The ageing process is never kind, especially to the face, where wrinkles and sagging skin readily appear. Most of the changes that we attribute to ageing, are in fact caused by sun damage, leading to damaged collagen fibers, which are the major support structure for the skin.

Prior to the introduction of lasers in cosmetic surgery, facial rejuvenation was only achieved by cutting and lifting the skin - the traditional face lift. Obviously the traditional face lift did not repair the damaged collagen, so the effects on wrinkles were limited, and not long lasting.

Laser resurfacing, has revolutionised the treatment of wrinkles caused by sun damage, by removing damaged collagen, and producing new collagen fibers. This produces a long lasting correction of wrinkles, without requiring any cutting, lifting, stitching or scars.

The sometimes unnatural appearance of facelifts that have been pulled too tight in an attempt to remove wrinkle lines, is no longer necessary for this purpose.

How does laser resurfacing work?
Laser resurfacing uses a laser beam, either Carbon Dioxide or Erbium, to selectively remove damaged areas of the skin. The laser beam must be used very precisely in order to only remove damaged skin, but leave normal skin intact.

Once the damaged skin is removed, new skin will form, from the hair follicles and oil glands, where it has been protected from the sun’s rays. The new collagen forms tight bands, giving the skin greater strength and elasticity, while tightening the skin surface. Wrinkles disappear, and are unlikely to reform unless further sun damage occurs.

Which lasers are used for skin resurfacing?
The original laser used for skin resurfacing was the Carbon Dioxide laser. Even though the results were often dramatic and long lasting, there were some problems which limited its use. Side effects occurred due to the heat generated by the carbon dioxide laser, which led to prolonged redness, and some loss of skin pigment in certain individuals.

The newer Erbium laser can remove damaged skin more precisely, without any heat being released into the skin. The result is that there is less redness, and less alteration in the skin pigment. The results have been excellent, although it is difficult at this stage to compare long term results to the Carbon Dioxide laser.

Who may benefit from laser skin resurfacing?
People with wrinkles, due to sun damage, benefit most from laser resurfacing. Wrinkles around the eyes, cheeks, and mouth achieve the best results, while movement lines tend to recur. People of all age groups may benefit, from 30’s to 80’s, often the more wrinkles, the better the result.

Is skin colouring important for laser resurfacing?
Carbon dioxide laser resurfacing is only suitable for patients with lighter skin, and preferably female. The Erbium laser is much more versatile, being suitable for patients of any skin colour, age or sex.

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How long does healing take after laser resurfacing?
The healing time after laser resurfacing will depend on the degree of wrinkling ,and the depth of laser resurfacing that is necessary to remove them. Following Carbon Dioxide laser resurfacing, healing normally takes 10-14 days, while Erbium laser treatment will normally heal in 7-10 days.

After healing, redness may be present for up to 6 months, following carbon dioxide laser treatment, or 6 weeks following Erbium treatment. Makeup will usually successfully cover skin redness after 14 days.

Is laser resurfacing painful?
When laser resurfacing is performed, local anesthetic is usually necessary, otherwise it may be uncomfortable. If large areas are being treated, a twilight sleep will produce maximum comfort.

Following laser resurfacing a special clear thin plastic dressing is used, to promote healing, and minimise pain. If a dressing is not used, stinging may occur following treatment.

Is hospitalisation necessary for laser resurfacing?
No. Laser resurfacing is performed as day surgery, so you can go home the same day. Alternatively, you may wish to stay for a short period at a private hospital.

What happens after the operation?
After the operation, a clear plastic dressing is applied to the skin. This will aid in the healing process, and will help to minimise discomfort. This dressing will require changing the next day, and then when necessary for the first week. Our staff is highly trained and skilled in post laser care, and will manage all these dressings for you.

Usually after 7-14 days, the skin will be healed sufficiently for makeup to be applied. Most people can return to work at about 2 weeks, with make up.

What other problems may occur with laser resurfacing?
Although laser resurfacing is a straight forward procedure, the post operative care requires the expertise of a trained dermatologist, who really understands the skin.

Many small problems may occur following laser resurfacing, which are readily treated, and will go away quickly, if the doctor recognises the problem. On the other hand if the problems are not anticipated and recognised immediately, permanent consequences may result.

Pigmentation
This is a common but self limiting problem following laser resurfacing. It is more likely to occur in patients with darker skins, and may occur in the absence of sun exposure. For this reason, most patients who undergo laser resurfacing, will require a special bleaching cream, to prevent pigmentation.

Infection
This is a rare problem following laser resurfacing, as long as proper post operative care is carefully adhered to. Antibiotics are prescribed routinely to further minimise this potential problem.

Cold sores
Because the risk of developing cold sores, is high, all patients undergoing laser resurfacing, must be given anti-cold sore tablets.

Pimples and whiteheads
This may occur after laser resurfacing if greasy creams or ointments are used. Dr. Weinstein, will suggest special products that are suitable for use post laser resurfacing.

Itchy skin
This may be a temporary problem after laser resurfacing, but will respond to special creams.
Scarring, although this is the most feared consequence of laser resurfacing, it is less common with the improved laser technology, especially with the introduction of the Erbium laser.

Contrary to popular opinion, the results of laser resurfacing depend on the skill and experience of the doctor, as well as the correct post operative care. Scarring may occur in some individuals for no particular reason. If it does occur, it must be treated early with injections of Kenacort and/or 5FU. In most cases, it will largely resolve.

Loss of skin pigment
This problem may be only seen many months after laser resurfacing. It was very common with the carbon dioxide laser, but is much less common with the Erbium laser. It tends to occur in people with lighter skin. Once it occurs, it rarely resolves.

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How long does the improvement last after laser resurfacing?
Improvement in wrinkles will last for many years after laser resurfacing, if the skin is looked after. Smoking and excessive sun exposure will lead to new damage to collagen fibers, so new wrinkles can appear.

How much improvement can be expected with laser resurfacing?
In expert hands, it is possible to obtain 70-90% improvement in wrinkles caused by sun damage, which includes wrinkles around the mouth, eyes, cheeks and forehead. Furrows, which are related to movement, tend to recur, e.g. - frown and smile lines. However, if laser resurfacing is combined with special injections, frown and smile lines improve dramatically. Even deep lines especially around the mouth will improve dramatically.

Acne scarring
Acne scarring will also respond to laser resurfacing. Depending on the depth of the acne scars, the degree of improvement will vary. As acne scars are generally deeper than wrinkles, the improvement will generally be in the order of 50-70%. Pitted scars respond best, while soft sloping scars will require a combination of laser resurfacing, and filling injections, for optimum results.

If acne is present at the time of resurfacing, will this affect the final result?
Active acne may be present without affecting the result of laser resurfacing

Does Ro-Accutane therapy affect laser resurfacing?
If patients have recently been taking Ro-Accutane for acne, the skin may heal abnormally, and scarring may result. Although it is not exactly known when it is safe to perform laser resurfacing after Ro-Accutane therapy, it is generally accepted a one year interval is safe. If there is any doubt, a test area may help.

Facial scars
Laser resurfacing can also help to modify facial scars which occur as a result of surgery or trauma. The best results can be obtained, if laser resurfacing is performed within 2 months of the original surgery, or trauma. Although scars cannot be completely eliminated, they may be greatly modified.

Sun damage, brown spots
Laser resurfacing is an excellent treatment for people with extensive sun damage of the face. Recent scientific studies have demonstrated that laser resurfacing will significantly reduce the risk of skin cancers, in those people with sun damaged skin. Scaly red sun spots and brown blemishes will also be removed on most occasions.

Can laser resurfacing be performed on the neck?
The neck is a very hazardous area for laser resurfacing, as scarring and loss of skin pigment will easily occur. It is not possible to remove wrinkles on the neck, but brown discolouration will respond.

Conclusion
Laser resurfacing has revolutionised the treatment of ageing skin, but a great deal of experience is necessary to obtain the best results. It is also important that the person undergoing such a procedure, has realistic expectations of what can possibly be achieved.

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1155 High Street, Armadale, Victoria, 3143, Australia Ph: 1300 667 039 | Email: info@doctorskin.com.au