ProvidersUsha P. Reddy, MD
Although lasers have been utilized in medicine for many years, new technology has allowed us to predictably and precisely smooth and rejuvenate aged and sun-damaged skin. Laserbrasion is indicated for the softening/removal of facial wrinkles, the elimination of superficial sun or age spots, the camouflaging of scars (whether secondary to injury, acne, chicken pox, etc.), or the improvement of one’s overall facial complexion. The laser-treated skin is removed in sequential layers to achieve the desired goal of surgery. The initial pass results in the removal of the top layer of skin (epidermis), while deeper passes extend into the lower skin layer (dermis) for tightening of the collagen and the elimination of abnormal skin pigmentation. The advantage of this technique includes no significant bleeding and minimal post-operative pain. The laserbrasion procedure is often used in conjunction with “lifting procedures” (facelift, eyelid surgery, or browlift) to smooth as well as support the sagging tissues.
Some skin types tolerate laserbrasion better than others do. Individuals with a fair complexion are usually better candidates than those with an olive or brown complexion, because they typically have less pigmentary changes observed during the healing process.
For those individuals who are interested in laserbrasion, we recommend a consultation to discuss the areas you desire to improve and how you can achieve the best result. Once your laser treatment is scheduled, you will be given several prescriptions in preparation for the procedure. These include: 1. Retin A, a cream that helps to prepare the skin for laser treatment by thinning the top layer of epidermis and promoting post-operative healing. 2. A hydroquinone (bleaching cream), which stops the production of pigment formation in the skin. This will help to prevent the skin from hyperpigmenting (turning brown) after the laser treatment. Both of these medications are typically started 3-4 weeks pre-operatively and are utilized up until your day of surgery.
Laser skin rejuvenation is performed in our office under local anesthesia. Sedation, either oral or intravenous, may be provided depending upon the extent of the laser treatment. We do ask that you come to the office approximately one hour prior to your scheduled surgery. Medications are given before the operation to help prevent infection, promote healing, and reduce post-operative swelling. The procedure will require from ½ hour to 2 hours depending upon the total surface area of your face being treated. During the laserbrasion your facial skin is numb, but on a rare occasion you may feel a warm or stinging sensation as the laser is systematically moved around the face.
Following laser therapy, the treated areas will be red with a tendency to weep and form a thin crust. These areas will be covered with a clear, semi-permeable occlusive dressing (Second Skin) and Aquaphore, a soothing gel. Cold compresses will also be utilized as needed. These measures will help to facilitate healing, reduce swelling, and decrease pain (some burning and stinging is expected). Crusting of the skin will be noted to a mild to moderate degree. Do not pick any crusts but gently pat these areas with your fingertips while washing. The treated areas should be rinsed with lukewarm water 4-5 times per day, cleansed with a mild soap (Cetaphil), then covered with the Second Skin for the first 4 days, followed by Aquaphore, until a new layer of skin has formed. No makeup should be applied until the new layer of skin has completely formed in 10-14 days.
Following new skin formation, water-based makeup can be used to camouflage the treated areas. We recommend a green-colored base followed by additional makeup as desired. A sunscreen (at least SPF15) is also recommended for a minimum of three months. Redness will fade gradually over a period of 2-4 months depending on your skin type and the depth of the laser treatment. On rare occasions, fading may not be complete until 6 months or longer. No activities where you exert yourself should be participated in until the new layer of epidermis (skin) has formed. Even after initial healing, exercise will cause a temporary flushing (or increase redness) in the treated area, depending upon the areas treated, most people can return to work once a complete layer of new skin is formed and makeup can be applied for camouflage (10-14 days).
While the laserbrasion procedure lessens wrinkles and pigmentation changes, it will not correct areas of skin laxity; this would require surgery to remove, lift, and tighten the skin. The skin of your neck cannot be safely laserbraded because of an increased risk of scarring and unpredictable healing. There are other options for treating this area. Laserbrasion may not entirely remove deeply etched wrinkles. In some cases, we recommend a second laserbrasion treatment 3-6 months later for additional benefit.
Laserbrasion can result in a slightly increased pigmentation of the skin. This occurs most often in darkly pigmented skin, especially following exposure of the treated areas to the sun. Avoidance of sun exposure for 3-6 months as well as the use of bleaching creams may be necessary to help correct this problem. There is a small risk of scarring following laserbrasion. Adherence to the post-operative instructions will significantly decrease the risk (<1%). The treatment for residual scarring is dependent upon its location and extent but may include massage, cortisone injections, and/or excision.
Laserbrasion, while a remarkable new treatment for the correction of aged and sun damaged skin, is not a panacea. Our goal is to create an overall improvement in the appearance of your facial skin while avoiding potential complications. We will do our utmost to make this a pleasant experience that will provide pleasing, long-term results.