Post-Operative Instructions for Laser Resurfacing

Post-operative care is very important.  Unnecessary pain and the complications of infection and swelling may be minimized if the instructions are followed carefully.  Sometimes the after effects of surgery are quite minimal, so not all these instructions may apply.  Common sense will often dictate what you should do.  However, when in doubt, follow these guidelines or call our office any time for clarification. The laser procedure has the ability to produce the most dramatic results in skin rejuvenation.  It also has one of the more formidable recoveries. This first week after laser skin resurfacing is challenging in terms of care. You will be swollen, covered with creams and not presentable to leave the house. This all begins to change at about day 5-6. After this the recovery is much easier. Just remember that the reward is at the end of the healing journey.

Laser resurfacing removes the outer layers of the skin. It is very important to manage this treatment to ensure proper healing. As with any burn, do not touch your face without washing hands. Bacterial and
yeast infections can occur if you touch other body parts then touch your face.

Immediately Following Surgery:

  • An adult should stay with you for at least the first 24 hours after surgery. 
  • You should rest with your head elevated in a recliner or with at least 2 pillows for the first 48 hours after surgery. 
  • Take the prescribed pain medications before you begin to feel discomfort.  It is easier to prevent pain than control it. 
  • Restrict your activities the day of surgery and several days afterwards.  It is not unusual to require 7 to 10 days before you are feeling back to normal, and before you can resume strenuous physical activity. 
  • The immediate post laser treatment consists of covering the lasered skin with Vaseline (Aquaphor or whatever the specific product you are instructed to use) and using cold packs for discomfort and swelling.  Refer to the section on swelling for further explanation.
  • Caution: If you suddenly sit up or stand from a lying position you may become dizzy.  If you are lying down following surgery, make sure you sit for one minute before standing.  Stand up slowly to provide time to steady yourself.  If you feel dizzy when you sit or stand, you should lie back down immediately to minimize the possibility of fainting.

Bleeding

Mild oozing from the lasered skin is not unusual.  Mild pressure will control the bleeding that does occur.  The main reason bleeding occurs is from patients elevating their blood pressure by bending, lifting, straining, coughing, sneezing, straining on the toilet and other strenuous activities.  

To avoid complications from bleeding you must absolutely refrain from activities that may increase blood pressure or bleeding for 10 days after your surgery.  We ask you to elevate your head for the first week and simply relax. Take advantage of this vacation and turn your family into servants!

You must also refrain from taking any drugs that may prolong bleeding.  Remember even 1 aspirin per day is very dangerous for bleeding around the eye.  Some homeopathic herbs may also elevate bleeding times and should not be used before or immediately after eyelid surgery.  Ginko, Garlic, and Ginseng, as well as high doses of vitamin E can increase bleeding.  If bleeding is heavy or prolonged call Dr. Hammond immediately.

Swelling

After your laser resurfacing procedure, we will recover you in our office for approximately 30 minutes.  During this time we will place cold compresses on your face, neck, and chest.  This will make you feel comfortable as well as lessen swelling.  The best thing to do is to continue this for 48 hours at home.  

The swelling that is normally expected is usually proportional to the depth of the laser resurfacing procedure.  Swelling around the eyes and down into the cheeks and face is not uncommon.  This is the body’s normal reaction to surgery and eventual repair.  The swelling will start the day of surgery and will not reach its maximum until 2-3 days post-operatively.  Occasionally, the eyelids will swell completely shut.  The swelling will rapidly decrease after the 3rd day. 

The immediate post laser treatment consists of covering the lasered skin with Vaseline (Aquaphor or whatever the specific product you are instructed to use) and using cold packs for discomfort and swelling. The best treatment to be comfortable is to apply cold compresses to the treated areas of the face. We recommend that you take a salad bowl and wash it well.  Fill it with 6 cups of cold water, 1/8 cup white vinegar, ice cubes and soak several wash cloths (or gauze) in the bowl and keep the bowl in the refrigerator.  Apply the cold cloth to the face and this will ease the discomfort and burning and assist the swelling.  When the cloth becomes warm, replace it with a new cold cloth. You can do this as much as you wish, but doing this will wash off the protective cream (Vaseline, etc), so remember to place a good coat of Vaseline (or whatever product our office recommends) over the treated areas when needed. For the first 5-6 days, you need to keep your face greasy and clean.

juvederm sample

Ice water soaks are kept on the lasered skin for the first 48-72 hours

Pain

Generally the procedure is not extremely painful, and feels more like a sunburn. The first 48 hours is the most uncomfortable and the discomfort should quickly subside. Some of our patients do not require pain medication but I would recommend taking a dose of your pain medicine about 1/2 hour before going to bed and shower and wash your face immediately before going to bed. By taking the pain medicine ½ hour prior to your shower, you will be more comfortable when washing as well as more ready to sleep. I also recommend taking a pain pill immediately upon awakening in the morning and taking a shower ½ hour after that.

For mild pain, one or two tablets of Tylenol or Extra Strength Tylenol may be taken every three to four hours.  Ibuprofen is generally not recommended for the first several days after surgery.  This is because ibuprofen can cause increased bleeding and/or bruising.

For severe pain, take the narcotic pain medication as directed.  This prescribed pain medicine will make you groggy and will slow down your reflexes.  Do not drive an automobile or work around machinery until you are no longer taking any narcotic pain medications and your vision is clear.  Avoid alcoholic beverages as they will enhance the effect of the narcotic.  This is a dangerous combination.  Pain or discomfort following surgery should begin to subside after the first two to three days.  If pain persists, it may require attention and you should call the office.  Do not routinely take Tylenol with prescription pain medications.  Many prescription pain medications already contain Tylenol.

Diet

After general anesthesia or I.V. sedation, clear liquids should be initially taken.  Over the next several days a high calorie, high protein intake is very important.  Nourishment should be taken regularly.  You should prevent dehydration by taking fluids regularly.  Keeping well hydrated also prevents nausea and vomiting.  Try not to miss a single meal.  You will feel better, have more strength, less discomfort, and heal faster if you continue to eat. Decreased activity may promote constipation so you may want to add more raw fruit to your diet and be sure to increase your fluid intake.

Care for the treated skin

Your face will ooze and swell for the first 48 hours and then will quickly improve.  Generally the procedure is not extremely painful, and feels more like a sunburn.  You should shower and gently wash your face each morning and night.  This way, you will be taking 2 showers per day and soaking and washing your face.  Do not use overly hot shower water and only use the towel to blot dry, do not rub your face.  When washing in the shower you can use Cetaphil Gentle Cleanser for your face (available at drug store) and baby shampoo for your hair.  The goal is to soak and gently remove the dead skin and residue from the creams.  You want to keep all the “crusts” soft and do not let them dry out.  Your body will secrete serum in a normal response to the burn to the skin and this will tend to accumulate like a yellowish paste, especially around the lower lids and mouth.  It is “nature’s Band Aid” and help protects the healing skin.  Although it looks unsightly, do not aggressively attempt to scrub it off.  If the crusting is severe, soaking the area (usually lower lids) with hydrogen peroxide several minutes before your shower will help reduce them.  If some of the yellowish paste comes off in the shower, that if fine and it will all come off soon, but if you remove it and the underlying skin bleeds, you are being too aggressive.

Your skin will begin to wash or peel off about the third or 4th day and your face will become red over the first few days and remain red for a week, will then gradually fade to pink, and then over the next several weeks will normalize.  Some individuals progress quickly from red to pink, while others may take weeks or in some cases months.  The pinkness can be covered with makeup as soon as the skin heals.

After all the crusts are gone and the skin is no longer oozing, the “greasy” creams will be stopped and you will begin using a hypoallergenic moisturizer.  You may use Cetaphil Moisturize.  The moisturizer is applied generously to the lasered skin and since it is less greasy than Vaseline, you need to apply more moisturizer and use it more frequently.  The whole idea is to hydrate the skin so it does not dry out during the healing process.

Overview

Day 1 – Cold packs (Moist cloths) and “grease” (Vaseline or Aquaphor)

Day 2 to 5 – Begin showering twice a day and gently washing face with Cetaphil cleanser.  Apply Vaseline/Aquaphor to all treated areas.  Continue with the cold packs.

Day 5 to 7 – Continue washing the treated areas with Cetaphil cleanser.  Begin using Cetaphil moisturizer instead of Vaseline/Aquaphor if skin is smooth, without crusts and not oozing.  Stay out of the sun!

Day 7 to 14 – Continue with face washing and moisturizer, makeup can be applied when skin is smooth and pink, without crusting.  Begin using fragrance free sun screen by day 14 or earlier if outside or riding in car.  You will also have a prescription for Epiquin/Hydroquinone which you should start to apply to the treated areas after 2 weeks.  Stay out of the sun and use sunscreen anytime you are outside.

Your laser resurfacing is a safe and predictable procedure, but is reliant on multiple medications to prevent viral and bacterial infection, reduce swelling, control discomfort and assist in sleeping if necessary. It is imperative that you understand the prescription regimen and take the medicines as directed by Dr. Hammond. Some of the medications are patient dependent. You may not receive all of them. Ask Dr. Hammond if you have any questions.

Valtrex (anti-herpes medication given to all patients) – all laser patients are susceptible to herpes outbreak after their laser treatment. This medication is very important, as a herpes outbreak can cause permanent scarring. This medication is taken every 12 hours. We will have you begin this medication 48 hours before your laser surgery and continue taking them until they are gone.

Keflex (antibiotic medication given to all patients) – this medication will protect your healing skin from bacterial infection. You should not take this medication if you are allergic to penicillin. In the case of allergy, we will prescribe you a different antibiotic. The Keflex should be taken every 6 hours around the clock until gone. We prefer that you begin this medication 24 hours before your laser surgery.

Prednisone – this is an anti-swelling medication (only given to some patients) and will decrease your swelling after your surgery. The Prednisone should be started after surgery and will be taken for 5 days. 

Benadryl – Many people will complain of itching as the skin heals.  It is important not to scratch the treated areas.  Benadryl may be used to help with the itching.  Take one 25 mg tab twice a day as needed for itching.

Discomfort Medication (given to all patients) – you will receive a prescription for discomfort. You only need to take this medication if you have discomfort. If you wish, you may take Tylenol or Advil instead. If
you have had other procedures such as eyelid surgery, facelift or brow lift with your laser, then do not take aspirin, Advil or any medication that increases bleeding. Tylenol is safe.

Sleeping Medication – (only given if needed) If you are having trouble with restful sleep, our office will provide a sleeping medication.

Sunscreen – Keeping sun off the face is very important and important for proper healing.  All patients should avoid direct sunlight for 4-6 weeks after surgery.  Using sunscreen, sunglasses, and a wide brimmed hat are necessary.  It is also important to protect your healing skin from sunlight that comes through car or office windows.  Using a high quality sun screen with at least SPF 30 is recommended. This should be applied several times per day, every day during the healing period.

If you have been using Retin-A, Obagi or other skin care products before your laser, you need to stop them until your healing is complete. We like to have all patients on Retin-A and skin care products before and after their skin resurfacing. We generally begin the post laser skin care 4-6 weeks after the laser procedure. Your new skin is sensitive and requires gentle care. You will love the changes but it takes some time to get to that point.

Itching is a common symptom of newly healing skin. This can be controlled by using topical steroids (with permission from Dr. Hammond), Benadryl, or white vinegar soaks. You can take a quart of tap water and
add a tablespoon of white vinegar.  Placing saturated wash clothes or paper towels with the vinegar solution will help the itching.  If the itching is resistant, Dr. Hammond can prescribe specific medications.

Discoloration

If you had laser your skin will be pink. Some patients will only be pink for several weeks and other patients will be pink for months. The pink skin will eventually resolve and is generally easily covered with makeup.  You can camouflage the discoloration to some extent by using a thick make-up, PANCAKE, by Max Factor (two shades darker than your skin color), may be applied with a moist sponge; after it dries, a second layer may be applied. It can be removed with water. Revlon-Erase (two shades darker than your skin color) may be used over “hard to cover” areas. Do not apply make-up over the treated skin for at least 10 days.

About 30% of laser patients will experience hyperpigmentation after skin resurfacing. This usually occurs about 4 weeks after the procedure. This is a temporary blotchy tanning or darkening of the lasered skin. It is a reversible situation and generally quickly responds to bleaching creams. Any irritation to the healing skin such as hot air from hair dryers, car defrosts, sun exposure, and bright overhead lights can contribute to hyperpigmentation. Again, it is always temporary.

Nausea and Vomiting

In the event of nausea and/or vomiting following surgery, do not take anything by mouth for at least an hour including the prescribed medicine. You should then sip on flat coke, tea, or ginger ale.  You can also purchase coke syrup over the counter which can have a soothing effect on the stomach.  You should sip slowly over a fifteen-minute period.  When the nausea subsides you can begin taking solid foods and the prescribed medicine.  Please call if the nausea does not subside within 3 hours.  There are medications we can call in to your pharmacy that work very well to control nausea and vomiting.

Additional Information:

  • Numbness of the skin surrounding the surgical site is normal and there is no cause for alarm.  As stated before surgery, this is usually temporary in nature although in some instances, it can be permanent. 
  • Slight elevation of temperature immediately following surgery is not uncommon.  If the temperature persists, notify the office.  Tylenol should be taken to reduce the fever.
  • Your case is individual as no two people are alike.  Do not accept well intended advice from friends. Discuss your questions and concerns with either Dr. Hammond or a member of their staff. 
  • If you are involved in regular exercise, be aware that your normal nourishment intake is reduced.  Exercise may be much more difficult.  We recommend that you take at least 14 days off from any vigorous physical activity.  When you do resume your exercise regimen, start with a light to moderate workout and gradually increase your regimen over several sessions.  Stop exercising if you get light headed.
  • You should wear clothing that fastens either in the front or at the back rather than the type that must be pulled over the head for one week.
  • An appointment will be made at the front desk for 1 week to check the surgical sites.  If you did not receive an appointment please don’t hesitate to call our office so we can see you.
  • Do not smoke for at least 2 weeks post operatively as smoking significantly delays healing and increases the risk of complications.
  • Wait at least 2 weeks before wearing contact lenses. 
  • You will have sensitivity to light and wind, tearing, and possibly double or blurred vision for several days and sometimes weeks.  Wear sunglasses as this will help with the sensitivity.
  • If you have any questions regarding your condition, it is best to call the office during our regular office hours.  A follow-up visit is provided as a courtesy at no charge.  If you have a true emergency, Doctor Hammond or his assistant can be reached 24 hours a day 7 days a week.  During the day call the office number.  At night, call Dr. Hammond on his cell phone.  If there is no answer, leave a message and Dr. Hammond will call you back as soon as possible.