IF YOU’RE CONSIDERING LASER RESURFACING …
A WORD ABOUT THE LASERLaser resurfacing is performed using a beam of laser energy which vaporizes the upper layers of damaged skin at specific and controlled levels of penetration. It’s clear that laser resurfacing may offer a number of advantages over other resurfacing methods: precision, little (if any) bleeding and less post-operative discomfort. However, laser resurfacing isn’t for everyone. In some cases, an alternative skin resurfacing treatment, such as dermabrasion or chemical peel, may still be a better choice. All resurfacing treatments work essentially the same way. First, the outer layers of damaged skin are stripped away. Then, as new cells form during the healing process, a smoother, tighter, younger-looking skin surface appears. Laser resurfacing is a new method being used by plastic surgeons to remove damaged skin. Because it is new, there are no long-term data on this technique. However, a number of studies using microscopic examination have shown that the physical changes that occur to laser-treated skin are essentially identical to those that occur with either dermabrasion or chemical peel. Ask your plastic surgeon about the latest facts concerning long-term follow-up. For superficial or medium resurfacing, the laser can be limited to the epidermis and papillary dermis. For deeper resurfacing, the upper levels of the reticulas dermis can also be removed. Varied penetration allows treatment of specific spots or wrinkles. It’s also important to consider the length of recovery when choosing among the skin-resurfacing alternatives. In general, the more aggressive the resurfacing procedure is, the more prolonged the recovery is likely to be. “Light” resurfacing procedures, such as superficial chemical peels or superficial laser resurfacing, offer shorter recovery times. However, these lighter procedures may need to be repeated multiple times to achieve results comparable to those achieved with more aggressive techniques.
THE BEST CANDIDATES FOR LASER RESURFACINGIn many cases, facial wrinkles form in localized areas, such as near the eyes or around the mouth. The laser can be precisely controlled so that only these specific areas are targeted.
ALL SURGERY CARRIES SOME UNCERTAINTY AND RISKWhen laser resurfacing is performed by a qualified, experienced surgeon, complications are infrequent and usually minor. However, because individuals vary greatly in their anatomy, their physical reactions and their healing abilities, the outcome is never completely predictable. Risks associated with laser resurfacing include: burns or other injuries from the heat of the laser energy, scarring, and obvious lightening or darkening of the treated skin. Also, laser resurfacing can activate herpes virus infections (“cold sores”) and, rarely, other types of infection. Additional corrective measures and treatment may be required if healing seems abnormal or delayed or if there is any evidence of abnormal pigmentation or scarring. You can reduce your risks by choosing a qualified plastic surgeon who has received special training in laser surgery.
PLANNING YOUR SURGERYNot every practitioner who offers laser surgery has the same level of experience and skill with laser use. That is why it is especially important that you find a plastic surgeon who is adequately trained in the procedure. One safety measure is to find out whether your surgeon has privileges to perform laser resurfacing with a CO2 laser at an accredited hospital. Even if the operation is to be conducted in your doctor’s private facility, the fact that he or she has privileges to use that same laser in a hospital ensures that the doctor has been reviewed by the institution’s experts. In your initial consultation, be frank in discussing your expectations with the surgeon and don’t hesitate to ask any questions you may have. Your surgeon should be equally frank with you, explaining the factors that could influence the procedure and the results – such as any abnormal skin condition which has been diagnosed or previously treated, medications you are taking or have taken in the past, previous skin injuries or previous operations. Your surgeon will discuss your medical history, perform a routine examination and photograph the area to be treated. He or she should explain the procedure in detail, along with its risks and benefits, the recovery period and the costs. Remember, cosmetic laser treatments can be expensive and are usually not covered by medical insurance. On rare occasions, the procedure can be used for modification of scars or the removal of pre-cancerous skin growths. These conditions could meet the criteria for “medical necessity,” usually required by insurance companies before coverage will be provided. Your plastic surgeon can advise you how to contact your insurance carrier to determine whether benefits will be allowed in such instances.
PREPARING FOR THE LASER PROCEDUREDepending on your individual needs, your surgeon may recommend that you begin a pre-treatment plan to prepare the skin for resurfacing. At the time of the procedure, you will be given specific instructions on how to care for your skin immediately following your laser treatment. Your surgeon may also instruct you to follow a specific maintenance regimen for long-term care of the skin to maximize the benefits of the procedure. While you are making plans, be sure to make arrangements for someone to drive you home if you will be given tranquilizers or sedation for your laser treatment.
WHERE YOUR LASER TREATMENT WILL BE PERFORMEDLaser resurfacing may be performed in a hospital, an outpatient surgery center or a surgeon’s office-based facility. For cost containment and convenience, laser resurfacing is usually done on an outpatient basis. For the more extensive resurfacing procedures or for resurfacing combined with other surgical procedures, you may be admitted to a hospital or a recovery center.
TYPES OF ANESTHESIALaser resurfacing is most commonly performed under local anesthesia with sedation, especially when it’s used to treat localized areas of the face. You’ll be awake but relaxed, and will feel minimal discomfort. For more extensive resurfacing, your surgeon may prefer to use general anesthesia, in which case you’ll sleep through the procedure.
Laser resurfacing is a relatively quick procedure. It usually takes anywhere from a few minutes to 1 1/2 hours, depending on how large of an area is involved. When the imperfections are especially deep, your surgeon may recommend that the resurfacing be performed in two or more stages. During the procedure, the activated laser is carefully passed back and forth over the skin until the surgeon reaches the level that will make the wrinkle or scar less visible. When the procedure is over, your surgeon may choose to treat the resurfaced skin with applications of protective creams or ointments until healing is complete. Some surgeons choose to apply a bandage over the treated areas which will cover and protect the healing skin for the first five to ten days.