What is laser resurfacing?
Laser resurfacing is a technique to improve wrinkles, discolorations and acne scars of the face. Resurfacing techniques involve ablation of the epidermis, the superficial layer of the skin, and a variable depth of ablation of the dermis, the structural supportive layer of the skin. Following this ablation, re-healing of the skin from deep epithelial elements occurs and skin is fresher with diminished wrinkles or scar irregularities.
Laser resurfacing is used primarily for facial scar improvement (especially post acne scar treatment) and for facial aesthetic enhancement to tighten skin and soften wrinkles.
There are three ways to achieve effective skin ablation for resurfacing. These are:
a) Chemical peeling, whereby an acid is used to burn into the skin layers: this is effective but messy and lacks control.
b) Dermabrasion whereby a physical abrasion with a burr denudes the skin: again this is messy and not that controlled – but when done effectively works well
c) Laser ablation whereby a high powered focused beam of light ablates skin layers into the dermis : because the light beam seals blood vessels, this is a relatively clean and neat procedure. Also, because te amount of energy delivered to the skin can be carefully controlled, this is a relatively precise technique with accurate control of the depth of ablation achieved.
Laser Resurfacing is now preferred to dermabrasion and chemical peel or can be used in conjunction with other facial rejuvenation procedures.
|Operating Time:||.5 to 3 Hours depending on areas treated|
|Hospital Stay:||Usually day stay surgery|
|Recovery Time:||Approx. 2 weeks|
The effectiveness of laser resurfacing depends on the level of ablation into the dermis. A deep resurfacing into the mid dermis will give the most effective result. This depth of burn is associated with a raw skin (like sunburn) healing phase of 7 to 10 days and a subsequent period of skin redness for a further 3 to 4 weeks. Commonly used lasers that can readily achieve the depth of burn to achieve adequate results include the carbon dioxide (Co2), erbium lasers and modern ablative FRAXEL lasers. Q-swith ruby lasers can give a gentler treatment with short downtime recovery.
The laser has greater advantages over the older methods in accuracy and precision. The laser allows the skin to be vaporised in a controlled method layer by layer.
What are the advantages of laser?
The laser seals all blood vessels and lymphatic vessels at the same time, leaving a clean dry surface to work from.
Bacteria and viruses would be killed by the intensity of the heat.
A more uniform thickness of skin can be removed at once, due to precise control.
Am I suitable for laser resurfacing?
Laser resurfacing is suitable for someone who:
- Wants to rejuvenate the damaging effects of the sun’s ageing process.
- Is concerned with the colour, texture or condition of their skin’s surface.
- Has acne or chicken pox scarring.
- Has scarring due to an injury or accident.
How long does it take?
Usually about 30 – 90 minutes, depending upon the areas to be resurfaced.
Is hospitalisation required?
Surgery can usually be performed as a day only procedure. You would be able to go home after a few hours.
Does it hurt?
Anaesthesia is required. Local anaesthesia can be used for smaller regions but general anaesthesia is used for the whole face resurfacing.
What should I expect after surgery?
Usually for the first week your skin will look grazed and scabs may form. This will be covered by regular applications of Vaseline.
Gentle skin washing with a mild soap and application of diluted hydrogen peroxide or antibiotic ointment is used to remove the yellowish crust which usually forms on the lasered area.
When the crust falls off, smooth, new skin will be healing underneath. This will be pinkish for a few weeks but will continue to fade.
A camouflage make-up can be applied to the area to blend with the normal skin colour when the skin has healed, usually 10-14 days.
You can usually return to work at about 2 weeks. For larger areas or deeper resurfacing, the area may be very red and three to four weeks off work may be required particularly if you have an occupation which requires close personal contact. Following this, you will need to wear moisturizer and sun block SPF 30+ for six months.
Will my skin be more sensitive?
For the first three months, certain creams and make-up may sting.
Is this permanent?
For scars, the unevenness will be improved and is permanent. It may never remove the scars completely but the aim is improvement. Secondary procedures are sometimes necessary to obtain further improvement. Usually 30% to 60% improvement in post acne scarring is achieved.
If you are sensible and keep out of the sun, wear sun protection and carry on with a maintenance skin care programme, your result will be optimized.
Are there any complications that may occur?
Prolonged redness: Redness will last from three weeks to 4-6 months.
Pigmentation changes: Occasionally, patients may develop irregular hyperpigmentation (brown spots) during their healing interval and these can occur up to six months after surgery. You will be provided with cosmetic products after surgery to help minimise this risk. Patients are encouraged to aggressively apply sun screen products as ultraviolet light exposure is counterproductive to achieving and maintaining a revitalised configuration for the skin. Hyperpigmentation is generally transient and resolves after 6 months or so.
Hypopigmentation or loss of skin pigment is much less common (1% or so risk). This occurs more in darker skins and does however, tend to be permanent.
Telangiectasia (fine vessels): A rare problem but recovery is quick. Further laser treatment may be required.
Milia (small cysts): These are caused by blocked pores and glands and they usually disappear in 6-12 weeks but this is also rare. Sometimes these are manually removed.
Herpes Zoster/Cold Sores: Laser may reactivate Herpes virus leading to fresh lesions following the lasering. In order to reduce the chance of Herpes reactivation, if you have a history of Herpes or cold sores, you will be prescribed antiviral tablets before and following the surgery and antiviral cream for your lips following the surgery.
Should there be any questions regarding laser resurfacing, be sure they are answered in advance by Dr Drielsma. Well meaning friends are not a good source of information. Find out everything before proceeding with the operation – a well informed patient is a happy one.
Finally, there can be no absolute guarantee with any surgery. Remember the realistic aim of this operation is improvement, not perfection.
Please note: The above information mentions only some of the benefits and complications of laser resurfacing. This information should not be regarded as a substitute for information and advice provided by Dr Drielsma during consultation.