For skin complexions with extensive photodamage where maximal correction is desired, resurfacing lasers can provide dramatic improvement of fine lines and wrinkles. These laser resurfacing or laser peels in our office are performed with the erbium and/or CO2 laser. Resurfacing can be performed as an isolated procedure or in conjunction with other facial surgery.
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Laser resurfacing vaporizes the upper layers of the skin with each pass increasing the depth of the resurfacing dependent upon the level of correction necessary. Laser resurfacing may, under some circumstances, be performed in multiple stages, for maximal correction, to minimize side effects associated with aggressive resurfacings. These procedures are performed under anesthesia, either with intravenous sedation or general anesthesia. The resurfacing may take from 15 minutes, for areas around the mouth, to 45 minutes for full facial resurfacing. The depth of treatment and the level of aggressiveness desired are dictated by the amount of correction to be performed. Lighter resurfacing is used for fine lines and color improvement, and deeper resurfacing is used for coarse wrinkles and advanced sun damage. Immediately after resurfacing, a medical grade silicone mask and topical anti-inflammatory gels are applied, until the new skin is formed.
Resurfacing with new healthy skin takes from 4 to 8 days, with strict instructions provided for immediate post laser care. Immediate showering is advised, and cool packs to the face and soothing gels are used judiciously. Follow up care is closely monitored for healing and is done weekly until the new skin is completely formed and mature. Strict sun avoidance is essential, and redness in the treated areas may persist for several weeks. The length of redness is directly related to the depth of treatment. Make-up can be used and is encouraged to soften the early inflammation, and sunscreen is essential to protect ones new complexion.
The latest technology for managing photoaging (the cumulative damage to the skin from ultraviolet absorption) is fractional resurfacing. A departure from traditional resurfacing, this technology is considered non-ablative, since it does not physically remove skin elements. This significantly increases the scope of treatment areas, to include face, neck, chest, arms and hands, not previously available with traditional resurfacing technology. The first generation fractional devices were an erbium-based platform, i.e. Fraxel. In our practice, we use the second-generation technology, or a CO2-based platform. The fractional C02 devices provide the advantage of more intrinsic tightening of the skin and promotes more native collagen production for fine line, and wrinkle improvement.
Fractional resurfacing patients present to the practice 1 hour prior to the procedure for topical anesthesia application. The procedure is performed without the need for sedation and takes approximately 15 minutes for the entire face. Two areas, at any given time, are done during one laser session to limit local anesthesia absorption. Specially compounded creams are used for days 1 through 4, to improve post procedure comfort, decreased swelling and limit redness. These are followed by peptide-infused moisturizing creams provided for days 5 through 9, at which time the native complexion is typically restored. Showering is allowed immediately. Make-up is allowed on or around days 6 through 7. Strict sun avoidance and sunscreen use are essential to prevent any increase in post procedure pigmentation.
This technology is superb for the improvement in uniformity of facial color, management of fine to medium wrinkle lines and may be repeated indefinitely, until desired results are achieved, all the while maintaining a normal complexion without the stigma of previous laser procedures.