WHAT DOES THE SURGERY INVOLVE?
Laser resurfacing involves the use of a carbon dioxide laser to precisely remove the outer layers of skin. It is an extremely effective method of removing wrinkles and improving acne scars.
As our skin ages, we develop fine wrinkles on our faces and so-called ‘smokers’ lines’ on the lips. These happen as a consequence of our genetic makeup, sun exposure, environmental pollution and whether we smoke or not. Although historically these lines have been treated by deep phenol peels or dermabrasion, the resurfacing laser provides the safest most controllable method for getting rid of these lines. The laser works by targeting water in the outer cell layers of the skin and vaporizing layer upon layer of skin cells in a very precise and controlled way. Small areas of the face can be treated with local anaesthetic alone but for the whole face general anaesthesia is necessary. Antiviral prophylaxis is given to all patients starting 48 hours prior to treatment to prevent any coincidental cold-sores popping up and potentially creating a visible scar in the treated area. Special goggles need to be worn in order to protect the eyes from the laser light in the operating theatre. Gradually and carefully the layers of skin are removed until the ideal depth is achieved and certain key changes are seen. The deeper winkles are given extra treatment and then a light pass with the laser is made just outside the treated area in order to blend the edge in. A special post-laser resurfacing healing cream is then applied to the face and the patient is discharged home.
ARE THERE ANY SCARS?
No – the face is not cut in any way, it simply has the outer layers of skin removed. Extremely rarely, delayed healing may lead to reddened thicker patches within the treated area, so called hypertrophic scars.
IS IT PAINFUL?
The laser does create discomfort in the face similar to a partial thickness burn. This is soothed by application of the special post-laser cream and patients are offered a short course of pain killers on discharge from hospital.
WHAT HAPPENS AFTER SURGERY?
Patients are discharged home the same day (except those undergoing full face treatment who are kept in overnight and discharged the following morning). Patients should wash their face in lukewarm water with a non-perfumed soap and gently pat the treated area dry with a clean, dry towel three to four times per day prior to applying more healing cream. Patients can cool their faces with a fan but must always try to keep the treated area moist under a layer of cream. The treated area will be red and ‘oozy’ for several days. The underlying soft tissues will swell and remain red and raw until approximately nine to 14 days after treatment when it should be fully healed. The patient is followed up in the clinic two weeks after the laser treatment when things should be settling nicely but the treated skin will still be quite red. As soon as the skin has dried up (re-epithelialised) it is possible to conceal the post-laser redness with moisturising makeup (preferably one with a SPF factor of 30 or above). The redness takes five or six weeks to fade but can be covered with makeup until it has faded completely. The treated skin should be protected from the sun for at least six months following lasering as it will initially have a tendency to become darker than the surrounding skin (hyperpigmented), and then will gradually lose its pigment and be slightly hypopigmented (paler) in the long term. With the lower Fitzpatrick skin types that we have in the UK, long term pigment changes are estimated to occur approximately 15% of the time. Sun sensitivity can also occur and sunblock (SPF factor of 30 or above) must be worn in the UK for the first summer after treatment. Any treatment which provides significant tightening of the skin and loss of wrinkles causes post-treatment redness and pigmentation changes. TCA peels come nowhere near to the laser in terms of effectiveness and controllability. Deep phenol peeling or dermabrasion are just as likely to cause redness and pigment changes as the laser as these are depth and skin-type related issues rather than operator dependent issues.
WHAT COULD GO WRONG?
Scarring is extremely unlikey as the laser is so controlled and precise. Long term redness and pigmentation irregularities can occur but are also rare. Infection of the treated area is also unlikely as the patient is already taking antiviral prophylaxis.
Darker skin types require a test patch in an inconspicuous area prior to having a facial treatment in order to see how the skin responds.