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How does it work?
Carbon dioxide
lasers have been in use for many years to treat different benign and malignant
skin conditions. A new generation of carbon dioxide lasers use very short pulsed
light energy (ultrapulsed) 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. These lasers have been successfully used
to treat wrinkles and scars as well as other benign skin growths such as warts,
linear epidermal nevi (birthmarks), rhinophyma (enlarged oil glands on the
nose), and other skin conditions.
The field of carbon dioxide laser resurfacing is rapidly changing and
improving. The ability to rejuvenate sun-damaged, wrinkled skin has been
revolutionized by this new technology. Carbon dioxide laser resurfacing is yet
another tool in our treatment options, which include Retin-A products, vitamin C
lotion, alpha hydroxy acids, chemical peels, dermabrasion, collagen or fat
augmentation, and botulinum toxin for decreasing facial lines and scars.
Patients are encouraged to seek out surgeons with documented training and
experience in laser surgery.
What can be expected during and after the procedure?
In
general, carbon dioxide laser resurfacing is performed on an outpatient basis,
using local anesthesia in combination with orally- or intravenously-administered
sedative medications. Wrinkles around the eyes, mouth, or forehead may be
treated individually, or a full-face laserabrasion may be performed. The areas
to be treated are numbed with a local anesthetic. General anesthesia may be used
when the entire face is treated. A partial-face laserabrasion takes 30 to 45
minutes, and the full-face treatment takes 1Ѕ to
two hours.
Following the laser resurfacing procedure, a Telfa dressing is applied to the
treatment sites for 24 hours. The patient then cleans the treated areas two to
five times a day with 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 to 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 resurfacing. Green-based makeups are
particularly suitable for this camouflage. Oil-free makeups are recommended. The
redness in the laser-treated sites generally fades in two to three months but
may take as long as six months to disappear. The redness generally persists
longer in blondes and redheads.
Patients with darker skin tones have a greater risk of healing with darker
pigmentation (hyperpigmentation). This may be minimized by preoperative use of a
bleaching agent as well as continued use of this agent after healing.
What are the possible side effects?
- 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.
- Hyperpigmentation, and more rarely hypopigmentation, may result in the
laser-treated areas. In general, the hyperpigmented areas may be treated
with bleaching cream to facilitate fading of the pigment.
- Reactivation of a herpes simplex cold sore may occur, especially after
laser resurfacing around the mouth. This can be prevented by giving an
antiviral medicine prior to the surgery and continuing it for seven to 10
days afterward.
- Bacterial infections are also prevented by taking an antibiotic prior to
the surgery and continuing for seven to 10 days afterward.
- Postoperative swelling is to be expected and is lessened by administration
of intramuscular steroids.
- Patients are encouraged to sleep on an extra pillow at night to help
reduce the swelling. Ice pack application is also helpful in the first 24 to 48
hours.
- Scarring, although very rare, may occur in laser-treated areas.
- Cessation of smoking is highly recommended because of its documented
harmful effects on the healing process.
How is the skin cared for afterwards?
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, and 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 the procedure or as directed by their physician.
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