Laser Skin Resurfacing/Chemical Peels

Laser skin resurfacing is a procedure that can take decades of aging off the face in a matter of minutes. Although chemical face peels are reliable for sun damage and fine wrinkles, the laser can address much deeper wrinkles, acne scars and other complexion problems. Ideal laser patients are those without extreme skin sagging, but with wrinkles and sun or age spots. Laser skin resurfacing can be done on patients with lax skin, although these patients may benefit from a face-lift or other cosmetic procedures at the same time. Laser skin resurfacing is still the gold standard for wrinkle improvement and to date no technology has surpassed laser skin resurfacing. The recovery is one to two weeks, but don’t be fooled by “light” lasers claiming huge results with minimal downtime. It is a myth! If you want to improve 40-50 years of aging, ten days is not an unreasonable recovery.

6 weeks after laser resurfacing with eyelid surgery

Dr. Hammond has several lasers and has performed thousands of laser procedures. These lasers are used for resurfacing (ablative lasers) and for minimally invasive (non ablative) treatments such as spider veins, facial skin pigmentation, sun damage, and skin tightening. Dr. Hammond works with several laser wavelengths for minimally ablative skin resurfacing as well as for deeper skin resurfacing. He has both the CO2 and Er:YAG lasers within his surgical center.

4 months after a facelift and laser ablation

The biggest consideration for potential laser patients is to decide what is the best laser for their specific condition. Although the CO2 laser is the gold standard for skin tightening and wrinkle reduction, it has the longest recovery time of up to 2 weeks. The CO2 laser causes redness for about one week and then the skin is pink in color for several weeks. At 10-12 days make up may be applied. If the patient can return to work with a pink (looks like sunburn) face then most patients only need a week for recovery. If the patient is in a job situation where a pink face is not an option, then two weeks off may be necessary. A popular option is to have the procedure on a Friday, then take off the weekend, the next work week and the following weekend. This provides 9 days of recovery with only one week off of work.

6 months after laser resurfacing

Traditional CO2 laser skin resurfacing remains the “gold standard” for wrinkle, pigment improvement, skin tightening and acne scars.

Don’t be fooled by pumped up and sensational claims that “new” lasers provide the same results with only several days of down time. This is impossible. Many patients have new or fractional laser procedures, spend thousands of dollars and require 3-5 treatments of painful treatment only to see little results. Having a shorter downtime is no benefit if you have to have 4-5 procedures. Do the math! A single traditional CO2 laser treatment takes about 12 days of downtime. That is not a bad deal to erase decades of aging.

Before and after a single treatment of laser resurfacing.

How Laser Resurfacing Works

The laser is a concentrated beam of light that creates a precision burn on the outer layers of the skin. A single pass with the laser will remove a very thin amount of skin, about the thickness of a human hair. Patients with minimal sun damage or wrinkles may only need a single pass. Patients with advanced sun damage, wrinkles or deep acne scars will need multiple passes. Every patient is different and there is no cookbook formula for the number of passes.

Since the outer layer of skin will be removed, several medications will be necessary to prevent infection and assist healing. The patient is prescribed an anti-herpes medication, antibiotics, as well as medication for swelling and discomfort.

The actual laser procedure takes about 45 minutes and the patient is sedated. Immediately after the laser surgery, the patient’s face will be covered with Vaseline and cold packs.

Beginning the third day a gentle cleanser is used several times per day to wash the face and the Vaseline is continued. The face is very red for the first week and fades to pink for the next week. At 10 to 12 days, the patient can wear makeup to cover the pinkness. Generally, by the third or forth week, the majority of the pinkness is gone and the positive effects of the laser resurfacing can be appreciated. Some patients may stay a very light pink for several months, but this can be covered by make up. Research has shown that the improvement of wrinkles will continue to be seen as the skin continues to heal over the course of 18 months. So, for most patients, if they look good at several weeks, they will look better at several months.

The CO2 laser has somewhat involved recovery, especially for the first 4-5 days. It is not that the patient is in severe pain; in fact some patients do not take any pain pills. The major hassle is being red and having Vaseline on one’s face for 4-5 days. After this period, the recovery improves dramatically. Like anything else in life, you get what you pay for. In this case not the money you pay, but the recovery you require. The results are usually extremely dramatic with aggressive laser resurfacing and no other therapy can touch them. It does take a little longer to heal, but if a patient wants to turn back the clock by decades, they must be able to sacrifice 1-2 weeks of work.

Complications

Like any surgical procedure, complications are possible, but are rare with experienced doctors. Dr. Hammond has performed thousands of laser procedures with multiple types of lasers.

Prolonged Redness

After the laser treatment the skin is pink. This can be covered by makeup at about 10-12 days and generally resolves in most patients by 4-6 weeks. Some patients may remain a very light pink for several months but it is always a temporary situation.

Hyperpigmentation

It is not uncommon to have increased pigmentation which happens about a month after the procedure and can occur in 30-40% of patients. This manifests as blotchy tan areas on the face and is temporary. This happens more frequently to patients that are exposed to sunlight or other forms of irritation such as wind, hair dryers, etc. This is always a temporary condition and is usually easily treated with bleaching creams.

Scarring

Scarring is extremely rare and prudent practitioners are conservative with laser treatment. It is always safe to under treat a patient and perform a touch up later. In fact, patients with significant wrinkling or acne scars may need multiple procedures. Dr. Hammond recommends waiting 12 weeks before retreating an area with the laser.

Touch Up Surgery

Many patients are completely treated with a single laser procedure, but for extreme wrinkles or acne scars touch up treatment may be required. Frequently we will treat the entire face on the first laser treatment and then for touch up procedures only certain areas of the face need to be treated.

Face and Neck Demarcation

Damages skin is darker than undamaged skin. Look at the outer surface of your forearm and it is darker than the under surface because of sun exposure over the years. The underside of the forearm is lighter. When the face is lasered, the new skin will be lighter because it is healthier. There is a demarcation between the lasered skin and the non lasered skin. Dr. Hammond will usually do a very light resurfacing of the neck and chest in order to decrease the incidence of the line of demarcation. Even if a transition line is apparent at first, it usually blends in well.

Fraxel Laser Technology For Resurfacing

Ultralight laser procedures have become very popular. Fraxel® (fractional laser) technology allows a more conservative treatment with faster healing. Instead of the laser burning the entire surface of the skin the fractionated technology leaves gaps between the treated spots. This means that the entire face is not burned and heals faster with less down time.

Is Fraxel right for you?

Fraxel is right for you if:

• Have a busy lifestyle or cannot be away from work for a long time
• Want noticeable results with minimal downtime
• Want to treat age spots, fine lines, wrinkles and skin laxity

What you can expect from Fraxel?

Dr. Hammond performs the procedure in the office with a topical anesthetic cream that is applied 30-40 minutes before the Fraxil procedure begins. The procedure can also be performed with a light IV sedation. You can drive yourself home after the procedure if performed with topical or local anesthesia. With a gentle washing and moisturizing regimen, your photodamaged skin will begin to flake off within 2 days. After about 3-5 days, you will probably be able to wear make-up. Pinkness should be gone in about a week or two.

Fraxel benefits

Fraxel treatment produces a younger and smoother skin:

• Causes immediate skin tightening
• Reduces wrinkles and fine lines
• Noticeably improves skin tone and texture
• Stimulates new collagen formation and plumps the skin
• Improves sun and age spots

The results of Fraxel laser treatment are long-term and, with proper sun protection, can persist for many years. Most effects of treatment become visible right away, whereas others such as new collagen formation, which leads to continued inner tightening build up gradually and become more evident over time. Therefore, most people look even better 3-5 months after the procedure. While some patients benefit from a single treatment multiple treatments will produce a more dramatic rejuvenation.

Deep Fractional Resurfacing

Deep FX CO2 laser resurfacing is a new technology designed to treat wrinkles, sun damage and scars with reduced recovery time. Unlike non fractional lasers the entire skin surface is not lasered. This laser produces micro columns of treated tissue surrounded by small areas of untreated skin.

Due to this, the face heals faster. Unlike traditional CO2 laser resurfacing, the Deep FX treatment does not cause a wet (weepy) skin surface, but rather heals with a dry bronze surface. This recovery is generally faster and easier than previous laser treatments.

The main reason that differentiates the Deep FX treatment from other laser treatments is the depth of penetration of the laser. This laser is designed to penetrate the skin to greater depths than previous lasers which improves the result. One other difference is that the deeper treatment stimulates the collagen and the final result may not be completed until 90 days after the procedure.

A skin rejuvenation program is often used in conjunction with either chemical peels or laser wrinkle removal to reduce the fine wrinkles of the face, lighten areas of hyper-pigmentation, and produce a softer texture to the skin. The program can be accomplished separately or in conjunction with the other procedures listed here. It is followed at home by the patient after a consultation and a treatment plan is established for the patient’s cosmetic needs. Our skin care department is dedicated to providing you with the latest and most effective skin treatments available.

We invite you to inquire about laser skin resurfacing and hope it can help you achieve smoother, fresher, younger-looking skin.

Chemical Peels

Chemical face peeling is a time tested technique that when performed properly provides significant rejuvenation with minimal healing time.

There are many types and levels of chemical peels that vary from extremely superficial peels to deep peels. The very superficial chemical peels may be performed by beauty salons or non-medical facilities. Although these “lunch time” peels provide some benefit, they are in no way as effective for rejuvenation as the deeper peels. The deeper face peels require IV sedation for pain control. All of the discomfort happens while the patient is sedated. After this, the healing is virtually pain free. The face feels tight and small areas of irritation may be noticed, but the pain is much less than a sunburn.

Chemical face peeling can improve fine lines and small acne scars. The main benefit of chemical face peeling is a rapid turnover of the skin cells which causes the formation of new collagen. This causes a generalized tightening of the skin and eliminates much of the superficial pigmentation such as sun spots, age spots, liver spots, freckles and blotchiness.

Trichloroacetic acid (TCA) is a common peeling agent that can improve fine wrinkling and pigmentation problems. This type of peel is done with IV sedation. The TCA solution is applied to the face and reacts with the skin. The procedure takes about 30 minutes. The patient feels like they have sunburn for the first day. At 4-5 days, the skin begins to peel and the “new” skin becomes visible. The improvement is obvious immediately and is much smoother than before the peel. Most of the abnormal pigmented areas are cleared as well. Most patients heal by day 7 and are back in makeup. Patients usually miss one week of work when recovering from a face peel. This is one procedure that has virtually no post operative pain and the patient could actually not miss any work if they were not interacting with the public. The peeling skin would be quite visible, but again, it does not hurt or prevent the patient from working.

Post Chemical Peel Hyperpigmentation

Many laser or chemical peel patients can experience temporary hyperpigmentation (blotchy tan coloration of the lasered skin) as part of the normal healing process. Patients with pigmented skin and/or dark eyes or hair color are more prone to hyperpigmentation. It is a temporary condition and resolves in several weeks with bleaching creams. Post laser hyperpigmentation will generally appear about a month after the procedure and resolve in the recovery process.

Chemical peels can be used in many age groups. They can be utilized in younger patients as part of an acne control program or to improve pigment problems. In adults the most common reasons for face peeling are wrinkles, dark spots and weathered skin. The face peel can remove decades of skin damage like stripping layers of paint from an old wall.

Skin Care

Skin care is something that millions of men and women take for granted. Although it is common for females to spend thousands of dollars on cosmetics, many women are missing the true basis of skin care and concentrating on camouflage. Age, sun damage, smoking and heredity take their toll on all of us. Skin damage begins in childhood and much of it does not show up visibly until we are older.

Damaged Skin

Over time, normal aging and damage from the environment (sun, stress and pollution) cause skin to lose its ability to “renew” itself properly. Cell turnover slows, causing the dead skin layer at the stratum corneum or surface to be thicker and slowing the flow of moisture from within, resulting in dry uneven skin texture. Skin cells are disorganized and misshapen. Daily exposure to sunlight causes the amount of pigment in each cell to increase, producing freckles or age spots and uneven skin tone. Collagen and elastin begin to break down, causing the skin to lose its resilience, resulting in fine lines, wrinkles and sagging.

Your Transformation

The skin’s cellular functions are accelerated allowing continual renewal as dead skin cells are replaced by fresh cells pushed to the skin’s surface, making the surface (stratum corneum) smoother and naturally hydrated. Freckles and age spots seem to disappear. Pigment cells (melanin) are more evenly distributed, helping prevent the appearance of new freckles and age spots. The skin is rich in collagen and elastin that promote resilience and firmness. All these functions work together to keep skin looking and acting younger and healthier.

This sun damage is not visible with the naked eye. It is important to protect our children from sun damage and adherence to “sun sense” is mandatory. Wearing protective clothing, using proper sun screens and avoiding the sun from 10am to 4pm is a great start.

The skin normally has a complete turnover from the bottom layers to the top about every 30 days. Modern medical research has provided skin care regimens and products that actually attack the problems of aging instead of merely covering them up. Our office prescribes an affordable regimen of Retin-A in combination with bleaching agents, skin cleansers, toners, sunscreen, and moisturizers. These medically based products accelerate exfoliation of the dead skin as well as effect changes in the deeper layers of the skin to remove blotchy pigmentation, sun spots and fine wrinkles. These products contain prescription strength ingredients and cannot be purchased in stores. They are only available by a doctor’s prescription. The difference between store bought products and prescription strength products is similar to Tylenol versus Morphine. In other words, strong medications cannot be sold without a prescription.