Laser Resurfacing

What is laser skin resurfacing?

Laser skin resurfacing denotes a procedure whereby a light emitting device (laser) is used to remove the skin in a controlled precise way.

Lasers emit a single wave length of light. The lasers used for resurfacing of the skin (carbon dioxide and Erbium lasers) emit invisible light which is absorbed by water. Skin cells are composed almost entirely of water. Once the laser light strikes the skin, the water within these cells is heated very rapidly and vapourises (turns to steam). This allows the removal of the skin cells layer by layer by the laser.

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What will laser skin resurfacing achieve?

This technology has been applied with great success for the treatment of the ageing face and to remove signs of photodamage including sunspots, skin wrinkles, pre-cancerous skin lesions and some skin cancers. It has also proved very helpful in the treatment of scars resulting from acne, trauma, infection or surgery. The laser can also be used like a scalpel to cut away small benign skin growths or to remove excess skin and fat of the eyelids.

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Who should have laser skin resurfacing?

People who have wrinkles and/or general sun damage and sunspots achieve the best results. Wrinkles around the eyes and mouth respond particularly well. Those that have excessive skin laxity with the appearance of jowls and/or facial sagging will often require an additional procedure such as a facelift or liposculpture to achieve the best results.

Mild acne scarring responds well. Acne scars which are pitted and not too deep, improve but are not eliminated completely. Additional procedures are often required to achieve optimum results. Some facial scars, particularly those following surgery or trauma, can be improved significantly by laser resurfacing. Many benign skin growths such as warts and growths around the eyelids are easily removed with the laser. Brown spots are totally eliminated and pre-cancerous scaly spots (actinic keratoses) are removed or greatly improved.

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Is skin colour important?

Most skin types are suitable for laser resurfacing, however people with darker skin may experience transient increase in pigmentation of their skin and may need to use a pigmentation correction cream for a period of time following the procedure. Those with pale skin may become slightly paler after the procedure. There may be a slight residual difference in colour and texture between the resurfaced skin and the non laser treated skin. This is more frequent with the carbon dioxide laser and is rare with the Erbium laser.

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Is laser resurfacing suitable for one wrinkle?

In most instances it is preferable to treat an entire cosmetic unit, for instance the whole of the upper lip and not just one line.

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How much time off is necessary following laser resurfacing?

It is advisable to take 10 to 14 days off work to permit adequate time for healing. After two weeks your skin will still be red or pink, but you will be able to wear a cover-up make-up or tinted sunscreen or foundation. Occasionally healing may be slower.

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Do I need to do anything before the procedure?

Prior to the procedure you will be offered a complimentary PCA peel. These peels were designed by physicians in America specifically for laser treatments. Physicians Choice provide a range of products for pre and post laser skin care. The peel is designed to regenerate new cells so they occur at a faster rate than they would do naturally in turn speeding up the healing process.

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What is involved in the procedure itself?

Prior to your procedure, photographs will be obtained. If you give your permission, these may be used for teaching purposes. You will also be required to fill out an Informed Consent Form. If you do not fully understand any of the instructions, you must raise your concerns with the Surgeon.

If only a small area is to be treated, local anaesthetic in the form of either a topical preparation (topical cream - Emla), or local anaesthetic infiltration suffices. If there are several areas to be treated, or your entire face is to be treated, intravenous sedation is preferable.

On the day the Surgeon will meet you prior to your procedure and mark out all areas to be treated and confirm the treatment plan with you. It is important to arrive without any make-up.

If you are having intravenous sedation you will also be interviewed by our anaesthetist (see attached Intravenous Sedation information sheets for more information on your sedation). The procedure is done in our operating theatre and takes between 50 and 90 minutes, depending on the areas of your face to be treated. If you undergo intravenous sedation, you will need to stay with us for 30-60 minutes after your procedure (please refer to documentation on intravenous sedation).

When you wake, a dressing covers all of the laser treated areas on your face. You may experience some increased heat in your face, but it should not be painful. Due to the risk of infection, you may be provided with a prescription for medication including an antiviral agent (Zovirax), an antibiotic (Ciproxin) and sometimes an antifungal agent (Sporanox). You will also be given specific ointments to use and clear instructions on how to care for your skin for the next few days.

The first night following your surgery it will be helpful to sleep propped upright to reduce any swelling in the laser treated areas.

You will be seen the next day at the Clinic by a nurse and the dressings will be changed as required over the next few days. Generally at 5-7 days the dressings will discontinue and you will be instructed on the use of creams to keep your face moist while it heals. You must not use any of your own cosmetics, as this may interfere with healing. Healing is usually complete at 7-10 days. Further instructions will be given on your skin care over the next few weeks.

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How will I look over the next two weeks?

For the first week you will look bad. You will generally not be able to socialise or be seen in public, however you should have no pain and be able to do normal household activities, read books, watch television, videos and so on. By the second week you will look much better and by 10-14 days you should be able to apply camouflaging makeup.

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What happens after two weeks?

After two weeks most people are able to get back to normal activities, wearing make-up and sunscreen. Our Appearance Medicine Nurse will help by showing you how to cover the redness. You will look presentable. If a pigmentation correction cream is being applied, it is very important that you use this and avoid sun exposure.

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Will my skin be more sensitive after laser resurfacing?

Your skin may be a little more sensitive for 2-3 months. It will return to normal after that. During this time you should use non-perfumed cosmetics and minimize sun exposure.

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Will my skin age more quickly after laser resurfacing?

No, just the opposite. Because laser resurfacing removes sun damaged skin, new skin forms which is not sun damaged. It is tighter and less likely to wrinkle, however laser doesn't prevent natural ageing. Of course, if you develop sun damage on your new skin, you will soon develop wrinkles again.

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How do I use the pigmentation correction cream if I need one?

Pigmentation correction cream - Light n Block, is applied just before going to bed. Wash your face first and let it dry thoroughly before applying the cream, otherwise it may sting. Once applied, let it dry and leave it on. Do not wash it off. If you need to use a moisturiser, wait at least half an hour. If your skin becomes irritable from the Light n Block, use it every second night. However, if you have no trouble, use it twice a day - morning and night. In the morning apply it just before your moisturiser and sunscreen. If the pigmentation still appears, please ring immediately. You may need a stronger pigmentation cream.

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Do I need to stay out of the sun afterwards?

You will need to avoid the sun completely for the first two weeks. After two weeks you will be able to apply a sunscreen. It is never the less very important that you avoid sun exposure as much as possible while the skin remains pink, in order to avoid increased pigmentation in the lasered areas.

After the redness has gone, your skin has essentially returned to normal and you will have a natural amount of sun protection.

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How long do I need to use a sunscreen?

Forever. This is to prevent your skin from further photo aging. Whether you have had laser resurfacing or not you should wear a sun block every day.

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What complications can occur?

Reaction to anaesthetic:
This is rare, however some people may react to local anaesthetic or intravenous sedation.

Cold sores or activation of the chicken pox virus:
People who are prone to cold sores or have had chicken pox in the past, may experience a severe flare-up following laser resurfacing. For this reason you are given Zovirax which prevents outbreaks in most cases. However some people may still develop an outbreak. Early detection is important. If left untreated, it may go on to scar.

Infection:
Although rare, infection can occur in some people. Antibiotics are given, but occasionally antibiotic resistance occurs and a different antibiotic is prescribed.

Prolonged redness:
Redness is normal. It occurs with everyone who undergoes laser resurfacing. It normally lasts three weeks, but in some people it may last as long as several months. Prolonged redness is more common with the carbon dioxide laser than with the Erbium laser.

Scarring:
Scarring with the laser is very uncommon. It may appear as an area of redness or thickening of the skin. It is most likely to appear on the upper lip and jawline. It is treated with a combination of steroid creams, steroid injections and special dressings. In most cases it will disappear.

Pigmentation:
Increased pigmentation is a normal part of healing in some individuals. None the less it is undesirable. A pigmentation correction cream and sunscreen may be used after two weeks.

Loss of pigmentation:
This may occur and may be permanent. Usually it occurs in darker skin patients. It is only a shade paler than your skin and is generally not very noticeable.

Flare of acne:
People who are very prone to acne may experience a flare-up of their acne following laser resurfacing. It is best not to use any greasy creams or ointments. Use oil-free products only. If a flare-up does occur, antibiotics may be necessary and in some cases Isotane is prescribed.

Lack of expected result:
In order to avoid disappointment, you need to have realistic expectations.

Recurrence of wrinkles:
Although laser resurfacing is useful for wrinkles around the mouth and eyes, movement lines and deep furrows will appear with some facial expressions. Botox injections may be helpful to prevent recurrence of wrinkles around the eyes and forehead.

Please advise your Surgeon or one of the nursing staff if you have ever had electrolysis treatment in the past , as this may affect wound healing.

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Where do I go from here?

Booking an Appointment
If you are interested in this procedure for yourself or your child, you can telephone the Skin Institute and book a consultation with one of our Surgeons who perform the procedure at our Takapuna Clinic.

Photography
In order to accurately record the results of the operation, we require medical photographs to be taken before and after the procedure. These photographs are confidential and will be kept on your patient file. They are a great way of comparing how your ears look before and after the surgery and you can request copies of the photographs for yourself.

Surgery and Anaesthesia Costs
The cost of the procedure varies depending on the extent of the area being treated and the estimated length of the procedure. We will discuss costs with you at your consultation and a quote for the procedure will be given after a full consultation and assessment by the Surgeon.

Laser resurfacing before and after photos>>
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