The procedure should be carried into the hairline and at the jaw and chin; a feathering technique should be used. This includes a zone of decreased energy, decreased density, or pulse overlap. When treating a patient with moderate to severe photodamage, it is important to blend into the neck as much as possible. Another option is to laser the neck, which will be reviewed later in the chapter. Postoperative care Wound care is critical, and regimens vary among physicians.
Occlusive and nonocclusive dressings are available. Occlusive dressings cover the skin and are usually removed in 1—3 days. These can decrease patient discomfort, but may promote infection by harboring bacteria or yeast. When opaque, the dressings can mask visualization of the wound, thus delaying the detection of an infection.
Clear dressings e. When used in our office, they are most commonly removed on the second day postoperatively and the patient is switched to open healing. Open dressings or nonocclusive dressings are usually petroleum-based ointments. Frequent soaking and 21 cleaning are necessary at least 4 times daily , followed by frequent application of petroleum jelly, Aquaphor ointment or one of the many wound care ointments that are available. Additives, fragrances, or dyes will increase the chance of contact allergic or irritant dermatitis developing and should be limited as much as possible.
In very sensitive individuals, pure vegetable shortening can be used. Dilute vinegar can be used to soak and debride the wound, promote healing, and inhibit bacterial growth. Wound care needs to be performed until reepithelialization is complete. Depending on the type of laser used and how aggressive the surgeon was with his or her settings, re-epithelialization should be complete within 5—10 days.
Prolonged healing times can indicate an infection, contact dermatitis, or other problem, and increases the risks of complications. Box 3. If facial swelling is severe, oral or intramuscular steroids, and non steroidal anti-inflammatory agents NSAIDs can be administered. Papules are an occlusive phenomenon, and will resolve without treatment.
Infections can occur, and may be bacterial, viral, or fungal in nature Table 3. Pruritus, especially, should alert the physician to a possible infection. Appropriate evaluation may include tzanck smear, potassium hydroxide KOH prep, gram stain, and cultures to accurately diagnose the causative agent. Treatment should begin early, pending culture results. Thus, broad coverage should be initiated, and should generally include an agent that will cover Pseudomonas aeruginosa.
Acne is another complications that can be seen relatively early in the course. Oral antibiotic therapy and discontinuation of petroleum-based ointments usually suffice. Topical acne therapies are not generally well Fig. The patient noted increasing discomfort and pruritus. Contact dermatitis can occur, and may be due to an allergic reaction or an irritant reaction.
It may occur within the first few weeks or months after laser resurfacing. Redness, pruritus, and delayed healing may be noted, but vesiculation is rare. Topical antibiotics are a common cause of allergic contact dermatitis, and should be avoided. Patients may be using them without the knowledge of their physician. Topically applied agents should be reviewed and discontinued. Dyes and fragrances that are added to laundry detergents, fabric softeners, and skincare items are also potential causes. Discontinuation of the offending agent s and topical corticosteroids should be initiated early.
This should be avoided as indicated previously, but when faced with such a patient, treating the remaining skin will lighten the hyperpigmentation and help to blend in the differences. Although topical agents such as retinoids and hydroquinones can be used, visible results take months and are not practical for most patients.
Superficial resurfacing is all that is required for most, and the Er:YAG laser is an excellent device. The goal is to remove the epidermis, and one or two passes maybe all that is required. This heals rapidly and with minimum risks. In the very sun-damaged patient, it may be difficult to find a good stopping point.
In these instances, treating the full face may only accentuate the discoloration of the neck. Light rejuvenation of the neck can be done, but may accentuate the damage to the chest. Light resurfacing can be performed down the neck and chest area, extending onto the breast — but this may then accentuate the damage to the arms and forearms, etc. Several intense pulsed light IPL systems are now available, which use a broad-spectrum intense pulsed light source with changeable crystals attached to the hand- Fig.
This modality has been applied to the face, neck, chest, and upper extremities. The fluence varies with skin type and area, but the neck is generally treated more conservatively and using lower fluences. Depigmentation True depigmentation of the skin following laser resurfacing is more difficult to treat than the pseudohypopigmentation described above. The skin acquires a whitish coloration and does not flush or change color with normal sun exposure Fig. The latter represents superficial scarring or fibrosis. It can occur after any form of resurfacing, but it is more commonly encountered with CO2 laser resurfacing and is much less common with Er : YAG resurfacing.
Like pseudohypopigmentation, depigmentation seems to be more 03 Carniol Depigmentation has been considered a permanent complication of CO2 laser resurfacing. When evaluated histologically, there is a varying quantity of epidermal melanin present. Residual epidermal melanocytes are present, indicating that repigmentation should be possible. Grimes et al18 have reported successful treatment of hypopigmentation following CO2 laser resurfacing using topical photochemotherapy twice weekly.
Using the same reasoning, narrowband UVB and an eximer laser may both be effective. Narrowband UVB, which emits at — nm, has been reported to be efficacious for vitiligo, while excimer lasers emit at nm and can be targeted to a given site. They speculate that repigmentation is related to the stimulation of melanocyte proliferation and migration, along with the release of cytokines and inflammatory mediators in the skin.
Potential disadvantages of any of these therapies, however, include the time necessary to see repigmentation, cost, erythema and pruritus during therapy, and hyperpigmentation of skin immediately surrounding the treated skin, which can take months to return to normal. Unfortunately, the results are mixed, and return to baseline can occur after therapy is discontinued. Repigmentation has been an unrealistic goal, and until more data are available on investigative tools such as phototherapy, an honest discussion must take place with the patient.
Additional resurfacing of the unaffected skin may be helpful to reduce any hyper pigmentation or dyschromia if present, but will only help to reduce the differences with adjacent areas. Once again, care should be taken not to re-treat too aggressively. Scarring The development of scarring following laser surgery is perhaps the most feared and distressing complication encountered.
Deeper wounds are more likely to result in scarring, which is not usually encountered unless the wound extends into the reticular dermis. However, since this is the level that is generally targeted with the CO2 laser to eradicate wrinkles, acne scars, and varicella scars, cosmetic surgeons will be faced with scarring if they perform enough procedures. Hypertrophic scars can develop anywhere, but are most likely to occur around the mouth, chin, mandibular margin, and less often over other bony prominences such as the malar and forehead regions.
Nonfacial skin is also more likely to develop scarring due to the relative paucity of pilosebaceous units and adenexal structures. It has been the experience of one of us DAG that patients with a history of acne scarring, regardless of prior isotretinoin use, are more likely to develop delayed wound healing and hypertrophic scarring when compared with the average patient. The surgeon should be alerted to possible scarring when there is delayed wound healing for any reason.
Infections need to be treated early and aggressively. Candidal, bacterial, and herpetic infections can delay healing, prolong the inflammatory stage, and increase the chance that the wound will heal with scar development. Likewise, contact dermatitis that is not controlled early and poor wound care are potential precursors for postoperative scarring.
Early on, the treated skin may appear redder than the surrounding skin. As the process continues, textural changes can be discerned with palpation of the area Fig. In the early stages, topical steroids may have a role. A medium to potent steroid should be used twice daily, but should be applied only to the area of concern and not to the entire lasered area.
If prolonged erythema alone is noted without any discernible textural changes, a class II or III steroid may suffice but if thickening or induration is present, a class I steroid should be considered. The patient needs to be monitored closely so that steroid-induced atrophy, stria, or telangectasia do not develop and so that progression of the scarring can be followed.
Intralesional glucocorticosteroids are probably more effective than topical steroids if textural changes and induration have developed. We typically use triamcinolone acetonide diluted to a concentration of 2. A gauge needle is used to minimize further trauma to the area, and the injection is given into the superficial dermis of the scar. Injections can be repeated every 2—4 weeks, depending on the response or progression of the scar.
Treatment should be continued until the skin returns to the same texture and consistency as the surrounding tissue. Overtreatment can result in atrophy, and telangectasia can develop. Some surgeons use occlusion therapy in the early stages of scarring. A very large number of silicone gel dressings have become available over the past few years. If utilized, they should be applied to the scar daily and worn for 12—24 hours per day as tolerated. A mild dishwashing detergent can be used to clean the 25 dressing.
An onion skin extract, Menderma gel Merz Pharmaceuticals, Greensboro, NC , is also marketed to improve and prevent scarring. Its efficacy in not known, and patients using any such product need to be monitored for irritant and allergic contact dermatitis. Another treatment used after laser surgery to treat scars is 5-fluorouracil 5-FU.
Although effective, the injections are quite painful. The addition of Kenalog should be considered and is mixed such that 0. Less pain and potentially greater efficacy are associated with the latter solution. Approximately 0. Injections should be performed two or three times weekly initially, and only the indurated portions of the scar should be injected.
Side-effects include pain with injection, purpura, and rarely superficial tissue slough. Newer vascular lasers and intense pulsed light sources are also being used to treat surgical scars. The V Beam Candela Corp. Treatments are administered at 3- to 4-week intervals, and generally will require a minimum of 2—4 treatment sessions. Because of the low fluences used, purpura generally does not develop. Although well accepted as an effective treatment, not all studies have demonstrated good results using the pulsed dye laser for scars.
In a study by Wittenber et al,23 the flashlamp pulsed dye laser and silicone gel sheeting showed improvement in scar 03 Carniol Combining modalities will ensure the best results in reduction of scar volume and erythema and improvement of texture. Laser therapy can be added to the regimen after the scar has begun to show flattening with 5-FU or steroids. Thus, fibroblast activity is suppressed by 5-FU, inflammation is suppressed by corticosteroids, and pulsed dye laser suppresses angiogenesis and endothelial cell growth factors. Concomitant use of the CO2 laser and the pulsed dye laser has been described for nonerythematous scars.
Then the nm pulsed dye laser is used with fluences of 6—6. Finally, resurfacing can be tried for scars that have not responded to the treatment modalities already described. This, however, can result in further scarring, and should be used judiciously. The patient needs to be counseled extensively regarding the potential risks. The scarred area and a small amount of normal appearing skin surrounding the scar should be anesthetized with local anesthesia. The scarred area should be ablated superficially with an additional pass to blend with the surrounding skin. Wound care is performed in the standard fashion.
Less commonly, hypertrophic scars are hyperpigmented. In these cases, either a pulsed dye laser or a pigment-specific pulsed dye nm laser and a nm frequency-doubled neodymium Nd :YAG laser can be used to lighten the scar. The immediate endpoint is the production of an immediate ash-white color. The preoperative care is the same, but the face is first resurfaced or peeled to the desired depth. When using chemical peeling, the face is first degreased with alcohol or acetone.
Application of the TCA is performed one cosmetic unit at a time to decrease discomfort and to monitor for the desired level of frost. Once the peel or superficial laser resurfacing has been performed, the perioral area can be treated with the more aggressive CO2 or Er:YAG lasers as described above.
The peeled skin will be red and clearly identifiable to the laser surgeon. Wound care is the same as previously described. Due to the smaller surface area that is more deeply treated, there is less total swelling and exudative drainage.
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This approach is especially popular in our patients who are ready to undergo a second resurfacing procedure for the mouth area but have retained satisfactory results to the rest of their face. Neck resurfacing Due to the relative paucity of adenexal structures in the neck, rejuvenation procedures need to be performed judiciously. The use of the Er:YAG laser to improve photoaging was established in the late s, but only modest improvements were seen. Despite some obvious improvements noted in the color and texture of the skin although no improvement in wrinkling was observed , it was concluded that the risks outweighed the potential benefits, at least at the three different parameters studied.
In , Kilmer et al28 reported their experience in performing CO2 neck resurfacing in over patients. Only 2 patients developed hypopigmentation. Any patient who had undergone 03 Carniol Topical EMLA was used as previously described in this chapter with a second application 45 minutes before the procedure. Lower energy densities were used as the treatment proceeded down the neck. Epidermal debris was not wiped off the neck, in order to minimize additional trauma.
Fractional CO2 resurfacing Carbon dioxide laser resurfacing can give the most dramatic improvements, in terms of smoothing skin, decreasing rhytids, removing lentigines and tightening facial skin. However, due to the typical associated length of recovery it remains unpopular with patients. Other lasers have been developed to try to achieve a more carbon dioxide laser resurfacing type of improvement with a relatively brief recovery period. Although fractional lasers are now available in several different wavelengths, the fractional 10 nm carbon dioxide laser can offer some of the beneficial ablative and tightening effects associated with traditional Carbon dioxide laser resurfacing.
In fractional photothermolysis, a fraction of the skin surface is treated with the laser, resulting in small zones of thermal injury bridged by surrounding areas of untreated skin. Between the spots there are areas of untreated skin. This laser is designed to decrease the possible lateral thermal effects of the laser, while allowing the deeper thermal heating effects in each of the treated areas for stimulation of neocollagen production and inducing skin contraction.
Since the laser treatment is fractionated the lateral heating effects are decreased by leaving adjacent untreated areas which allow for heat dissipation. This allows for additional thermal relaxation between pulses resulting in less overall thermal injury, and quicker recovery. Posttreatment erythema resolves more rapidly. The treated areas are smaller and placed in a less dense manner than in traditional CO2 laser resurfacing.
Settings are variable and are based on patient need in terms of acceptable downtime and degree of photodamage or acne scarring. Initially, post treatment patients develop area of punctate crusting surrounded by areas of unlasered skin. As could be anticipated this also becomes pink and develops mild swelling.
Typically, the third author has the patients keep the area moist until it completely reepithelializing.
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This can be achieved by application of Aquaphor Beiersdorf, every 8 hours or other dressings with a moisturizing effect. The third author also routinely gives antivirals starting twenty four hours prior to the laser treatment. Each physician, must decide in their own prophylaxis and after care regimens.
Typically patients can resume their regular activities 4—7 days post treatment.
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They have noted improvement in their skin texture, wrinkles, and lentigines as well as some mild skin tightening. More aggressive settings can also be used for more dramatic results dramatic results with a consequent increase in patient downtime.
Skin Resurfacing Treatments | ABCS
Patients with deep rhytids and significant skin laxity who are willing to deal with the healing process associated with CO2 resurfacing can have a non-fractionated resurfacing. This laser penetrates the skin more deeply than the traditional CO2 laser and may allow a greater tightening effect. This laser is designed to resurface similar to an erbium laser but to provide deeper associated thermal effects to create greater collagen stimulation 03 Carniol The effect is between the effect of the typical erbium laser and the carbon dioxide laser.
It is used to improve skin smoothness, reduce mild wrinkles and decrease hyperpigmentation. Further improvements in patient outcomes may be obtainable with combination therapy including using nonablative lasers, fillers, neurotoxins, and cosmeceuticals. The push continues for less invasive, more efficacious tools with added predictability and safety. The key is to a successful resurfacing practice hower, still involves proper patient selection, good technique and wound care, and the early identification and management of complications.
Treatment of basal cell carcinoma with the pulsed carbon dioxide laser: a retrospective analysis. Dermatol Surg ;— Full face laser resurfacing: therapy and prophylaxis for actinic keratoses and non-melanoma skin cancer. Kilmer SL, Semchyshyn N. Ablative and nonablative facial resurfacing. In: Goldberg DJ, ed. Laser Dermatology. Berlin: Springer-Verlag — Tretinoin accelerates healing after trichloroacetic acid chemical peel.
Arch Dermatol ;— Histologic study of dermabrasion and chemical peel in an animal model after pretreatment with Retin-A. Aesth Plast Surg ;—6. Penneys NS. Ochronosis-like pigmentation from hydroquinone bleaching creams. Arch Dermatol ; — Nester MS. Prophylaxis for and treatment of uncomplicated skin and skin structure infections in laser and cosmetic surgery.
J Drugs Dermatol ;—5. Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. Am J Med ;— J Drugs Dermatol ;—8. Effect of botulinum toxin pretreatment on laser resurfacing results: a prospective, randomized, blinded trial. Arch Facial Plast Surg ;—9.
West T, Alster T. Effect of botulinum toxin type A on movement-associated rhytides following CO2 laser resurfacing. Full-face laser resurfacing using supplemented topical anesthesia protocol. The incidence of adverse healing reactions occurring with UltraPulse CO2 resurfacing during a multicenter study.
Lasers Surg Med ; Suppl 8:S Infections complicating pulsed carbon dioxide laser resurfacing for photoaged facial skin. Railan D, Kilmer SL. Ablative treatment of photoaging. Dermatol Ther ;— Laser resurfacing-induced hypopigmentation: histologic alterations and repigmentation with topical photochemotherapy. Short-term effects of nm xenon-chloride excimer laser and narrow-band ultraviolet B in the treatment of vitiligo: a comparative study.
J Kor Med Sci ;—8. The safety and efficacy of the nm excimer laser for pigment correction of hypopigmented scars and striae alba. Fitzpatrick R. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg ;—7. Alster T. Improvement of erythematous and hypertrophic scars by the nm flashlamp-pumped pulsed dye laser. Ann Plast Surg ;— Prospective, single-blind, randomized, controlled study to assess the efficacy of the nm flashlamp-pumped pulsed-dye 03 Carniol Laser scar revision: comparison of CO2 laser vaporization with and without simultaneous pulsed dye laser treatment.
Treatment of pigmented hypertrophic scars with the nm pulsed dye laser and the nm frequency-doubled Nd : YAG laser in the Q-switched and variable pulse modes: a comparative study. Laser resurfacing of the neck with the erbium : YAG laser. Resurfacing of photodamaged skin on the neck with 29 an UltraPulse carbon dioxide laser. Lasers Surg Med ;—9. Safe and effective carbon dioxide laser skin resurfacing of the neck.
Lasers Surg Med ;—7. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med ; — For thousands of years, humans both male and female have been utilizing treatments to improve the appearance of a poor complexion or to enhance the beauty of a natural complexion. Throughout the ages, humans have sought out simple, elective cosmetic methods to improve highly visible and undesirable permanent cutaneous signs: facial wrinkles and residual facial scars that may follow ailments such as acne, smallpox, and chickenpox.
Ancient Greece and the Roman Empire are both well represented in the quest for more beautiful skin, and Cleopatra whose name has been synonymous with beauty through the ages wrote a book on beautification that was quoted by Galen and other medical writers. Her recipes were quoted well into the Middle Ages. The transition to utilizing chemicals for ASR occurred in the early to mid s. Phenol was first prepared in by the French chemist August Laurent and presented at the Paris Exhibition. The mid to late s also found Hebra3 utilizing various acids, alkalis, and other corrosives to treat freckles and melasma.
It is not clear whether Hebra treated wrinkles with these chemical agents. Chemical agents facilitating ASR particularly phenol became more widely utilized in the early s, and George Miller MacKee4 became a proponent of chemical ASR after first experimenting on himself. He proposed dermabrasion as a better method to improve acne pits and scars. The last decade has seen unprecedented technological development of lasers, other light sources, and radiofrequency RF approaches for ASR. They have dominated the ASR arena, although a reverse trend towards a return to chemical exfoliation exists in some practices.
Currently lasers, other light sources, and RF devices are generally classified as ablative and nonablative. Goldberg6 has reviewed the four different tissue interactions of laser, light, and RF with regard to the biological effects of ASR devices on skin and adjacent structures.
The description traces the evolutionary development of these devices: 1. The initial devices ablated the epidermis, caused dermal injury, and provided a significant thermal effect carbon dioxide CO2 lasers. Subsequent devices caused highly selective epidermal ablation, with minimal thermal effects erbium : yttrium aluminum garnet Er:YAG short pulsed lasers. Later devices ablated the epidermis, caused dermal injury, and provided variable thermal effects dualmode and long- or variable-pulsed Er:YAG lasers.
The more recent evolution of devices do not ablate the epidermis, wound the dermis and provide 04 Carniol The fifth generation of devices not mentioned by Goldberg are nonablative or subablative devices that produce a more substantial thermal effect for skin tightening and rejuvenation, and include mono- and bipolar RF devices, with or without optical energy, and infrared and fractionated devices.
Variable-pulsed Er:YAG lasers are also included in this category, as these devices have been developed to provide higher degrees of thermal effects at the level of the dermis and perhaps below as one function of their clinical application. The first laser used for laser-assisted skin rejuvenation LASR was a pulsed CO2 laser that Fitzpatrick and colleagues modified from a device that had been developed for otolaryngological and gynecological use.
It was initially utilized for periorbital and perioral LASR, but initial appraisals of substantial aesthetic improvement led to its use for full facial rejuvenation. Although the long-term skin rejuvenation and tightening provided by this device are unparalleled, marked erythema persisting for weeks or months and permanent sometimes delayed hypopigmentation occur at a rate that is not acceptable for many patients. Subsequent to the laser boom of the early to mid s, further research led to the development of other lasers for LASR.
The aim was to employ a more precise laser beam, resulting in less intense adverse sideeffects and a shorter recovery period. In , Kaufman and Hibst8 reported on the cutaneous laser ablative effects of the mid-infrared Er:YAG laser utilized in short pulses. They employed the laser on pig skin and on experimental patients, treating superficial lesions such as epidermal nevi.
Skin resurfacing procedures: new and emerging options
Kaufman and Hibst8 concluded that the laser should have potential for LASR, but also noted that, due to the limited dermal thermal depths of action, bleeding could be a problem. Initial enthusiasm for the Er:YAG laser was high due to its ability to operate at a more superficial level and with greater precision. Concurrent with its introduction, some short comings of the Er:YAG laser became apparent. A major disadvantage of the superficial and fleeting energy absorption of the Er:YAG laser is its poor ability to maintain hemostasis.
The blood spatter also creates more of a biological hazard to the surgeon and assistants. The other limitation of the Er:YAG laser is that there is less collagen contraction, although this may be due to the fact that comparable depths of resurfacing are not being accomplished due to the lack of hemostasis. These dual-mode capabilities allow the operator to dial in the depths of ablation as well as the thermal effects coagulation desired. In the Nd:YAG laser, the dopant is the rare earth element neodymium.
Er:YAG lases at a wavelength of nm. Its absorption bands suitable for pumping are wide and are located between and nm, allowing for efficient flashlamp pumping Fig. The Er:YAG laser emission couples well with water and bodily fluids, making these lasers especially useful in medicine and dentistry: Er:YAG lasers are used for treatment of tooth enamel as well as aesthetic dermatological applications.
Er:YAG lasers are also used for noninvasive monitoring of blood sugar. Er:YAG lasers operate at relatively eye-safe wavelengths radiated incident through the lens is absorbed in the eye and does not damage the retina , work well at room temperature, and have high slope efficiency. Er:YAG laser light is pale green. Erbium laser light—tissue interaction biophotonics There are four primary interactions of laser light with tissue Fig.
The first interaction is surface reflection. There may also be scattering. This is then 33 Fig. Erbium is associated with several other rare earth elements in the mineral gadolinite fromYtterby in Sweden from which both the names yttrium and erbium are derived.
The absorption of laser light in tissue is a remarkably strong function of wavelength. The result is that lasers of different wavelengths have qualitatively and quantitatively different interactions with tissue Fig. The thermal relaxation time depends very strongly on the absorption length.
Taken together, these two parameters determine a critical power density. This is the minimum power density that must be used to limit thermal damage to a depth equal to one absorption length Table 4.
For the Er:YAG laser, the absorption length is 0. In addition to the initial interactions of light with the target, subsequent interactions can be summarized as having photothermal, photochemical, or photoacoustic effects on the target. As is widely recognized, the Er:YAG wavelength of nm is absorbed 12—18 times more efficiently by superficial water-containing cutaneous tissue than is the CO2 laser emission at 10 nm.
The vaporization threshold of the Er:YAG laser is 0. The fluence and depth of tissue ablation are directly related. Stimulated emission occurs when a population inversion occurs, with more members in an excited state than in lower-energy states. This allows for precise control of tissue ablation. Pulsed laser energy causes controlled vaporization of the skin according to the principles of selective photothermolysis.
Target tissues contain chromophores with absorption peaks that selectively absorb the particular wavelength of the laser pulse. Tissue adjacent to the chromophore absorbs the energy to a much lesser degree. The interaction of target tissue with the CO2 laser is predominantly a thermomechanical reaction that leads to target destruction of dermal vessels and proteins. The Er:YAG laser interacts with tissue via a photomechanical reaction. Absorption of the optical laser energy causes immediate ejection of the dessicated tissue from its location at supersonic speeds.
This popping sound like a cap gun is audible and represents the microexplosion taking place at the tissue level. The translation of Er:YAG laser energy into mechanical work is an important factor that protects the surrounding tissue: minimal thermal energy remains to dissipate and cause collateral damage. Selective photothermolysis describes the process of wavelength-specific target destruction. These will be listed as shortpulsed systems, dual-mode systems, and variablepulsed systems.
This is the minimum power density that must be used to limit thermal damage to a depth equal to one absorption length. Short-absorption-length lasers such as Er:YAG are capable of producing less thermal damage than lasers with long absorption lengths. In order to achieve this desirable effect, these strongly absorbed lasers must be operated at high power density.
When laser energy is delivered in a pulsed mode, it is possible to limit the tissue damage to one absorption length while working at an average power density less than the critical value. This result is only possible if the pulsed energy exceeds the critical value shown in the last column. Coherent Ultrafine Erbium Fig. At the time of its release in , the UltraFine Erbium was advocated for incision, excision, ablation, vaporization, and coagulation of soft tissue, including superficial skin resurfacing, precision microplaning, etching, and tissue sculpting.
It is equipped with a computerized pattern generator as well as a variablewidth handpiece. We have used this laser for 10 years, and it has been very reliable. The Nexgen Pixel is a short-pulsed Er: YAG laser that utilizes a pixel grid pattern of 49 or 81 ablations, sparing intervening epidermis. One of the earliest dual-mode systems was the Sharplan DermaK. Both Coherent and Sharplan brands are now owned by Lumenis.
Both the CO2 laser and Er:YAG laser are clinically proven to be effective technologies for ablative skin rejuvenation.
Yet, alone, each laser has its limitations. In order to provide physicians access to the best characteristics of each laser wavelength, Sharplan combined a high-power Er:YAG laser and a subablative CO2 laser in the blended DermaK system. At the same time, the laser heats the underlying skin dermis , which causes collagen fibers to shrink. Ablative laser resurfacing typically takes between 30 minutes and two hours, depending on the technique used and the size of the area treated.
Nonablative laser resurfacing can be done in your doctor's office. Your doctor will protect your eyes and numb your skin with a topical anesthetic one hour before treatment. If you're having fractional photothermolysis, you might need additional pain relief. To protect the outer layer of your skin, your doctor will apply a water-based gel. The laser damages collagen beneath your skin and stimulates the growth of new collagen, tightening underlying skin and improving skin tone and appearance.
No skin is removed. A series of treatments is typically scheduled over the course of weeks or months. After ablative laser resurfacing, the treated skin will be raw, swollen and itchy. Your doctor will apply a thick ointment to the treated skin and might cover the area with an airtight and watertight dressing. To relieve pain, take an over-the-counter pain reliever and apply ice packs. Your doctor will explain how to care for your skin.
You might prefer to remain home while you heal. Once new skin completely covers the treated area — usually after one or two weeks depending on the depth of resurfacing and type of laser — you can use cosmetics to conceal any redness. After nonablative laser resurfacing, your skin might be temporarily red or swollen. Use ice packs as needed. You can apply makeup and resume your normal activities immediately.
After ablative laser resurfacing, your skin might stay red or pink for up to several months. However, once the treatment area begins to heal, you'll notice an immediate difference in your skin quality and appearance. The effects can last for years. Results after nonablative laser resurfacing tend to be gradual and progressive, rather than immediate and dramatic.
You're more likely to notice improvements in skin texture and pigment than in wrinkles. After laser resurfacing, avoid unprotected sun exposure for one year to prevent irregular pigmentation. Keep in mind that your results might not be permanent, since as you age you'll continue to acquire lines by squinting and smiling.
Cosmetic Rejuvenation Lasers: Everything You Need to Know
New sun damage also can reverse your results. This time period can be from 2 weeks to 2 months, depending on the depth of your peel. Even if you do decide to return to work before healing is complete, you must absolutely continue to follow the recommendations of your surgeon in regards to sun exposure and the use of protective skin barriers. Possible short-term risks and complications include prolonged redness of the skin, tenderness or a burning sensation, itching, increased sensitivity to light, and easy flushing.
In rare cases, the procedure can trigger the re-appearance of an existing dormant virus or infection. You may also experience skin irritation caused by sensitivity to the post-procedure healing cream. This usually resolves on its own. More long-term problems can include changes in skin color, like hyperpigmentation or hypopigmentation. It is also possible for a surgeon to go too deep during the procedure, resulting in scarring. The U. Skin resurfacing is usually not covered by insurance unless it is being performed to treat precancerous skin conditions or improve scars from a previous reconstructive procedure or trauma.
In the past several years, lasers have become a staple in the world of aesthetic improvement and anti-aging procedures. In addition to skin resurfacing , they have been shown to be effective for non-surgical skin tightening , improvement of stretch marks, hair removal, and even teeth whitening. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. More in Plastic Surgery. Anesthesia is given. In this case, a waiting period is usually required before beginning the actual procedure, to allow time for the anesthetic to work.
For deeper peels, the area may be injected with a local anesthetic. An oral sedative may be given to help you relax. In rare cases, or when other procedures are being performed in conjunction with resurfacing, IV sedation , or even general anesthesia may be used.