Deep Facial Laser Resurfacing

“Wrinkles and acne scars can leave more than a mark on your face”

Facial laser resurfacing, using the Sciton® Erbium laser,  can help produce more aggressive wrinkle and scar removing results similar to the phenol peel and carbon dioxide laser, but without some of the side effects of phenol or CO2. Skin resurfacing helps to “refinish” the skin’s top layers through a method of controlled superficial skin layer removal. The treatments soften the sharp edges of surface irregularities, giving the skin a smoother appearance.  As the skin heals after lasering, the collagen contracts, tightening skin and smoothing out wrinkles and irregularities.

Facial laser resurfacing  is most often used to improve the look of facial skin left scarred by acne or accidents or to smooth out fine facial wrinkles, such as those vertical lines around the mouth. It’s also sometimes used to remove the pre-cancerous growths called actinic keratoses. Important factors to consider are your skin type, coloring, and medical history. For example, black skin, Asian skin, and other dark complexions are at greater risk for skin which is discolored or blotchy after a skin-refinishing treatment. Often pre and post laser use of Obagi® or other products can decrease and resolve these issues.  People who develop allergic rashes or other skin reactions, or who get frequent fever blisters or cold sores, may experience a flare-up. It is important to let Dr. Guy know about your skin history, so that medicine can be prescribed to avoid these issues.  If you have light freckles, they may disappear in the treated area.

Laser resurfacing can be performed on small areas of skin or on the entire face. It can be used alone, or in conjunction with other procedures such as facelift, blepharoplasty, scar removal or revision, or chemical peel.  The amount of time for healing is dependent upon the patient’s skin and on the depth of treatment with the laser.  Some laser treatments simply brighten the skin without any down time, while deeper treatments require more healing time, commensurate with the depth: anywhere from 2 to 14 days.

Laser Resurfacing Basics

Procedure:
Laser vaporization of the top layer of the skin.  Softens sharp edges of surface irregularities, including acne and other scars and fine wrinkles, especially around the mouth.

Length:
A few minutes to 1 hour. May require more than 1 session.

Anesthesia:
Local, numbing cream, dental blocks, or general.

In/Outpatient:
Usually Outpatient.

Side Effects:
Temporary tingling, burning, itching, swelling, redness. Temporary sensitivity to sun. Need for special skin care during healing.

Risks:
Abnormal color changes, such as PIH, or post inflammatory hyperpigmentation (brown splotches – this can be treated with skin care products, and is rarely permanent). Tiny whiteheads (temporary); infection; scarring; flare-up of skin allergies, fever blisters, cold sores. Pigment changes (light or dark, though this is rare with the more modern lasers).

Recovery:

Back to work:
Depends upon depth of treatment.  For a deep laser resurfacing for maximal results, 2 weeks. More strenuous activities: 4 to 6 weeks.

Fading of redness:
About 3 months. Return of pigmentation/sun exposure: 6 to 12 months.

Duration of Results:
Permanent, although new wrinkles may form as skin ages.

Laser peels and resurfacing are normally safe when they’re performed by a qualified, experienced board-certified physician such as Dr. Guy.  Dr. Guy performs all the facial laser resurfacing herself.

You may develop tiny whiteheads after surgery. These usually disappear on their own, or with the use of a mildly abrasive pad or soap; occasionally, Dr. Guy may have to remove them with a tiny needle. While infection and scarring are rare with skin-refinishing treatments, they are possible. Some individuals (very rare) develop excessive scar tissue (keloid or hypertrophic scars); these are usually treated with the application or injection of steroid medications to soften the scar.

Consultation & Preparation

Because skin resurfacing treatments have sometimes been offered by inadequately trained practitioners, it’s especially important that you find a doctor (generally a plastic surgeon like Dr. Guy) who is trained and experienced in the procedure. In your initial consultation, be open in discussing your expectations with Dr. Guy, and don’t hesitate to ask any questions or express any concerns you may have. Dr. Guy will explain the factors that could influence the procedure and the results-such as your age, skin condition, and previous plastic surgeries.

Dr. Guy will discuss your medical history, conduct a routine examination, and photograph your face. She will explain the procedure in detail, along with its risks and benefits, the recovery period, and the costs.

Dr. Guy will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, and on avoiding aspirin and other medications that affect blood clotting. You may also be given special instructions regarding the care and treatment of your skin prior to surgery. If you smoke, you will be asked to stop, since smoking decreases blood circulation in the skin and impedes healing.

If you are planning to have some sedation for the procedure, be sure to arrange for someone to drive you home after your surgery, and to help you out for a day or two, if needed.

The Skin Treatment

Laser skin resurfacing can be performed fairly quickly. The procedures usually take from a few minutes to an hour or two, depending on how large an area of skin is involved and if pre-treatment with skin numbing cream is needed. It’s not uncommon for the procedure to be performed more than once, or in stages, especially when scarring is deep or a large area of skin is involved. Skin resurfacing may be performed under local anesthesia, which numbs the area, combined with a sedative to make you drowsy. You’ll be awake but relaxed, and will feel minimal discomfort. Sometimes a numbing cream is used along with or instead of local anesthesia. Or, in more severe cases, Dr. Guy may prefer to use general anesthesia, in which case you’ll sleep through the procedure.
In laser skin resurfacing Dr. Guy vaporizes away the outermost layers of skin with a computerized laser pattern generator, which precisely treats the depth she wants to use. The vaporization continues until Dr. Guy reaches the safest level that will make the scar or wrinkle less visible.

Dr. Guy may then treat the skin in a number of ways, including ointment, cool compresses and creams.

Recovery & Results

If you have a deep laser resurfacing, right after the procedure, your skin will be quite red and swollen, and eating and talking may be difficult. You’ll probably feel some tingling, burning, or aching; any pain you feel can be controlled with medications prescribed by Dr. Guy. The swelling will begin to subside in a few days to a week.

A light crust (eschar) may form over the treated area as it begins to heal depending upon the type of cream or dressing applied. This will fall off as a new layer of tight, pink skin forms underneath. Your face may itch as new skin starts to grow, and Dr. Guy may recommend an ointment to make you more comfortable. If ointment is applied immediately after surgery, little or no scab will form.
In any case, Dr. Guy will give you detailed instructions to care for your skin after surgery. For men, this will include delaying shaving for a while, then using an electric razor at first. It’s very important that you understand Dr. Guy’s instructions and follow them exactly, to ensure the best possible healing.

Your new skin will be a bit swollen, sensitive, and bright pink for several weeks if you have the deep laser resurfacing. During this time, you can begin gradually resuming your normal activities. The pinkness will take about three months to fade. When your new skin is fully re-pigmented, the color should closely match the surrounding skin, making the procedure virtually undetectable.
You can expect to be back at work in about two weeks, or much sooner with lighter resurfacing or fractional resurfacing. Dr. Guy will probably advise you to avoid any activity that could cause a bump to your face for at least two weeks. More active sports-especially ball sports-should be avoided for four to six weeks. If you swim, stick to indoor pools to avoid sun and wind, and keep your face out of chlorinated water for at least four weeks. It will be at least three to four weeks or longer before you can drink alcohol without experiencing a flush of redness. Above all, it’s important to protect your skin from the sun until the pigment has completely returned to your skin–as long as six to twelve months. A barrier sunscreen with micronized zinc oxide and titanium dioxide is best.  Dr. Guy usually has you see one of her aestheticians post laser to help you with your skincare and advise you about the best sequencing of skincare products, sunscreens, make-up, etc.

Be sure to look at our before and after photos in our website photo gallery.