Laser Surgery, Laser Skin Resurfacing, & Wrinkles

SURGERY USING LASERS
What is a laser? A laser is a high-energy beam of light that can selectively transfer its energy into tissue to treat the skin. Lasers contain a material that produces and amplifies light. Two mirrors cause the light to reflect back and forth through this material. The result is a light beam that is collimated and intense. This light is either one pure color or several different pure colors. These properties which separate the laser from a light bulb, are important to the medical application of lasers.

Many procedures cannot be done without the laser. Likewise, many procedures are better performed without the laser. Even with the sparkle, pure color, and high-energy beam, the laser is not always the best tool for surgery. The choice of using a laser or other surgical methods is carefully made by the facial plastic surgeon. Your surgeon has the preference to consider the results, the possible complications, and the alternatives.

In this pamphlet, you will find some of the procedures that can be performed with the laser. You are also given a brief explanation of the laser. Always remember that there are very few “right” and “wrong” answers with laser surgery. Many procedures can be performed with different lasers. The choice of the laser depends upon many factors, including the surgeon’s experience, the size of the area to be treated, and the expectations of the patient.

WHAT CAN LASER SURGERY DO FOR YOU?
The use of lasers in medicine is complex, and your facial plastic surgeon is trained in the use of lasers and understands how and when to use a laser. Your surgeon will decide if a laser is appropriate, and which laser is best for the situation.

In medicine, physicians can use lasers to make incisions, vaporize tumors, close blood vessels, selectively reduce pigmentation, or even treat skin wrinkles. The laser makes it possible to change tissue without making an incision. So a surgeon can treat birthmarks or damaged blood vessels, remove port-wine stains, and shrink facial “spider veins” without major surgery.

Is it any wonder that many facial plastic surgeons use lasers on a routine basis? They use the laser as a “light scalpel.” The tissue is left sterile, and bleeding is greatly reduced. When the laser is used to treat port-wine stains, no cuts are made. The laser energy penetrates through the skin to shrink the abnormal blood vessels that are the cause of these marks.

TYPES OF LASER SURGERY
Laser Skin Peeling
Lasers can be used to reduce wrinkles around the lips or eyes, even the entire face, softening fine wrinkles and removing certain blemishes on the face.

Laser Removal of Birthmarks and Skin Lesions
Port-wine stain birthmarks respond remarkably well to laser treatment. The abnormal blood vessels that cause these marks are reduced in size by the laser. This results in a lightening of the treated area. Skin growths, facial “spider veins,” warts, and some tattoos respond to laser surgery. Most situations take more than one laser treatment, but some respond to a single treatment.

The facial plastic surgeon often uses the minimum laser intensity possible. The low intensity requires many treatments. However, the low intensity also preserves as much of the healthy tissue as possible. This produces an aesthetically pleasing result. Many of these laser surgeries are performed as outpatient treatments in hospitals or offices.

Laser Hair Transplants
In this procedure, lasers are used to prepare the area where the hair transplants will be placed.

New Lasers
There are constant technologic advances which lead to even new applications of future generations of lasers. Please ask your doctor to discuss the latest advances with you.

UNDERSTANDING YOUR SURGEON
After your surgeon has indicated that a laser can be helpful in the surgery, your surgeon will explain the laser of choice and what can be accomplished. As with all surgery, the laser has its limitations. Often the results are spectacular. Your surgeon will give you the best judgment for the particular procedure.

Some surgeons may use local anesthetics to numb the treated area before the surgery. Surgery can sometimes be done in the surgeon’s office; other times the surgeries are performed in outpatient facilities at a clinic or hospital. Your surgeon will decide on the appropriate method, dictated by the nature of the surgery.

Because safety is a major component of laser use, your surgeon will describe safety precautions before the surgery. If you are treated with a local anesthetic, you will be required to wear protective glasses or goggles during laser use.

WHAT TO EXPECT AFTER THE SURGERY
After the surgery, you will probably experience some swelling and skin redness for several days. Antibiotic ointments may be used during the healing process. It is important for the patient to follow all the post-operative directions of the surgeon, particularly in using sunblock and avoiding sun exposure.

The full impact of the laser may not be apparent for a month or two, especially with vascular deformities. Additional treatment sessions will not be scheduled until the healing process for a particular treatment is complete.

It is important for the patient to realize that lasers have specific applications. The facial plastic surgeon is experienced in the use of the laser and is the best source of information as to whether laser surgery is appropriate for your condition.

Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve congenital deformities or accidental skin injuries may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.

© Copyright 2000 American Academy of Facial and Reconstructive Plastic Surgery

LASER SKIN RESURFACING

FACIAL PEELS AND LASER SURGERY
In the last half of this century, men and women have had more leisure time to spend outdoors than in previous generations. Many hours spent on outside recreations and the prevalence of both summer and winter vacations, have all taken their toll on people’s skin. Premature wrinkling is more common now than ever before. Both men and women seek facial plastic surgery to reverse the effects of sun damaged skin. Surgery may also improve the pitted look of acne scars and remove pre-cancerous skin growths called keratoses.

If you’ve wondered how skin resurfacing with chemical peeling or dermabrasion could improve the look of your skin, your self-confidence, or your health, you need to know how chemical peeling and dermabrasion are performed and what you can expect from these procedures. No pamphlet can answer all of your concerns, but this one can provide answers to many common questions about chemical peeling and dermabrasion.

Successful facial plastic surgery is a result of good rapport between patient and surgeon. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Your surgeon can answer specific questions about your specific skin problems.

IS SKIN RESURFACING FOR YOU?
The most basic requirement for any surgery is good health. Other requirements are more subtle and should be carefully considered in discussions with your surgeon. Expectations of surgery and of the surgeon must be realistic. Skin resurfacing procedures cannot produce perfect skin; rather the goal is to improve the appearance of the skin as much as possible.

Skin type and color, ethnic background, and age are important factors that should be discussed prior to surgery. If you have dark skin or problems such as allergies, previous burns, a history of poor scars, or radiation exposure, you may need special evaluation to determine if you are a candidate for these procedures. If you have had episodes of cold sores and blisters around the mouth, inform your surgeon of this condition.

Before deciding on a skin resurfacing procedure, your facial plastic surgeon may recommend a skin care regimen prior to the procedure. If you have extensive damage from aging or injury, more than one procedure may be necessary.

MAKING THE DECISION FOR SKIN RESURFACING
Whether you seek a chemical peel or dermabrasion for functional or cosmetic reasons, your choice of a qualified facial plastic surgeon is of paramount importance. The surgeon will examine your skin to assess factors that could affect the outcome of the surgery and to determine the proper procedure for your condition. You and your surgeon will explore your attitudes toward surgery, and discuss realistic expectations and risks. Trust is built through these discussions, and the agreement between surgeon and patient is a prerequisite for a successful outcome to the surgery.

After you and your surgeon decide to proceed with a chemical peel or dermabrasion, all options for the procedure will be discussed along with the risks. You will also receive information relating to each procedure. Bear in mind that neither chemical peel nor dermabrasion can correct sagging skin or halt the aging process. Furthermore, as some chemical peels lighten skin color, you must make a commitment to use sunblock. Following a thorough medical history, your surgeon will advise you as to anesthesia options, the surgical facility being used, any additional surgery options, and the costs for the procedure. Your surgeon may also suggest other surgery, either before or after your resurfacing procedure in order to enhance your overall appearance.

UNDERSTANDING THE SURGERY
The skin is composed of the epidermis and the dermis. Within the dermis are two layers, both of which are constructed of collagen, long fibers that loosen and stretch with age and sun damage. If the deepest layer, the reticular layer, is damaged, scars result, while the upper layer of the dermis, the papillary layer, heals from injuries without scarring. In a chemical peel, the surgeon applies one of several chemicals to the skin. Glycolic acid is the mildest. TCA, trichloroacetic acid, can be used in varying strengths for longer-lasting smoothness. The deepest peel is done with phenol.

Before any peel, the face is first thoroughly cleansed with a solution to remove oil and to prepare the skin for deepest penetration. As the chemical is applied, the epidermis is removed, and the chemical penetrates into the first layer of the dermis.

Dermabrasion is a surgical technique where by some deeper scars and wrinkles can be smoothed. The surgeon uses a local anesthetic and/or a freezing agent to render the skin numb. Then, using a high speed rotating brush, the surgeon removes the top layer of skin to the appropriate level for the best results. The size and depth of scars and the degree of wrinkling determine the length of the surgery.

Laser surgery is used to resurface facial skin with wrinkles caused by excess sun exposure, “crow’s feet,” and acne scarring. The high energy, amplified light waves of carbon dioxide (CO2) laser vaporize the top layer of skin instantly, with no beeding and minimal trauma to the surrounding skin.

WHAT TO EXPECT AFTER THE SURGERY
Immediately following a chemical peel or dermabrasion, the surgeon may apply a dressing to your skin. Swelling and “crusting” of the skin are normal, and ointments to keep the skin supple will be applied for seven to 10 days following surgery. The redness of skin that persists after the initial healing phase will usually fade in about 4 weeks. The surgeon often recommends a soft diet, avoidance of extremes in temperature and any activity that would cause stress to healing skin. It is imperative that you follow the post-operative instructions of your surgeon to the letter. Should you experience any increase in redness or itching in the days after surgery, notify your surgeon immediately.

In one to two weeks after surgery, new skin will emerge that is pinkish, finer, and free of many wrinkles. But it will take several weeks for all the redness to vanish. Follow-up care involves using sunblock in order to protect the skin while new pigment is created. Patients will notice that the skin remains lighter for a long time after surgery, but that condition will usually subside when the skin’s pigment level has been restored.

Facial plastic surgery makes it possible to correct many facial flaws and signs of premature aging that can undermine self-confidence. By changing how you look, cosmetic surgery can help change how you feel about yourself.

Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve major deformities or accidental skin injuries may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.

© Copyright 2000 American Academy of Facial and Reconstructive Plastic Surgery

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UNDERSTANDING VARIOUS TREATMENTS OF FACIAL WRINKLES
The gradual development of facial wrinkles, whether fine surface lines or deeper creases and folds, is the classic early sign of accumulated skin damage and inevitable aging. Premature aging and wrinkling of the skin may be accelerated by excessive exposure to the sun and other elements, overactive facial expression muscles, the frequent use of tobacco products, poor nutrition, or skin disorders. Fine surface wrinkles that progress to deeper creases, deepening facial expression due to repeated skin folding, and deep folds which develop with one’s maturity are obvious changes which may combine to portray a less desirable appearance. Persistent facial lines, especially those involved in negative emotional expressions, may mistakenly portray to others, the look of worry, anger, anxiety, disgust or sadness, despite one’s own positive internal feelings. Regardless of the cause of facial creases or folds, safe and successful treatments for reduction or elimination of these problems are now available with the help of a Facial Plastic Surgeon. Injecting or implanting substances which either temporarily weaken the muscles or act as skin volume fillers serve to soften or eliminate the appearance of wrinkles and produce a more youthful, rejuvenated appearance.

Treatments for facial wrinkles are usually performed in the office setting which is convenient, private, and safe for persons who desire therapy. Your health, in conjunction with the appropriate therapy to achieve your goals, is given full consideration by your Facial Plastic Surgeon prior to the any decision to undertake specific treatment. However, very few individual health problems would limit the use of these therapies due to their minimally-invasive methods of application. Your concerns and any medical requirements for each facial wrinkle therapy will be part of the consultation with your surgeon.

UNDERSTANDING TYPES OF TREATMENTS FOR FACIAL WRINKLES
Prominent forehead creases, brow furrows or eye lines (crow’s feet) produced by specific facial expression muscles repeatedly creasing the skin may be effectively treated by reducing the function of specific facial muscles. Botulinum toxin (Botox) is a sterile, purified protein produced from the bacteria, Clostridium botulinum, in the laboratory. Botox injected in small amounts into facial muscles binds to the nerve endings supplying the muscle and prevents nerve impulses from traveling to the muscle. When injected into muscle, it weakens or paralyzes the muscle around the area injected for a typical period of several months. The resultant weakening or paralyzing effect on the facial muscle temporarily reduces or eliminates previous skin creasing and new skin creasing is avoided. Botox may take several days to have its effect, and the effect typically lasts 3-6 months, in most individuals, before full muscle movement returns. At that point further treatment may be elected.

Injectable collagen is an animal protein filler material formulated for safe use in nearly all areas of the face, including the lips and crow’s feet. Fine wrinkles are filled in by the material to reduce their visibility. Other prominent facial creases and folds around the forehead, cheeks and chin can be treated as well with this material. Initial collagen allergy testing must be performed, and repeated treatments every 2-4 months are typically needed to sustain the desired result. The treatments are easily performed in the office and usually have minimal side effects.

Human collagen matrix, is an implant used for the reconstruction of soft tissue defects. It may be threaded beneath the deep creases of the brow or cheek folds or placed within the upper and lower lips, to flatten and reduce wrinkle visibility. Typically, this material maintains the majority of its volume correction similar to injectable collagen.

Another type of implant is a nonresorbable synthetic polymer material, ePTFE which may likewise be used in the forehead, cheek folds, and lips to produce volume enhancement and effacement of deep facial creases. This material does not incorporate into surrounding tissue, but it does not lose volume either. It provides more lasting change and may be placed during an office procedure using local anesthetic and small incisions with a relatively short recovery period.

Fat grafting creates a natural augmentation for the face, especially for the lips and mouth region. Fat is usually harvested from the abdomen and about one third of the volume remains after the treatment. Fat grafting can be repeated for additional fullness.

MAKING THE DECISION FOR A SPECIFIC THERAPY
Expectations of any facial wrinkle therapy must be realistic. While an expectation for the complete and permanent removal of facial wrinkles for those persons considering treatment may be attractive, it is unrealistic, due to the ongoing nature of wrinkle formation and the currently available methods for treatment. The patterns and severity of facial wrinkle formation are highly individual. Therefore, after consultation with your surgeon, the appropriate therapy for your specific problems must be tailored to meet your needs. Management of many facial wrinkles may require repeated treatments or the use of combinations of treatments to achieve optimal results. The goal is to improve or reduce the appearance of the wrinkle or crease. This can be accomplished by reducing skin folding caused by underlying facial muscle action, as in botulinum toxin therapy. Alternatively, the skin beneath the wrinkle can be augmented to efface the wrinkle with injected or inserted filler material. The choice of a type of therapy depends on the location and extent of the wrinkles, the desired duration of the effects, and the tolerance for potential side effects. All of these treatments provide additional and complimentary aesthetic benefits when combined with another facial rejuvenation procedure such as facelift, browlift, blepharoplasty or skin resurfacing.

WHAT TO EXPECT AFTER EACH TREATMENT
In comparison to typical cosmetic surgical procedures, the office time for these procedures and the subsequent recovery period until one returns to normal function are minimal. Botulinum toxin therapy typically takes a few minutes to perform, and most patients may return immediately to home or work. Minor local irritation, redness, bruising, or swelling at the injection sites are the most commonly observed side effects, all of which typically abate within a few hours. Likewise, collagen or human dermal injection therapy can be accomplished with a 5-15 minute procedure with similar attendant side effects. Some mild irritation at the injection sites is unavoidable but can easily be camouflaged with standard make-up, if necessary.

Filler implant insertions typically take up to an hour to perform in the office, depending upon the number and extent of treatment locations. Several sutures are used to close the insertion site. More swelling redness, and discomfort may accompany these procedures, which require the use of a local anesthetic. Local application of cold compresses may feel comforting. Most early swelling subsides within a day or two, though minor swelling and irritation may last for several weeks during the implant healing phase. Your activity level and medication for pain after the procedure are dependent upon your doctor’s recommendations.

Insurance does not generally cover surgery that is purely for cosmetic reasons. Surgery to correct or improve facial scars or contour deformities resulting from injury may be covered. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.