Laser Resurfacing

In laser resurfacing, sometimes called "laser peel," a Sciton Erbium laser is used to remove areas of damaged or wrinkled skin, layer by layer. The procedure is most commonly used to minimize the appearance of fine lines, especially around the mouth and the eyes. However, it is also effective in treating facial scars or areas of uneven pigmentation. Laser resurfacing may be performed on the whole face or in specific regions. Often, the procedure is done in conjunction with another cosmetic operation, such as a facelift or eyelid surgery.

Laser resurfacing is a very invasive procedure. However, it has been shown that in some cases, this surgical method produces less bleeding, bruising and post-operative discomfort than is typically seen with other resurfacing methods.

This page will give you a basic understanding of the laser resurfacing procedure - when it can help, how it's performed and what results you can expect. It cannot, however, provide all the details which may be relevant to your particular needs.

Please ask your plastic surgeon if there is anything about the procedure you don't understand.

Laser resurfacing is performed using a beam of laser energy which vaporizes the upper layers of damaged skin at specific and controlled levels of penetration. An accumulated amount of heat energy from the laser also acts on the collagen in the skin to cause varying amounts of contracture or skin tightening.

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.

For superficial or medium resurfacing, the laser can be limited to the epidermis and papillary dermis. For deeper resurfacing, the upper levels of the reticular 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.

In 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.

Men and women of all ages can benefit from laser resurfacing. The ideal patient for laser resurfacing has fair, healthy, non-oily skin.

When healing is complete, the face has a more youthful appearance.

Patients with olive skin, brown skin or black skin may be at increased risk for pigmentation changes no matter what type of resurfacing method is recommended. Your plastic surgeon at APSA will evaluate your skin characteristics and make recommendation accordingly.

Also, individuals who have taken the acne drug called Roaccutane in the past 12-18 months or are prone to abnormal (keloid-like) scarring or those with active skin infections on the treatment area may not be appropriate candidates for this procedure.

Remember, having laser resurfacing can help enhance your appearance and your self-confidence, but it won't completely remove all facial flaws or prevent you from aging. Lines that occur as a result of natural movements of the face - smiling, squinting, blinking, talking, and chewing - will inevitably recur. Your plastic surgeon can suggest ways to help you preserve your results by protecting yourself from sun exposure or using maintenance treatments, such as light chemical peels or medicated facial creams. Before you decide to have laser resurfacing, think carefully about your expectations and discuss them with your surgeon.

All surgery carries some uncertainty and risk. When 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. The most common risk associated with laser resurfacing is prolonged redness which in extreme cases can take many months to fade. Inevitably the new skin is paler than the non lasered skin and care needs to be taken to minimize lines of demarcation.

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.

Not every practitioner who offers laser surgery has the same level of experience and skill with laser use. You can reduce your risks by choosing a qualified APSA plastic surgeon: all of whom have received special training in laser surgery.

One safety measure is to find out whether your surgeon has clinical privileges to perform laser resurfacing 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 the HIC before a medical rebate can be paid. Your APSA plastic surgeon will inform you if you meet these criteria.

Depending 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 maximise the benefits of the procedure.

While you are making plans, be sure to make arrangements for someone to drive you home after your laser treatment and as you may not wish to venture out after the procedure make sure you either have a helper or stock up well before hand.

Laser resurfacing may be performed in a hospital, an outpatient surgery centre or a surgeon's office-based facility For the more extensive resurfacing procedures or for resurfacing combined with other surgical procedures, you may be admitted to a hospital or Day Surgical Centre. Surgeons at APSA use Adelaide Day Surgery on North Terrace.

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. This will also determine if the procedure is performed unde local anaesthetic or a full general anaesthetic.

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.

After your treatment you are likely to experience some mild swelling and discomfort. However, this can be controlled with cold packs and medications prescribed by your surgeon.

Your surgeon will provide instructions on how to gently wash and care for your healing skin. APSA has a team of well trained and experienced nursing staff who will help you in the immediate post operative period when you are asking yourself "why did I do this?"

During this phase of healing, it is very important that you not pick the crusts off the treated area or scarring may result. Most patients are free of crusts by about 10 days post-operatively. Redness may persist for several weeks.

Your new skin will usually remain bright pink to red in the weeks following the procedure. Your surgeon may prescribe medications to make this colour subside more rapidly. After about two weeks or so, most patients can safely apply makeup to conceal this temporary colour change. However, some pinkness may remain for up to six or more months.

Some patients may find that their healing skin is unusually sensitive to the makeup that was regularly used prior to treatment. In such instances, makeup should be avoided until a substitute can be found or until the healing progresses to a point at which the makeup no longer causes a reaction.

Above all, in the months following treatment, it's important to protect the treated area from the sun until all the colour has returned to normal. Using sun protection regularly will help to maintain your results and reduce the chance of any new sun damage to your skin.

If you must be in the sun, apply a strong sun block with an SPF of 15 or higher and shade your face with a hat or visor. If resurfacing was performed around the eyes, it's best to also wear good quality sunglasses with UVA and UVB filters.

The final result from laser resurfacing may take several months to fully appear. However, once the pinkness fades, patients usually notice a significant improvement in the quality of their skin and a fresher, smoother appearance.

It's important to understand that your results will be long-lasting, but not permanent. Remember, your new skin is not immune to the effects of aging. In the months and years following your laser treatment, your natural facial movements will eventually cause any "expression" lines to recur.

As with other methods of skin rejuvenation, laser treatments can usually be repeated. However, by protecting yourself from the sun and following a skin-care regimen recommended by your plastic surgeon, you can help maintain your rejuvenated look.

Other Laser Treatments include