 Laser resurfacing for wrinkles and scars works by two primary actions. The first is a very precise removal of the top layer of skin. This removes the extra fold which is causing the wrinkle, and leaves a normal skin surface. The second way the laser helps correct facial wrinkles and scars is by directly affecting the collagen within the dermis. The heat generated by the laser allows the collagen to re-form resulting in a tightening of the skin which provides a more uniform, smooth appearance.
Laser resurfacing offers significant advantages over conventional techniques such as dermabrasion and/or chemical peeling. It gives immediate, visible results so patients can see the benefits. Patients do not have to wait for peeling to occur several days later to evaluate the success of the treatment. Laser treatment has fewer side effects than dermabrasion and/or chemical peeling. With dermabrasion and/or chemical peeling, there is commonly a whitening of the skin, and there is an increased chance that the texture of the skin will change.
With laser resurfacing, patients should experience significant flattening of wrinkles and a generalized improved appearance of the skin surface. They should also enjoy an improvement in general skin appearance over the long-term. The benefits from laser therapy last varying lengths of time. The more excessive the wrinkling, the longer lasting the benefits - up to several years in most cases, and probably more.
The procedure is performed in the office. Usually, only local anesthesia is required. Rarely, patients request 5 mg. of Valium at the time of the procedure. The procedure lasts anywhere from one-half hour to two hours, depending on the extent of the procedure. It is not generally painful, and there is a mild discomfort afterwards. At this time, patients are given an appropriate analgesic so that they will remain comfortable.
A superficial wound, which requires postoperative care, occurs following laser resurfacing. Patients are asked to soak the area with water, and to apply ointment to the skin regularly for approximately a week, or until healing is complete. Healing occurs normally within a week to ten days if all wound care instructions are followed carefully. Patients are also given antibiotic and antiviral medicines during the post-operative period to facilitate healing. At the end of this period, there is a mild redness of the skin. Make-up can be used, however, once the area has healed. In certain cases, we may prescribe dressings to be worn at night to help reduce the remaining redness. This redness lasts anywhere from 2-4 weeks, and gradually disappears. Complete post-operative instructions will be provided prior to the procedure.
As with any treatment, there are potential risks with laser resurfacing. We feel, however, that the risks are minimal and certainly less than alternative therapies. Persistent redness rarely occurs but fades over time. Increased pigmentation may occur temporarily, however, permanent loss of pigmentation is unlikely. Although there is a chance of a scar occurring, this chance is extremely unlikely.
During the follow-up, patients are observed carefully to ensure that healing progresses properly. We also ask that they revisit the office one week after treatment and several times after that at longer intervals.
Preoperative Erbium Laser Instructions
- If possible, avoid aspirin, Advil, Motrin, Ibuprofen and similar non-steroidal anti-inflammatory medicines for ten (10) days prior to treatment, otherwise bruising will be greater than necessary.
- Tylenol is permissible.
- DO NOT consume alcoholic beverages for 24 hours prior to treatment, otherwise bruising will be greater than necessary.
- If you have a history of clotting problems or are taking anti-coagulants (Coumadin), please let the doctor know in advance.
- Start your prescribed antibiotic and antiviral pills the day before your laser treatment. Have a tube of Aquaphor healing ointment on hand for postoperative care.
- Apply EMLA cream to areas to be treated one hour before procedure.
Postoperative Erbium Laser Instructions
Immediately after treatment:
- A coating of Vaseline/Aquaphor with (or without) a dressing will be applied to the treated area. This dressing can be kept on until the following morning.
- A pain prescription will be written to be used if needed although Extra Strength Tylenol is usually all that is necessary.
HOME CARE
Day of the treatment:
- If a dressing is applied and it becomes loose, try to reattach it to the skin. If this is not possible, then gently remove the dressing, and apply a coat of Vaseline/Aquaphor to the treated area.*
- If a dressing was applied, do not apply ice packs until the day after the treatment. If no dressing was applied, begin applying ice packs to the treated area immediately. This will help keep down any swelling you may experience. (Swelling will be most evident around the eye area). Apply ice packs as much as needed, and always follow with a liberal coat of Vaseline/Aquaphor.
- You may begin taking pain medication to help alleviate any discomfort.
- Try to relax this day and keep your head elevated with two pillows to help reduce swelling.
Day 2 - 10:
- You may begin taking a shower the day following your treatment. The dressing applied at the office should be removed and the treated area can be cleansed in the shower. (If this is too uncomfortable, just apply a new coat of Vaseline/Aquaphor to the treated area and begin cleansing on the third day). Cleansing should be done with water alone.**
- Cool soaks with water should be applied to the treated areas at least three times daily. After soaking, apply Vaseline/Aquaphor to the treated areas to keep them moist.
- Continue to take pain medication and apply ice packs as needed to help alleviate discomfort and swelling. The discomfort usually subsides after 48 hours.
- Apply enough Vaseline/Aquaphor to prevent air from getting in. Otherwise, crusts may form, and can cause scarring.
Day 7 - 4 weeks:
- You may begin applying makeup once the skin has healed. This usually occurs at 5-10 days following treatment. A good moisturizer, such as Eucerin's Original Formula, Fragrance-Free Cream, needs to be used as the treated area will be very dry and tight at first.
- Avoid getting any sun on the treated area.*** The treated area will be very susceptible to sun exposure and damage can occur, especially darkening of the skin. After the skin is healed, you may go out with a sun block of 25 spf or greater, but you should still use additional measures (such as hats, etc.) to protect the treated areas from the sun. These measures must be used for approximately three months following the laser treatment.
- Once the skin has healed, the treated area will be mildly red. This will gradually subside over a period of 2-4 weeks, occasionally longer. A green based cover up makeup can be purchased from most cosmetic lines that can be worn under your own makeup to help cancel ut the redness of the laser treatment.
Notes
* - If you have any questions regarding the areas treated, please call the office at 241-3003
** - A dressing like the one applied at the office called Second Skin or Ultra-Thin Duoderm can be purchased at Jacobson's Pharmacy in Mount Kisco. This can be refrigerated and used at home for 2-3 days after your treatment to help with any discomfort. This is not required and is only optional.
*** - Sunlight goes through glass. Therefore, you must protect yourself when you are near any type of window (buildings, cars, buses, trains, etc...)
Informed Consent
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