Laser Skin Resurfacing: Trendy 'Wrinkle Zapper' or Proven Treatment?

Laser Skin Resurfacing: Trendy 'Wrinkle Zapper' or Proven Treatment?

If you read newspapers or magazines, or watch TV, I'm sure you've heard about laser skin resurfacing by now. This highly popular plastic surgery procedure has received a great deal of press coverage in recent past. It has been widely touted as a 'miracle' cure that safely smooths and diminishes facial wrinkles and lines, acne scars and surgical scars, 'crow's feet' around the eyes and other signs of aging. Separating the "hype" from the "truth" is important, however, especially if you, yourself, are considering this treatment.

Is it a miracle cure?

Laser skin resurfacing involves using a special laser to remove wrinkles, acne scars, chickenpox marks, and other permanent blemishes and imperfections from the face. In the past, the removal of wrinkles, acne scars, and the like from the face would have required other treatments, depending on exactly what was to be removed. These treatments include dermabrasion, where the outer layers of skin are actually "abraded" or sanded away, deep chemical peels, collagen injections, or more traditional surgery, where the surgeon cuts away the undesired tissue with scalpels and other surgical instruments. Many wrinkles are also removed, of course, during face lifts.

What makes laser skin resurfacing so attractive is that it gives the surgeon very precise control over the exact tissue to be removed, while minimizing harm or trauma to underlying or surrounding tissue. Additionally, because of the laser's exceptional precision, it allows the surgeon to work on areas of the face, such as close to the eyes, where other treatments might prove risky. In the right hands, laser skin resurfacing is very safe; it's also a quick procedure (relatively speaking), and patients recover quickly. It can produce dramatically positive results.

One should bear in mind, however, that laser skin resurfacing is not the only treatment in a plastic surgeon's "bag of tricks," and it certainly will not be effective for all patients, under all circumstances. What it does offer, however, is a new option in the art and science of appearance enhancement. Laser skin resurfacing can be used alone or in conjunction with other plastic surgery procedures -- to enhance the results of face lifts or eyelid lifts, for example. It pays to be smart about the procedure, to ask questions about it, and to understand its risks and benefits. This is true with any surgical procedure, and it's part of being a wise healthcare consumer.

In a nutshell: the advantages of laser skin resurfacing

How do laser treatments stack up against collagen and chemical peels?

Filling wrinkled areas with collagen is a temporary solution, at best. It must be repeated at regular intervals. Medium depth chemical peels can remove finer lines and wrinkles, but they aren't effective against more pronounced wrinkles and lines. Deep chemical peels can do a good job eliminating wrinkles. One of their problems, however, is less control over how much tissue will be removed compared to the laser. Also, deep chemical peels containing phenol can cause unwanted, possibly dangerous side effects if the chemical gets into your system. They also tend to give a white, waxy appearance to the skin after multiple applications.

Why laser skin resurfacing is not a passing "fad" type treatment

Before the procedure...

A medical history will be taken to determine your overall state of health. Your surgeon will specifically want to know if you've used oral Retin-A within the preceding year, or if you've had facial surgery during the previous six months. Prior poor wound healing, keloid scar formation, and extreme sun sensitivity are other factors your surgeon will consider. In some cases where hyperpigmentation a concern, patients will be given bleaching agents in advance of the procedure. Patients with a history of herpes simplex are given acyclovir five days prior to surgery for a total of fifteen days. If you are a smoker, your surgeon will advise you to stop smoking for a period of time before and after the surgery, since smoking constricts blood vessels and interferes with optimum wound healing.

The procedure: What can you expect?

In 99% of cases, laser skin resurfacing is an outpatient procedure -- meaning that no hospitalization is required. I perform laser resurfacing at an outpatient surgical center, where costs are less than in a regular hospital, but where I have easy access to the equipment and personnel I need.

You will be given injections of lidocaine or other local anesthetics in the facial areas where laser skin resurfacing is to be performed. This will make your face insensitive to any sting, burning or pain from the laser. Most patients describe the injections as the worst part of the procedure. It's similar to going to the dentist and getting a shot of Novocain before getting a filling or a crown. But great care is taken to make you, the patient, as comfortable as possible. (Many patients say that going to the dentist is actually worse.)

Once your face is anesthetized, the laser work commences. Your eyes will be shielded with special glasses or other protectors, so that your eyes will be safe at all times from the laser. As a safeguard, the laser has a special built-in system that allows the surgeon to confirm that it's focused on the area to be treated before any laser energy is delivered. As old tissue is removed by the laser, your surgeon will wipe the debris away with gauze soaked in salt water. The entire procedure takes 30 minutes to an hour and a half, depending on how much skin surface is to be treated. After the procedure, your surgeon will apply a special cooling dressing to the treated areas of your face.

What can you expect post-operatively?

You probably won't want to attend parties or other public events for a while after laser skin resurfacing. Your face will be red, yellow, scabbed, swollen, and will ooze for a while. This, I know, doesn't sound very appealing, but it passes quickly and it's a normal part of the process, medically speaking. You will be given oral antibiotics to lessen the chance of infection, which is a risk accompanying almost any surgical procedure. You will also be instructed to keep the treated area moist with antibiotic ointment or petrolatum, and to change your dressings often.

Some patients experience a burning sensation postoperatively. To minimize this discomfort, your surgeon will have you take Tylenol or generic equivalent (acetaminophen). You shouldn't experience a great deal of pain. If stronger pain medication is required, your surgeon will prescribe it for you.

Some patients have a problem with itching as the skin begins to heal. This is normal, but you should resist the temptation to scratch, as this can cause infection and damage the results.

In 10 days to two weeks, the redness of your face will give way to a lighter pinkish color. This is easily camouflaged with cosmetics and should disappear entirely in one to three months. During the healing process, your surgeon will tell you to use sunscreen with SPF 15 protection against both UVA and UVB rays, and to avoid sun exposure for several months. This is to help you avoid changes in pigmentation (coloration or discoloration to your skin). Most patients will see improvement about two weeks after the procedure.

Laser skin resurfacing can help banish or "soften":

Are you a candidate for laser skin resurfacing?

Several factors are taken into account in determining if laser skin surfacing is appropriate for you. These include your medical history, age, skin type (including pigmentation), and the results you desire. In some cases, another plastic surgery procedure may provide better results. In other cases, laser skin resurfacing can be used in conjunction with, or after, a surgical procedure, to enhance its effects. Sometimes more than one laser skin resurfacing treatment will be required to produce optimum results. In general, laser skin resurfacing tends to work best on fair-skinned individuals, but often surprisingly good results can be obtained in individuals with darker skin as well.

Good questions to ask your prospective physician

Before you consent to laser skin resurfacing, be sure to ask many questions of the physician offering the treatment. For example:

Does insurance cover laser skin resurfacing?

Unfortunately, since it's considered a cosmetic procedure by insurance companies and managed care organizations, the patient must usually pay, unless the surgery is used to remove pre-cancerous areas.

The cost can run from $1,000 to $4,000 or more, depending on the surgeon's fees, area of your face to be treated, the number of treatments required, where in the country the surgery is to be performed, and associated charges (such as outpatient facility charges, anesthesia, and so on).

About the author: Dr. Christine Rodgers is a Board Certified Plastic and Reconstructive Surgeon with a private practice in Denver, Colorado USA. You may contact her at: Christine M. Rodgers, M.D., 4600 Hale Parkway, Suite 430, Denver, Colorado 80220 USA, Telephone: (303) 320-8618.

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