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 doctor. Your doctor has the preference to consider the results, the possible complications, and the alternatives.

What Can Laser Surgery Do For You?

The use of lasers in medicine is complex, and your doctor is trained in the use of lasers and understands how and when to use a laser. Your doctor 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 doctor 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 doctors 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 doctor 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.

An Alexandrite-laser (755nm) is used to treat benign pigmented lesions such as lentigines and age spots on the face and hands.

Superficial telangiectasia are reduced by using a neodymium:YAG (Nd:YAG) laser (1064nm) on the face, decolletage and legs.  Deep red and dark blue blood vessels respond very well to this kind of laser treatment.

The Elite removes unwanted hair with unsurpassed efficacy and client comfort. That's because its revolutionary technology combines two optimal wavelengths in one system: the 755-nm Alexandrite laser and the 1064-nm Nd:YAG laser.

Easy, Safe, Effective And Fast

The 755-nm wavelength, as found in our Candela GentleLaser Pro laser, has high melanin absorption characteristics and proven long-term results for permanent hair reduction and pigmented lesion removal. It is the gold standard in laser hair reduction.

The high-powered 1064-nm Nd:YAG is the safest wavelength for permanent hair reduction on darker skin types and tanned skin. It is also the wavelength of choice for treatment of facial and leg veins—the most common form of vascular lesions.

The Elite delivers high fluence from large spot sizes-ensuring deeper penetration, faster treatment sessions and optimal results.

Understanding The Surgery

After your doctor has indicated that a laser can be helpful in the surgery, your doctor 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 doctor will give you the best judgment for the particular procedure.

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

Because safety is a major component of laser use, your doctor 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 Laser 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 doctor, 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 doctor 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.

Aging, sun exposure, heredity and lifestyle factors including nutrition, alcohol consumption and smoking all may contribute to facial wrinkling.

Pigmentary changes of the skin, such as blotchiness or brown spots, may also occur with age or as a result of birth control pills, pregnancy or genetic factors. Prior acne may have made the surface of your skin uneven. These problems, as well as certain other skin conditions, may be improved by skin resurfacing.

You may be a good candidate for skin resurfacing if you have one or more of the following conditions:

1. •wrinkled or sun-damaged facial skin
   

2. •vertical wrinkles around your mouth, such as those that cause lipstick "bleed"
   

3. •"crow's feet" lines around your eyes and perhaps some skin laxity in your lower eyelid area
   

4. •fine wrinkling of your upper eyelids
   

5. •brown spots or blotchy skin coloring
   

6. •certain precancerous skin growths
   

7. •acne or chicken pox scars
   

8. •superficial facial scars from a past injury
   

Patients may have their skin resurfaced at almost any age. You may have certain characteristics that make you a better candidate for one technique rather than another, or your doctor may have a preference based on his or her personal experience with the different methods.

The amount of time you can allow for recovery also may be an important factor in selecting a particular resurfacing method or determining the extent of treatment. All resurfacing techniques can be performed to varying depths.

A more superficial treatment will require less healing time, but you may need to have the procedure repeated more than once to achieve the same results as a deeper treatment. If you are having aesthetic (cosmetic) surgery, such as a facelift or eyelid surgery, you may be able to have a skin resurfacing procedure performed at the same time.

How will my doctor evaluate me for skin resurfacing?

Your doctor will carefully examine your skin to determine which resurfacing technique, or combination of treatments, will provide you with the best results. Your skin type, the severity of any sun damage, the extent of uneven pigmentation and the depth of skin imperfections will be evaluated. Fine lines, coarse wrinkling or deep acne scarring each may require a different approach to treatment.

You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. Be sure to tell your plastic doctor if you have ever had x-ray treatments of your facial skin such as those used in the treatment of acne or if you have had a prior chemical peeling procedure. Current or past use of Accutane, as well as Retin-A and other topical skin preparations, must be reported to your doctor. For your safety, it is important that you provide complete information.

Skin Resurfacing Techniques

Chemical peels, dermabrasion and laser skin resurfacing all achieve results in basically the same way. Layers of your skin are removed and, as the healing process progresses, a new, healthier-looking skin emerges. What differentiates the various resurfacing methods is the way in which the skin's layers are removed. Chemical peels involve the application of a caustic solution, dermabrasion utilizes high-speed rotary wheel, and laser resurfacing uses a laser beam.

Deep Laser Resurfacing (Laser Peel)

Indications for erbium-YAG (Er:YAG) laser resurfacing include fine lines, facial scars, sun damaged skin and uneven pigmentation. The laser works by removing areas of damaged or wrinkled skin layer by layer due to the absorption of the laser’s energy by water molecules in the skin. The most common application is for removal of fine lines, especially around the eyes and mouth, but the procedure can be used on the whole face. It can also be used in conjunction with other procedures, such as rhytidectomy or blepharoplasty. Patients with fair, healthy, non-oily skin are the best candidates for this type of treatment.

Depending upon the area to be resurfaced, operating time ranges from a few minutes to more than an hour. In some cases, the patient may need more than one laser session to achieve the desired result. The patient usually receives treatment under local anesthesia with sedation in an outpatient setting, but for extensive procedures, hospitalization and general anesthesia may be required.

Temporary side-effects include swelling and mild discomfort. Laser resurfacing produces little (if any) bleeding and post op discomfort is usually mild but may result in pain in the early post op period.

Risks include burns and other injuries associated with the heat of the laser, scarring, abnormal pigmentation and infection. Susceptible patients may also experience a flare-up of herpes virus (cold sores).

The new skin generally becomes crust-free about ten days post-operatively, but the patient's skin may remain bright pink for weeks. In some cases, pinkness does not fade entirely for up to six months. The patient should avoid sun exposure until all skin color has returned to normal and should wear sunblock outdoors thereafter. The patient can begin wearing makeup about two weeks after surgery, depending on the sensitivity of their skin.

Results of laser resurfacing are long-lasting, but not permanent. Treatments do not prevent the development of deeper wrinkles with aging.

Understanding Risks

Skin resurfacing procedures are generally safe when performed by an experienced doctor. The various resurfacing techniques discussed here have similar types of risks, although there are some differences. for example, infection or abnormal healing are infrequent but may occur with any of the treatments. If you are prone to skin disorders including allergic reactions or herpes, skin resurfacing can cause eruptions of these conditions. Even an AHA peel, which is the most superficial of the resurfacing techniques, may occasionally produce temporary minor skin irritation. Tiny whiteheads may develop on the skin following some procedures. These usually disappear with use of a mildly abrasive cleanser but occasionally may require removal by your doctor or a staff member in your doctor's office.

Some individuals have a tendency to form raised or thickened scars, and this may be unpredictable. Medications are available to treat such complications, but in rare cases some degree of scarring may be permanent. While the bleaching effect of a phenol peel is to be expected, other types of peels, dermabrasion and laser skin resurfacing sometimes may produce unanticipated color changes or skin blotchiness.

Following all resurfacing treatments, it is important that you avoid direct or indirect exposure to the sun until all the redness or pinkness of your skin has subsided. Even after that, it is advisable for you to protect your skin by regular use of a sunblock and, whenever possible, a wide-brimmed hat. This is particularly important if you have had a phenol peel which eliminates your skin's ability to tan. If the area around your eyes has been treated, you should wear good quality sunglasses when outdoors. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water.

You can minimize certain risks and help to maintain the results of your skin resurfacing treatment by following the instructions of your doctor.

How should I prepare for skin resurfacing?

Prior to a deeper chemical peel, laser resurfacing, or less often, dermabrasion, your plastic doctor may place you on a pretreatment program during which you will apply special creams, lotions or gels to your skin for a few weeks or longer. You may also be given certain oral medications that you should begin taking prior to your treatment. Your doctor will provide you with additional instructions.

Your skin resurfacing treatment may be performed in your doctor's office, a free-standing ambulatory facility or a hospital. You should arrange for someone to drive you home after the procedure and probably assist you for a day or two.

What will happen immediately before and after the treatment?

Medications will be administered for your comfort prior to the treatment. Frequently, local anesthesia alone or combined with intravenous sedation is used for patients undergoing skin resurfacing procedures.

When the treatment is completed, your resurfaced skin may be covered with petroleum jelly or other protective ointment. In some cases, dressings, tape or a bandage may be applied.

How will I look and feel initially?

Deeper chemical peels, dermabrasion or laser skin resurfacing will produce redness and swelling to varying degrees. Depending on the post-treatment regimen selected by your doctor, a scab may or may not form over the treated area. You will be advised about cleansing your skin, as well as if and when you should apply any ointments. In the case of men who have undergone resurfacing procedures, shaving must be delayed for a while. It is essential that you follow your doctor's instructions and avoid doing anything that might interrupt the healing process.

About seven to ten days after your skin resurfacing procedure, a new skin will have begun to form. After the initial redness subsides, your skin may be pink for several weeks to months. Camouflage makeup usually can be used within a couple of weeks, but your doctor will advise you.

Results of Skin Resurfacing

Because of the persistence of skin pinkness following many types of resurfacing procedures, it may take months before you can fully appreciate your new look. Most patients feel that the results are definitely worth waiting for and, in the case of deeper treatments, the benefits are relatively long-lasting. Superficial resurfacing procedures, such as light chemical peels, may need to be repeated periodically in order to maintain their benefits.

Your skin will, of course, continue to age. Also the type of wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may recur sooner than others, depending on their location as well as the type and extent of your resurfacing treatment. Despite this, you can expect that improvements in skin quality and texture achieved by resurfacing will make your complexion appear younger and fresher for many years to come.

When can I resume my normal activities?

Depending on the type and depth of your skin resurfacing, straining, bending and lifting should be avoided during the early period following your procedure. For deeper resurfacing, you should be able to return to work within a week or two, less for superficial peels such as glycolic acid.

Maintaining a Relationship with Your Doctor

You will return to your doctor's office for follow-up care at prescribed intervals, at which time your progress will be evaluated.  Please remember that the relationship with your doctor does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your doctor.

To visit Sciton’s website for further details regarding the Contour Laser, click here.

MicroLaserPeel®

What is a MicroLaserPeel®?

A MicroLaserPeel® removes a thin layer of damaged skin to improve texture and provide a more youthful appearance.  It provides superior results because it can be administered with great precision of depth. The procedure is performed in your physician’s office and can be custom tailored to your specific skin conditions and desired outcome.

How does MicroLaserPeel® work?

The MicroLaserPeel®’s beam is scanned over a treatment area to remove a very thin layer of the skin. Removing the top layer eliminates some of the damaged cells that can give skin a tired, aged look. As the skin heals, fresh cells grow and resurface the treated area. The result is healthier-looking skin, often with reduced wrinkles and improved color evenness. Patients often say that it looks like their skin went from looking tired to vibrant.

What conditions can be treated with MicroLaserPeel®?

• Mild wrinkles

• Scars

• Keratosis

• Sun damage (e.g., freckles)

1. •Pigment irregularities
   

What areas of the body can be treated?

Most skin areas can be treated. Popular treatment areas are the face and neck, though some people also treat the chest and hands. You should discuss your needs with your physician.

How many treatments will I need?

Excellent results can be obtained in just one treatment, however the number of treatments needed may vary from patient to

patient. Your physician can personalize a plan based on your specific needs and may chose to combine MicroLaserPeel® with other aesthetic procedures to further personalize your treatment.

What will happen during the procedure?

Your skin will be cleaned in the treatment area and your eyes will be protected with safety shields. The physician will position the laser hand piece above the skin and will hold it in place as the computer-guided scanner moves the laser beam around the treatment area. Depending on the size of the area being treated, the procedure usually lasts 15 to 30 minutes.

Will it be uncomfortable?

One of the primary advantages of MicroLaserPeel® is that it causes little pain because it does not penetrate very deep into the skin. At its most shallow settings, most people can tolerate treatment with no anaesthetic at all. At deeper settings, a topical numbing cream is typically used.

What should I expect immediately after the treatment?

Immediately after the treatment you will notice that the skin has a “frosty” appearance. This is the dehydrated skin that will peel away within next few days following the treatment.  You may experience some skin redness and a sensation resembling sunburn, as well as mild swelling.

How long will it take to recover?

Depending on the depth of treatment, most patients feel comfortable enough to return to work within 3 to 4 days – an attribute that has given rise to the nickname “the weekend peel.”

What aftercare do I need?

You may be given skin care products and instructions on how to use them. Your skin will be sensitive to ultra-violet light after the procedure, so you must avoid direct sun exposure until fully healed. It is recommended that you always use some level of solar protection to avoid sun damage and premature aging of your skin.

When should I expect results?

Because only the outer layer of skin is treated, most patients notice an obvious improvement in tone, texture and color evenness once the skin heals in approximately 3-4 days.

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