LASER RESURFACING

The peeling lasers

This information will help you in making an informed decision to undergo Laser resurfacing.  Should there be anything that you do not understand, please return for a further consultation any time.

What is Laser resurfacing?
Resurfacing lasers work by peeling the skin in a very accurate and controlled manner. The process is called vaporisation because the targeted skin is removed by turning into a vapour. The process removes the superficial layers of skin without damaging the surrounding or underlying skin. Healing occurs quickly, within a few days. These lasers are computer controlled and extremely accurate. Depending on the depth of the wrinkles or scars, varying numbers of passes are made to achieve the best cosmetic result. Once the damaged skin is removed, new skin will regenerate. Laser resurfacing also stimulates new collagen production in the deeper layers of the skin giving the skin greater strength and elasticity.

Why do people have Laser resurfacing?
Patients request these procedures to improve their appearance and to reduce the effects of aging and sun exposure. Wrinkles, age spots and loose skin will all be improved by laser resurfacing. Acne scarring is also responsive to this type of treatment.

What is the difference between Laser resurfacing and other types of peeling? Peeling of the skin of the face is a well established way of improving the appearance and reducing the effects of aging and sun damage. Peeling can be achieved by creams, chemical peels and dermabrasion, however, the most powerful method is laser resurfacing. Laser resurfacing of the face will achieve in a few days what other methods will take months and years to achieve. Recent advances in technology have made resurfacing lasers safer by pulsing the high energy laser beam so that the skin has a chance to cool down between pulses and unwanted damage is extremely rare. Which Lasers are used for Laser Resurfacing? In our practice we use the Derma K laser system which combines Erbium and C02 lasers.  Being able to mix these two powerful lasers enables ideal results to be achieved for different skin types and skin conditions. What is Conscious Sedation? Conscious sedation is the administration of drugs to dull the senses and alleviate pain. The patient at all times remains awake and in control of all vital functions such as breathing, swallowing, urine and bowel function.  The sedation is not sufficient to put the patient completely to sleep.  This is not a general anaesthetic. How much peeling can be done with laser resurfacing? Only the superficial layers of the skin can be peeled. Resurfacing the skin too deeply increases the risk of complications such as scarring. There are limits to what can be achieved in any one laser resurfacing session. It is better to partially treat some of the very deep wrinkles. Laser resurfacing can be performed again to the same area of the face after the skin has healed adequately.

What are the risks of Laser resurfacing?

1. Inadequate result – Even if you are a good candidate for laser resurfacing, no guarantee can be given that you will benefit from the treatment or that you will achieve a particular result.
2. Prolonged skin redness – The laser treated areas will appear bright red initially.  After the first week, the redness can be camouflaged with opaque makeup.  The redness fades to pink over the next several weeks and then to normal skin colour in an average of three months.
3. Skin darkening (Hyperpigmentation) – This can occur in the treated area and will eventually fade within two to six months. This reaction is more common in patients with dark or olive complexion and can worsen if the laser–treated area is exposed to the sun.
4. Skin lightening (Hypopigmentation) – This can occur in any treatment area which has already received prior treatment or it can be a delayed response to the laser treatment. The light spots can darken or re-pigment in several months, however, the condition can be permanent. This is a very rare complication.
5. Scarring – The risk of scarring is minimal, however, it can potentially occur. Strict adherence to all post-operative instructions will reduce the risk.
6. Infection – This can happen in the post-operative period. The risk is minimized by the use of antibiotics and good skin care.
7. Allergic reaction – Allergies are very rare but can be caused by the local anaesthetic used, topical creams and oral medications. During the first two weeks following laser resurfacing the healing skin is gentle and more easily irritated by skin applications. Use only mild, neutral skin applications in the post-operative period.
8. ACNE or Milia formation – Flare-up of ACNE or formation of milia (tiny white bumps) can occur in the post-operative period. This will recover, in due course. There is no way of predicting these complications.
9. Herpes Simplex or cold-sore formation – Laser resurfacing can activate herpes anywhere on the face and in particular around the mouth. If you are prone to herpes, you will be given anti-viral drugs at the time of operation.
10. Ectropion – In rare circumstances, when laser resurfacing is performed on the eye-lids, the skin of the eye-lids may become tight and the patient may experience difficulty with closing the eyes.  If the condition is persistent, it will require surgical correction.

What are the side effects of Laser resurfacing?

1. Pain – The sharp, burning sensation of the laser pulses may produce a moderate to severe amount of pain. Anaesthetic injections and intravenous sedation will be used to block the pain.  Oral pain medication will be prescribed during the post-operative period.
2. Swelling and oozing – This is a normal part of the recovery from laser resurfacing. Areas most likely to swell are around the eyes and neck. A clear fluid (serum) will ooze from the treated areas and may create a crust (scab) if the areas are not kept moist. The swelling, crusting and oozing stage will subside within five to seven days with regular application of ice and prescribed healing ointments.

What can I do to improve my Laser resurfacing result? Have a Botox treatment at least two weeks before your laser resurfacing treatment. Botox will relax the muscles of the upper face and promote better healing of the skin and a smoother result. For two weeks before and after the operation: No smoking No Vitamin E containing preparations No Non-Steroidal Anti-inflammatory drugs – i.e. Aspirin, Nurofen, (if in doubt, contact the operating doctor) No Period remedies – i.e. Naprogesic and Ponstan No Oil of Evening Primrose Take Vitamin B and C daily – to improve healing

For two days before and after the operation:

1. No Alcohol
2. No Garlic

After the operation:

1. Take Paracaetamol tablets to control pain – i.e. Panadol, Panadeine or Tylanol
2. Take the Antibiotic  prescribed to prevent infection – i.e. Keflex, Ceclor or other
3. Take anti-viral drugs if prescribed – i.e. Valtrex
4. Keep active but do not exercise, remember that you have healing skin on your face.

How is Laser resurfacing performed?

1. The operating doctor and a nurse will be present in the operating room. 
2. Clinical photographs are taken to allow comparisons before and after the procedure. 
3. You will be given an injection of a strong painkiller. You may feel sleepy but you will not fall asleep. You will remain in control. This is called Conscious Sedation.
4. Various monitors will be attached to you to assist the operating doctor and the nurse in monitoring your medical condition. 
5. When you are relaxed, the operating doctor will inject local anaesthetic solution into the areas to be treated.
6. If the skin around the eyes is to be treated, metal shields will be inserted in front of each eye.
7. Laser resurfacing will be performed with a range of specifically designed, precision laser instruments.
8. By the time the effects of the conscious sedation wears off, the Laser resurfacing will be almost over.
9. On completion of the operation, the patient is fitted with a dressing to cover the resurfaced areas. 
10. The patient is then dressed and discharged from the operating room into the care of a responsible adult.
11. It is illegal for patients to attempt to drive home after Laser resurfacing due to the drugs that have been administered during the operation.

How long will my Laser resurfacing take?
The operation will take between one and three hours, depending on the extent and complexity of the operation. 

What can I expect after the operation?
A dressing will be applied to the skin after the procedure. This aids the healing process and also reduces discomfort. The dressing is changed the next day. The second dressing is left in place until healing occurs. As new skin is developing the dressing will gradually loosen and fall off, revealing new fresh skin. Once the dressing is off, you will use skin care products as instructed.  The healing process is usually complete by day 10 after which time make-up can be applied to cover post operative redness. This should enable a return to work at two weeks. No dressings are required for lighter erbium laser peels.

When will I see the result of my Laser resurfacing?
Healing time depends on the depth of wrinkling and therefore the depth of resurfacing required to remove these wrinkles. The deeper the resurfacing, the longer it takes to heal and the longer the pinkness persists post operatively. In general terms, following C02 resurfacing healing normally takes 10-14 days, while Erbium laser treatments usually heal in 7-10 days. Light Erbium laser peels heal in 5-7 days.

How much improvement can be expected with Laser Resurfacing?
It is possible to obtain a 70-90% improvement in wrinkles caused by sun damage. This percentage improvement is lower in areas where the wrinkles are related to facial movement eg, crow's feet, frown lines between the eyebrows, horizontal surprise -lines on the forehead. Constant muscle action in these areas will cause these wrinkles to recur. Botox treatment to these areas is recommended to prevent the wrinkles from returning. The improvement in the skin should be maintained for many years if the skin is looked after. Exposure to the sun or heavy smoking will cause new wrinkles to appear.

Is my Laser resurfacing result guaranteed?
Unfortunately it is impossible to guarantee the result with Laser resurfacing.  There are many factors that contribute towards the final Laser resurfacing result. 

What is the cost of Laser resurfacing?
The range for most patients will be from $3000 to $5000.  The full and final cost of the operation will be determined by the operating doctor after examination of the patient.

The final analysis
Laser resurfacing is an extremely safe procedure that can be performed on a “walk-in walk-out “ basis with a minimum of fuss.  The procedure delivers excellent results for the majority of patients.  Should you have any further questions or require any further clarifications, please make an appointment.

What are the alternatives to Laser resurfacing?
If you are presently unable to take one to two weeks off work to recover from laser resurfacing, there are other alternatives for the treatment of your wrinkles . 
Botox can be used to relax the muscles of expression.
Fillers such as Collagen , Restylane and Aquamid can be used to reduce the appearance of wrinkles.
Laser rejuvenation treatments can be used to stimulate the skin of the face, reduce capillaries, redness and pigmentation.
All these treatments result in no down-time, no time off work and almost immediate results.

LASER RESURFACING
POST-TREATMENT INSTRUCTIONS

Following your laser resurfacing treatment, you will go through a few days of discomfort because the skin on your face has been peeled off and has to grow back. Most patients describe the experience as similar to receiving a major sun burn to the face. The aim of these post-operative instructions is to reduce your discomfort and promote the best and most rapid healing.

What to procure You will need the following: A pair of clean, soft cotton gloves – you will wear the gloves at night to prevent you from accidentally scratching the treated areas. A hand-activated mist spray bottle and a supply of sterile saline – you will spray the saline mist on your face to keep the treated area moist, reduce crusting (scabbing) and keep yourself comfortable A supply of clean petroleum jelly or Vaselline – you will apply this to the edges of the treated area in particular around the nose and mouth and around the eyes to again reduce crusting and keep yourself comfortable. A supply of Panadol and Panadeine – to be taken to control discomfort A supply of sleeping tablets – to help you sleep for the first few days A supply of ice-packs – to be used to increase your comfort Procure shopping supplies for at least one week or organize for somebody to do shopping for you.

What will happen?
Most patients are fine.  The first night will be testing. You will have a mask dressing on your face which you must leave intact. You can apply ice compresses to the treatment areas to speed up recovery and to make you more comfortable.  You will need to return to the clinic one to two days following your laser resurfacing. The dressing on your face will be changed and you will be given further instructions depending on your requirements. You will need to return to the clinic every few days until healing is complete.

How do I apply ice-compresses?
The most important thing to remember is to never apply ice directly to the skin because it can cause burning of the skin.  Always place a barrier between the ice and the skin.  A suitable barrier is a cloth like a tea towel.  Ideally the cloth should be lightly damp.  Place the ice or ice-pack inside the damp cloth and apply to the treatment areas for 5 to 10 minutes two to four times per day.  Apply ice compresses only if necessary, most people do not need them.

What should I avoid?

1. All sun exposure is to be avoided. Stay in-doors except when you visit the clinic.
2. Do not shower until given clearance to do so.
3. Generally avoid touching the treated area and always wash your hands before touching.

What can I do to improve my Laser Rejuvenation result?

1. Follow all instructions carefully
2. Take a multi-vitamin preparation.

Would you like more information about Laser Resurfacing Treatments?
e-mail consultation click here...  enquiry@abccs.com.au
The best way of getting more exact information is to come in for a consultation.
Please make a booking by telephoning 99605400.

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