Ultra Pulse CO2 laser.

When considering laser surgery, make sure you consult with a board-certified plastic surgeon or a board-certified dermatologist who has knowledge of lasers and how they work. Not every plastic surgeon uses lasers.

Laser Resurfacing

Laser resurfacing is a relatively new treatment for reducing facial wrinkles and skin irregularities, such as blemishes or acne scars.

The technique directs short, concentrated pulsating beams of light at irregular skin. Laser skin resurfacing removes skin very precisely, layer by layer. This popular procedure is known by several other names, including lasabrasion, laser peel or laser vaporization.

Who Is a Good Candidate For Laser Resurfacing?

If you have fine lines or wrinkles around the eyes, mouth or on the forehead, scars from acne, or non-responsive skin after a facelift, then you may be a good candidate for laser skin resurfacing.

If you have active acne or if you have very dark skin, you may not be a candidate. This technique is also not recommended for stretch marks.

How Does Laser Skin Resurfacing Work?

The two types of lasers most commonly used in laser resurfacing are carbon dioxide (CO2) and erbium. Each laser vaporizes superficial, damaged skin cells and both reduce the risk for the patient because they limit the amount of heat absorbed by the skin.

CO2 Laser Resurfacing

This method has been used for years to treat different skin conditions including wrinkles, scars, warts, birthmarks, enlarged oil glands on the nose (rhinophyma), skin cancer and other conditions.

The newest version of the CO2 laser resurfacing uses very short pulsed light energy (ultra pulsed) or continuous light beams that are delivered in a scanning pattern to very precisely remove thin layers of skin with minimal heat damage to the surrounding structures. Recovery time from the procedure is up to two weeks.

Patients should seek out surgeons with documented training and experience in laser skin resurfacing.

Erbium Laser Resurfacing

Erbium laser resurfacing is designed to remove superficial and moderately deep lines and wrinkles on the face hands, neck, or chest. One of the benefits of erbium laser resurfacing is minimal burning of surrounding tissue. This laser causes minimal side effects, such as swelling, bruising and redness, so your recovery time should be more rapid than with CO2 laser resurfacing - one week in most cases.

If you have a darker skin tone, erbium laser resurfacing may work better for you. Your doctor will determine which laser is best for you after he or she fully evaluates your medical history, current physical condition, and desired results.

What Can Be Expected During Laser Resurfacing?

Both erbium and CO2 laser resurfacing are performed on an outpatient basis, using local anaesthesia (pain relief at the site of the procedure) in combination with orally- or intravenously-administered sedative medications.

Wrinkles around the eyes, mouth or forehead may be treated individually, or a full-face laser abrasion may be performed.

A partial-face lasabrasion takes 30-45 minutes and the full-face treatment takes 1-1/2 to 2 hours.

What Happens After Laser Resurfacing?

Following laser resurfacing, a sterile dressing is applied to the treatment sites and the dressings are removed usually after 1 to 3 days. The patient then cleans the treated areas two to five times a day with cool tap water saline or a dilute vinegar solution. An ointment such as Vaseline, Eucerin or Aquaphor is then applied. This wound care is intended to prevent any scab formation. In general, the areas heal in 10-21 days, depending on the nature of the condition that was treated.

Once the areas have healed, makeup may be worn to camouflage the pink to red color that is generally seen after laser skin resurfacing. Green-based make-ups are particularly suitable for this camouflage since they neutralize the red colour. Oil-free make-ups are recommended after laser resurfacing. The redness in the laser-treated sites generally fades in two to three months but may take as long as six months to completely disappear. The redness generally persists longer in blondes and redheads.

Patients with darker skin tones have a greater risk of healing with darker pigmentation. This may be minimized by use of a bleaching agent before laser skin resurfacing as well as continued use of this agent after healing.

What Are the Possible Complications of Laser Resurfacing?

·               Milia, which are small white bumps, may appear in the laser-treated areas during    healing. These may be removed by gentle cleansing with a washcloth.

·               Hyper pigmentation (increased pigmentation), and hypo pigmentation (decreased skin pigmentation), may result in the laser-treated areas. In general, the hyper pigmented areas may be treated with bleaching cream to speed fading of the pigment.

·               Reappearance of a cold sore may occur, especially after laser skin resurfacing around the mouth. You can prevent this by asking your doctor for an antiviral medication, which you can begin taking before your surgery and continue taking seven to 10 days after laser resurfacing.

·               You can also prevent bacterial infections by taking an antibiotic prior to the surgery and continuing for seven to 10 days afterwards.

·               You should expect swelling after laser skin resurfacing. Ask your doctor about what you can do to lessen this effect.

·               Patients are encouraged to sleep on an extra pillow at night to help reduce the swelling after laser resurfacing. Ice pack application is also helpful in the first 24-48 hours.

·               Scarring after laser skin resurfacing, although unusual, may occur in laser-treated areas.

·               Cessation of smoking is highly recommended because smoking is known to have harmful effects on the healing process.

How Should I Take Care of My Skin After Laser Resurfacing?

It's important to remember that skin treated with laser resurfacing may react in different ways.

Most commonly, you may feel like you have moderate sunburn. There will be swelling and redness of the skin. You may experience itching or stinging for 12 to 72 hours after the procedure. Five to seven days after laser resurfacing, your skin will become dry and peel.

New skin will form after the treated area has been peeled. This skin will at first appear pink. It should begin to gradually lighten for up to a year after treatment. Your doctor will not consider retreating the area until the area is completely healed.

Daily sunscreen application is necessary after healing to protect the newly laser-resurfaced skin. A "broad-spectrum" sunscreen, which screens both ultraviolet B and ultraviolet A rays, is recommended. A sunscreen specifically formulated for use on the face should be chosen, with at least a sun protection factor (SPF) of 15.

Liberal moisturizer application is also recommended after healing. Patients may resume application of Retin-A and/or glycolic acid products around six weeks after laser resurfacing or as directed by their physician.