What is Skin Resurfacing?
Lasers are used to improve the texture, wrinkles, lines and pigmentation of skin: this is essentially skin resurfacing. The different lasers used for skin resurfacing include:
Fractionated erbium lasers: give a mild to moderate improvement with mild pinkness and healing over a few days.
Full erbium lasers: give a moderate improvement with pinkness and healing over about 7 to 14 days.
Fractionated CO2 lasers: moderate improvement with pinkness and healing over about 7 to 14 days.
Full strength CO2 lasers: used for deeper wrinkles and lines. They give dramatic improvement, but with marked pinkness for the first two weeks and gradual reduction of the residual pinkness over several weeks to as long as two to three months.
Radiofrequency, needle radiofreqency, and subcutaneous radiofrequency treatments: these give less improvement on the surface, although in some instances, a marked improvement can be obtained. They generally do not improve pigmentation.
Chemical peels: various types of peels are used, from mild to severe, allowing resurfacing of the skin. This is further discussed under Chemical Peels.
Fractionated erbium lasers can be used on the neck, the chest, arms, hands, legs to improve texture, discoloration and pores
Acne scars can be treated with a number of fractionated laser modalities, including the CO2 laser, micro-needling, and needle radiofrequency. Usually, we will used a combined approach to give the best results.
The Hammock lift together with a full face fractionated CO2 laser returns the facial tissues to years gone by….
"Well, the last time I had a picture taken I could hardly see my eyes because of the weight of heavy eyelid. Then I paid attention to how I was actually using my eyes and I really noticed when I was looking at anything especially the computer I was straining my forehead to see better. Since I have had it done I no longer have to lift the forehead and tilt my head to see. It is amazing! I love..." D. Rock 63 Yrs Old with Fat Droopy Eyes - Salt Lake City, UT
Am I a Candidate for Skin Resurfacing?
As there are so many options when considering skin resurfacing, and because so many other factors have to be considered (skin type, age, natural pigmentation in the skin, prior surgery, prior peels or lasers, exposure to sun, etc, etc), this can only be answered after a detailed history is taken and clinical examination has been performed.
The before-and-after photographs below give you an idea of the types of skin changes which are amenable to skin resurfacing.
Cosmetic surgery can be combined with fat grafts and the CO2 laser to give the best results in terms of structure as well as skin condition
CO2 lasers can be used to lighten dark eyelid skin and tighten tissues.
Proper knowledge of the use of the CO2 laser allows dramatic improvement of rhinophymas (associated with acne rosacea)
The fractionated CO2 laser is also used to enhance the results of a facelift together ith the use of fat grafts as seen here
A common problem seen in patients from the mid-thirties is the presence of lip lines, often called smokers’ lines, even when one does not smoke. Fractionated CO2 lasers used with proper levels are brilliant for giving excellent results. They are often combined with fillers to give the best lip shape and tissue tightening
We have developed a technique of using the fractionated lasers to upper and lower eyelids without performing incisional surgery to give an improvement in texture, skin tightening and eversion of eyelashes
How will I be Assessed?
Your skin needs to be examined without any makeup.
A detailed history of any prior plastic surgery or use of lasers needs to be taken.
If you have been treated with Accutane, we need to know when, for how long and when it was stopped.
Please bring a list of any prescription creams you may be using (steroids, anti-pigment creams, lotions and potions for skin conditions, etc).
We will also obtain a family history to ascertain your genetic history as far as your skin type is concerned. For example, some people may be one quarter or one eighth native American and yet have blue eyes and pale skin. Southern European skin responds differently to Northern European skin. Please be prepared to furnish all this information as assessment and choosing wisely is the key to safe and effective skin resurfacing.
*Dramatic improvement in wrinkles, pores and lax tissues can be obtained with fractionated erbium and CO2 lasers
"I had a excellent eye lift done by Dr. Patel. He knows what he is doing and is very pleasant. Dr.Patel was easy to get an appointment and he works with you. The office staff was very pleasant and made you feel calm." D. Gull Highly recommended for eye lift surgery - Salt Lake City, UT
Can skin resurfacing be performed in conjunction with other procedures?
Although isolated skin resurfacing may be performed (lower eyelids, forehead, lip lines, full face, etc), we often take advantage of any reconstructive or cosmetic procedures being performed by resurfacing the skin at the same time. This has the advantage of healing from both the surgery and the resurfacing concurrently. Also, the results of the different procedures and the use of lasers are additive and give better results than using just one modality!
I am worried about the pinkness and healing after skin resurfacing.
Some important points to remember:
Everyone who undergoes skin resurfacing will have pinkness of the skin. In the early days, and with the more aggressive lasers, there is redness, oozing and then pinkness!
Based upon the depth of the laser used and your skin type, we can guide you with the length for which the pinkness persists and for how long it takes to subside.
However, we know from understanding the skin and skin physiology that unless we create a controlled “injury” to the skin with the laser, one cannot hope to get an improvement. So please be careful of all the internet claims of “no down-time skin resurfacing”. It will cost you and will give you minimal to negligible results!
An old adage I coined some years ago: “it takes you 20, 30, 40, 50 years to age, it will take some days to weeks for you to properly heal.”
One can use fractionated modes of resurfacing to get incremental improvement in the skin, thereby reducing the degree of pinkness. These are then repeated to get the further improvement that is desired.
Most patients can cover up the pinkness with makeup, even after aggressive skin resurfacing as quickly as 10 days after treatment. Again, some residual pinkness persists for many weeks and will be more obvious (temporarily) after any makeup is removed. This is normal.
What kind of results can I expect after Skin Resurfacing?
This, of course, will depend very much upon what you choose to have done, what we decide would be best for you and the depth to which the skin is treated. There are very many variables resulting in a range of results. This is best illustrated with before-and-after photographs below.
Multiple examples of improvement in wrinkles, pigment spots, skin texture, pores and skin tightening with the use of the CO2 laser
CO2 LASER & ERBIUM LASER: HOW TO PREPARE FOR YOUR TREATMENT
PLEASE READ THROUGH THESE INSTRUCTIONS WELL BEFORE YOUR TREATMENT
1. If Dr. Patel has prescribed creams for you to be used before your treatment, please ensure that you have used them. In some instances, we will prescribe an anti-pigment cream (called hydroquinone) and Retin-A. These will only be prescribed to be used for a few weeks before your treatment if your skin type requires them. When using these creams, it is not unusual for the skin to feel dry: you may need to increase the amount of moisterizer you use during this period.
2. On the day of your treatment, please take the medication prescribed as directed. If you are having the laser treatment in our minor surgical theatre, you will be prescribed a pain medication and a sedative pill with instructions of when to take them prior to your treatment. You CANNOT drive yourself to or from the treatment! Please have a responsible friend or family member drive you on the day.
3. On the day of your treatment, please wear loose clothing, ideally a shirt with buttons. Your clothing may get mildly moist with the treatment, so please don’t wear your latest Gabana shirt.
4. If an anesthetic cream (EMLA) has been prescribed for you, please apply it over the area being treated before you leave home. These topical anesthetic creams are effective for several hours after you apply them. This also makes the local anesthetic injections which may be administered much less uncomfortable.
5. We never hurry our patients: to that end, procedure times are estimates. If you or another patient need more time, we always accommodate you, so please come with someone patient and without important appointments to go to.
6. BEFORE the day of your treatment, please ensure you have a pot of regular vaseline and a tub of moisterizer at home. You may use any moisterizer: examples are Eucerin, Lubriderm, Aquaphor.
7. BEFORE the day of your treatment, please ensure you have regular white kitchen vinegar at home. Most kitchens have this anyway.
CO2 LASER & ERBIUM LASER: POST-TREATMENT INSTRUCTIONS
PLEASE READ THROUGH THESE INSTRUCTIONS BEFORE YOUR TREATMENT
1. Please remember to take the prescribed Zovirax oral medication for at least the next five days. Sometimes you will also have an oral antibiotic prescribed (like Keflex). The Zovirax prevents cold sores from breaking out. You may use the prescribed pain medication if you need it but most people feel they need no more than extra-strength Tylenol after the first day or two.
2. It is normal for the skin to be sensitive (some people describe a burning sensation, others describe it as “tingly”. Please apply a moisterizer (Aquaphor, Lubriderm or Eucerin are examples). Some patients like using Vaseline, especially last thing at night as it stays on better. Whenever your skin feels dry, please apply the moisterizer. However, you need to use the moisterizer at least four to five times a day for the first week, and then about two to three times a day for the following three weeks.
3. Using a vinegar-and-water soak (one table-spoonful of kitchen vinegar in a glass of water) helps the skin to peel more quickly. Again, this is not vital, but most patients who start this the day after the laser find it soothing: they generally use it for four to five days and apply the moisterizer onto the skin after the soak. The vinegar-and-water soak also helps to remove the superficial skin cells that are supposed to come off after the treatment.
4. The day after your surgery, you may shower, wash/bathe and it is fine to use soap on the face. Be gentle!
5. Expect swelling, especially when you wake up in the morning or after taking a nap: you can use ice on-and-off. Putting the ice on for 30 minutes and off for 30 minutes can be helpful but you can vary this as needed. Many people find frozen peas the perfect ice pack for the face.
6. If you have any concerns, please send us photos of the full face and also oblique views: dena.magallanes@hsc.utah.edu (to Dena), or jill.streeter@hsc.utah.edu (to Jill). We will review them and call you back or e-mail you. Also, never hesitate to ask any questions and we are always happy to see you if there are any concerns. We want you to get the best possible result and will help you as you heal.
7. You should be able to use make-up by day seven, give or take a couple of days. However, the skin continues to mature and heal for many weeks. Therefore, it is normal for the skin to look more pink after any makeup has been removed or after a hot shower. This is normal. Over time, this pinkness fades away. It takes our skin 20, 30, 40 years to age, so the maturation of the collagen over few weeks is but to be expected.
8. Please use a sunscreen after a week if you are going out. You should need to moisterize only a couple of times a day.
9. Physical exercizes: you can resume most normal activities within a couple of days after the laser treatment. However, exertion (weights, hot-yoga, skiing, tennis, etc) should be delayed for a week.
10. Any other questions: please send us an e-mail or call us. We are always available.
Preservative-Free Artificial Tears, Ointments and Moisterizers to use on your skin
FAQS
WHAT DO I DO ABOUT MY BLOOD THINNERS BEFORE MY LASER TREATMENT?
Aspirin, aspirin-containing drugs, ibuprofen and other blood-thinners should be stopped 7 days before surgery. This includes herbs, all vitamins, and certain other drugs: we will give you a list which covers most such thinners. If you are on prescription blood-thinners like Coumadin or Plavix, we will advise you and your physician about possible changes in that medication prior to and after surgery. HOWEVER, if you are only having laser treatment to the face (without surgery), you do not need to stop these medications.
HOW WILL MY VISION BE AFFECTED AFTER MY LASER TREATMENT?
If you are only having laser treatment to the face, the swelling will definitely affect your eyelids, making it difficult for you to see clearly for the first few days. The swelling responds to the use of ice. You may also use artificial tears in your eyes as you need them.
WILL I BE EQUALLY PINK OVER MY WHOLE FACE?
Because the level of the laser treatment is varied to give you the best result, the degree of pinkness will also vary. Furthermore, some areas like vertical lip lines and deep pores need a more aggressive treatment, which makes the area around the mouth more pink. Eyelid skin is very thin and will invariably be pink and swollen. Once you are healed, there will not be differences from one part to the next.
HOW MUCH DRYNESS OF MY SKIN CAN I EXPECT?
Skin that is lasered needs a lot of moisterizer, both in the form of topical moisterizer, as well as good hydration with liquid intake. The skin tends to become very dry for the first week, gradually becoming more normal in the subsequent few weeks. It is always a good idea to keep the lasered skin moist and properly protected with a sunscreen.
IF I HAVE THE CO2 LASER TO MY FACE, DOES THAT MEAN I CANNOT GO OUT IN THE SUN?
Absolutely not. Of course, the first week, while you are healing, it is important to use a moistrizer and avoid direct sun exposure. Most of my patients will resume normal activities within a few days, even going out to the shops with a broad-rimmed hat on. Avoid direct biting cold or hot winds to the face. After the first week, you can use topical moisterizer and sunscreen and resume sports, jogging, etc. Makeup is able to hide the residual pinkness after the first week. We find that our patients become much more diligent about protecting their skin with an SPF 30 sunscreen after our laser treatment, which makes for healthier skin in the long term!
ARE THERE ANY TYPES OF CREAMS OR LOTIONS I SHOULD USE OR AVOID AFTER MY LASER TREATMENT?
If we started you on the Retin-A and Hydroquinone 4% cream prior to your laser, we will ask you to resume these about four weeks after your treatment. In some patients, they are restarted sooner: we will guide you. It is fine to use your normal line of makeup that you used to use. If you use creams with glycolic acid or lactic acid in them, please show them to us so we can review when you can restart those creams.
IS THERE A PARTICULAR BRAND OF FACIAL CREAMS YOU RECOMMEND?
As you know, it is very confusing for the lay public these days as there are new lines of creams and lotions and potions coming out daily. Of course, everyone claims to have the best products, often the most expensive. Although there are many good brands like SkinMedica, Obagi, BioMedic, and others, skin care really requires four basic things: a good moisterizer, a good sunscreen, an exfoliant (like retin-A or creams containing glycolic acid or lactic acid), and around the eyelids, hydrating Vitamin C serums. All of these are available in many different brands.
HOW MUCH BRUISING & SWELLING CAN I EXPECT AFTER LASER TREATMENT TO MY FACE?
Laser treatment works by treating the superficial but also the deeper structures in the skin. Because we are relying on heat causing tightening of collagen and making new collagen, there will invariably be swelling. Eyelids and the lower part of the face swell the most, and the swelling is often asymmetric (depending upon how one sleeps). Using ice on-and-off (20 minutes on and 20 minutes off works well) for the first two days helps reduce bruising and swelling more quickly. Sleeping with two or three pillows for the first couple of nights helps reduce swelling. Many patients tell me they find the use of ice very soothing and continue to use ice for several days.
Bruising occurs where local anesthetic injections may be administered. However, the laser treatment also causes some small blood vessels to leak fluid and this can look like a bruise. As with most bruises, this dissipates over the first few days.
HOW MUCH PAIN CAN I EXPECT?
Everyone experiences a sensation of tightness and tingling. Some patients experience a “burning” sensation for the first two to three days, especially when using the water-and-vinegar soaks. You may need the prescription pain medication for one or two days; thereafter, simple over-the-counter pain medication like Tylenol suffices.
HOW MUCH TIME OFF WORK WILL I NEED AFTER MY FACE LASER TREATMENT?
Most patients try to get a full week off work. Thereafter, makeup may be used. You can, of course, work on your computer from home even the day after the treatment.
HOW LONG WILL THE LASER TREATMENT TAKE ON THE DAY OF TREATMENT?
Preparation, applying local anesthesia and application of the laser take a total of about an hour, but we do not rush anything. When you come for your treatment, please do not make any other appointments for the day as the duration of treatment is not always predictable. Also, by the nature of Medicine, emergencies are seen almost daily and may delay more routine cases. Furthermore, it is not uncommon for the surgeon to take longer (or shorter) on some cases, depending upon findings: therefore, procedure times are ESTIMATES ONLY.
WILL MY FACE LOOK TIGHTER ONCE I AM HEALED?
Fractionated CO2 laser and Erbium lasers give excellent improvement in pores, fine lines, deeper lines around the lips and forehead and skin tightening. The skin actually feels tight in the first few weeks. Although this relaxes, you keep the improvement in the appearance of the skin long-term. Please remember that there are no lasers that actually lift and reposition tissues like we can do with a brow lift or a facelift or a necklift. The improvement and tightening are visible on the surface (skin): please see some of the photos of our patients on this page.
If you have jowls or a loose neck or drooping brows or baggy eyelids, we will discuss other options with you. We often combine surgery with the use of the CO2 laser to give our patients the best possible results.
HOW MANY LASER TREATMENTS WILL I NEED?
In the “old” days (not so long ago, actually), aggressive laser applications gave very good results, but there would be loss of pigment giving the skin a porcelain-white sheen. These days, we fractionate the laser. In order to give you the best result, without the loss of natural skin color, we generally perform two treatments with the CO2 laser, separated by about six months. Some patients prefer to have lighter treatments, in which case the treatments are repeated more than twice.
With the Erbium laser, two to four treatments are generally needed. The Eribium laser has quicker healing, but also gives more moderate tightening of the skin and wrinkles.
WHAT POSTOPERATIVE CARE WILL I NEED?
Although details of the post-treatment care are given in detail above, here is a summary:
You may wash/bathe the day after your surgery and even get your lasered skin wet. You can also use soap on the face.
Do not rub your skin vigorously for the first two weeks.
Expect some oozing of blood-stained fluid for the first two to three days: this is normal.
No swimming in a swimming pool for two weeks please.
No vigorous exercise for one week (tennis, skiing, etc).
Most patients can drive/walk/etc the day after surgery. Sometimes, swelling can make driving difficult for a couple of days.
You will have trouble wearing contact lenses for about a week.
Remember to read our instructions on the use of water-and-vinegar soaks and the use of a moisterizer several times a day.
DO I NEED THIS LASER TREATMENT?
Absolutely not! Laser treatments are chosen by the surgeon and by you with specific aims in mind. We may use these lasers to improve wrinkles, lines, pores, smokers’ lines around the lips, acne scars, trauma scars, etc. We can all live with all of these changes, so you have the choice of having or not having this treatment: it is entirely your choice.
WILL MY CO2 LASER TREATMENT BE COVERED BY INSURANCE?
In certain circumstances when we are treating scars on the face following trauma, we are able to submit the laser treatment to your insurance company or workman’s compensation fund, if the injury was work-related. However, whether they cover it or not is entirely dependent upon your insurance contract. We always work for our patients and will always try to get coverage for you whenever possible. However, treatment of cosmetic blemishes like wrinkles, lines, pores, etc cannot be submitted to the insurance company.
HOW DO I KNOW IF THE CO2 LASER TREATMENT WILL GIVE ME THE IMPROVEMENT I SEEK?
We keep photographs of patients we have treated for many conditions using laser beams. When one knows the physics of the different lasers, and the physiology of skin, one can predict fairly accurately what is and is not possible. To that end, we will always see and examine you to determine if the laser alone or a combination of surgery and laser might be best for your needs.
FURTHER QUESTIONS
Please be sure to ask us any questions you may have whilst you are being seen in clinic so we can help you understand the procedures. You may also contact us: Dena Magallanes (dena.magallanes@hsc.utah.edu or 801 585 6646) or Jill Streeter (jill.streeter@hsc.utah.edu or 801 585 6641).
Thank you for coming to see us.
Sincerely,
Prof. BCK Patel MD, FRCS