Laser Skin Resurfacing Questions
Questions and Answers
What are the types of skin damage
caused by age
and the sun?
The damage that develops in the skin over the years comes
from two sources. First there is intrinsic damage. This is
the spontaneous age-related changes which everyone develops
in varying degree. The second type is actinic or sun-caused
damage. This varies widely depending on one's skin type and
lifelong sun exposure. Together these changes are the differences
we see from the smooth, soft, resilient and attractive skin
of our youth. The specific skin changes include the following:
- Progressive development of fine and medium wrinkles.
Skin coarseness and irregularities of texture, larger pores,
etc.
Loss of skin elasticity and resilience.
Tissue sagging and laxity.
Thinning of the cellular layers of the epidermis.
Thickening of the dry keratin layers of the epidermis.
Pigmentary irregularities and "age spots" (lentigines).
Increase in visible blood vessels and spider veins.
Loss of healthy (Type I) collagen and elastin fibers from
the dermis.
Increasing deep dynamic wrinkles such as frown lines, crow's
feet, etc.
What options are available for
correcting this damage? What are the alternatives to laser
resurfacing?
Other procedures to treat the some of these conditions include
chemical peels, dermabrasion, conventional skin or plastic
surgery and electrosurgery. These techniques each have their
own advantages and disadvantages. And they each carry limitations,
risks, and possible complications. Laser skin resurfacing
is superior to, and has largely replaced, the use of deep
chemical peels and dermabrasion. Alternatives will be discussed
with you before deciding on treatment. If your condition
would be better treated by a non-laser method, you will be
referred to an appropriate specialist.
What are the benefits laser skin
resurfacing?
1. Sun damaged epidermis is removed. The purpose
of laser skin resurfacing is to precisely and safely remove
sun damaged layers of skin. The Erbium resurfacing laser
is the most precise method available for this. Sun damaged
epidermis is carefully removed. With it goes the damage from
years of sun exposure. Pigmentary changes are removed. Textural
changes and roughness are removed. Benign and pre-malignant
skin lesions are removed such as seborrheic keratoses and
actinic keratoses. New epidermis grows over the healthier
base in a matter of a days. The new cells grow from the gland
and follicles deep within the dermis that have never been
exposed to direct sunlight. So the skin is literally renewed.
This results in marked improvement of the effects of photodamage.
2. Wrinkles are removed or reduced. Wrinkles, especially
fine to medium wrinkles, are removed or reduced during the
resurfacing process with 70 to 90% improvement. Deeper wrinkles
may be significantly improved (50 to 80%), but may not be
completely removed.
3. Skin folds and frown lines are improved. Dynamic
wrinkles are caused by muscle movements from certain facial
muscles. These include frown lines, crow's feet, squint lines,
and brow furrows. These may be markedly improved by Erbium
laser resurfacing. But in time they can be re-created by
the same facial muscles and gradually return. It is possible
to improve these results and prevent recurrence of these
dynamic wrinkles by supplementing laser treatment with Botox
injections.
4. New collagen and elastic fibers create an improved
skin foundation. The resurfacing laser can stimulate
growth of a thicker and healthier layer of Type I collagen.
This results in better skin texture and resiliency with
a more youthful appearance.
5. Collagen contraction tightens slack and sagging skin. Laser
skin treatment with either the CO2 laser or an Erbium laser
(with diathermy effect) can cause the collagen in the dermis
to contract by 20 to 30% This markedly reduces sagging skin
and tightens laxity. This contraction effect can delay the
need for a face lift in many persons. The resurfacing laser
also improves skin thickness and elasticity by stimulating
the formation of type I collagen and healthy elastin fibers
in the dermis.
6. A new and healthier epidermis grows from undamaged
cells. Within days, the sun damaged epidermis is replaced
from new cells growing from within the skin glands and
hair follicles. These cells have never been exposed to
sunlight. So the skin is literally renewed.
7. Removing benign and pre-malignant lesions. Skin
resurfacing is not usually used to treat skin cancers. But
resurfacing removes most of the sun damaged cells which can
give rise to certain skin cancers. Skin resurfacing is an
effective treatment for pre-malignant skin lesions such actinic
keratoses.
How much improvement can be expected?
While laser skin resurfacing may be the most effective method
of correcting skin damaged, it does not provide 100% improvement.
Some patients may experience only moderate improvement (Typically
60 to 85%). You may review pictures of representative patients
so you fully understand the range of improvement that may
be achieved. Different treatment plans can produce greater
results in more severely damaged skin. While a gentler treatment
approach may be adequate for more mildly damaged skin. Different
treatment plans may influence expected healing times. This
should be discussed fully with Dr. Van Camp and Dr. Teng.
Does it hurt?
At Laser Medical Skin Center we expect to provide all patients
with an optimum experience and minimum discomfort. To achieve
this we select the most appropriate approach for each individual.
Shallow to medium skin resurfacing with the Erbium laser
can often be done with just an anesthetic cream and oral
pain medication. Patients describe the pain as "moderate" and
feeling like a sunburn. Some patients may require a deeper
treatment (more laser passes) to obtain the best results
possible. Then it may be better to use either numbing injections
of local anesthetic and/or intravenous pain medication. The
procedure should not be painful. A nurse anesthetist will
be present for intravenous medication and monitoring when
this is needed.
What are the medical reasons for
performing laser skin resurfacing ?
Improvement of non-dynamic skin wrinkles, especially around
the eyes, mouth and cheek regions. (Skin peels and dermabrasion
have produced disappointing results in these areas. (Face
lifts can improve skin laxity but have minimal effect on
these wrinkles.)
Improvement of sun induced pigmentary
and textural changes.
Improvement of atrophic facial scars such as those caused
by acne. (Deep pitted scars require other treatments to obtain
optimal improvement.)
Improvement of sun damaged lips with cracking, wrinkling
and scaling (actinic cheilitis).
Removal of epidermal lesions such as solar lentigo (brown
age spots). Pre-malignant lesions such as actinic keratoses
are removed during laser resurfacing. Warts and yellow patches
can also be removed.
Deeper dynamic wrinkles and skin folds can be improved by
laser resurfacing. The best result for these is often obtained
by pre and post - treatment with Botox.
Who should not have laser resurfacing?
Persons taking medications which prevent would healing.
Persons taking isotretinoin (Acutane) for acne should not
have laser resurfacing. This medication interferes with the
skin's ability to heal and fight infection. Six months should
lapse after using Acutane before considering laser resurfacing.
Persons with active bacterial or viral infections in the
areas to be treated should not have laser resurfacing until
the condition is resolved.
The presence of ectropion (outward pulling of eyelid) would
preclude laser resurfacing near the eyelids, which could
make it worse.
The following are '"cautions" which should be
carefully reviewed with the doctor before deciding on laser
resurfacing:
- History of scarring or dyspigmentatin after previous
procedures.
Collagen diseases (lupus, scleroderma), immunologic disease,
and certain skin conditions
Previous lower eyelid surgery.
Tendency to form keloids or hypertrophic scars. (Though
resurfacing can sometimes be used to help treat these.)
If you are interested in laser skin resurfacing, or if you
are interested in other aesthetic laser treatments, please
call to schedule a consultation. Risks of Laser Resurfacing
and Consent for Treatment.
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