Skin Resurfacing Information

A youthful and healthy appearance is important in our culture. Many people feel bewildered about choices of treatment for aging and are barraged with many treatment options as well as an expanding choice of products available as self-treatment or as prescriptions.

One important fact to recognize is the role of sunlight exposure on skin. Most of the aging changes are in fact secondary to the unprotected overexposure to sunlight. Changes include: pigmentation, wrinkles, roughness, sagging, redness and even cancers. We stress that avoidance to sunlight and protection with effective broad spectrum blocks are absolutely necessary. Commercial sun tanning lights may be the worst possible treatment for your skin and are highly correlated with photo-damage. If your lifestyle includes a deep tan or a lot of sun, you will find no effective treatment for reversal of damage and premature aging. In fact, you may actually get more damage following some treatments.

There are many unfamiliar terms you may have heard about various skin treatments. We will attempt to clarify a few for you so that you can understand your options for selecting the appropriate treatment for your condition.

Cosmeceuticals

The application of surface preparations goes back to the ancient times and the choice should not be based on commercial hype but on a rational, scientific approach. Savvy marketers capitalize on every possible angle to promote cosmeceutical products. Some of the claims do have some foundation in scientific plausibility but we and you do not have access to facts and studies from which to base our conclusions. The rapidly growing demand from consumers has led to a $15 billion market with most products falling into sun protection and anti-aging categories. There has been little regulation and supervision from the federal government to protect the public from ineffective or harmful products. The feeling of anxiety from patients leads to the sale of overpriced products, both in the over the counter category and from spas and medical offices. While we are not in a position to counter various claims, we wish to list several categories which clearly produce visible and valuable changes in skin color, texture and color.

Skin Lightening Agents

Hydroquinone

Exfoliants

Alpha and Beta Hydroxy acids

Sunscreens

Zinc Oxide, Titanium Dioxide

Retinoids

Retinol, Tretinoin (derivatives of Vitamin A)

Vitamins

Vitamin E, Vitamin C, Vitamin B

Lipid Barriers

Petrolatum

Metals

Zinc, Copper, Selenium

There are many, many other products and categories which have utility and are currently undergoing scrutiny by various medical studies.

Microdermabrasion

This treatment is frequently available at spas and at some medical facilities. It involves an abrasive particle blast to the skin to remove a small amount of the most superficial portion of the skin. It has some utility to make the skin softer and smoother but will not change the underlying nature of the skin and on occasion will clog pores instead of improving the skin.

Chemical Peel

There is wide variation of this technique and in skilled hands, there can be dramatic results. The ease of application and inexpensive materials makes it appealing. Peels are somewhat imprecise and some such as phenol or TCA can be painful and debilitating. Uneven peel depths may result. Deeper peels may require a longer healing time and be similar to an aggressive laser peel.

Intense Pulsed Light (IPL)

This is a recent application of light produced by electrical generation of beams which can vary in frequency (color). This is not laser light but can be very penetrating in the skin. The various and specific frequencies may be used to reduce pigmentation, redness or remove hair. There is some heating of skin and some, though minimal, skin tightening. There is no removal of skin, and the overall effect is less than a true laser. IPL treatment together with topical agents shows great promise in the treatment of acne and precancerous lesions. Caution should be observed with certain skin types because of the unwanted side effect of pigmentation changes.

CO2 Laser

This, for a long time, was the gold standard of skin resurfacing. The most dramatic results are achieved with CO2 skin resurfacing. Both deep wrinkles and pigmentation changes can be reversed with the CO2 laser, and there is a possible lasting side effect of skin tightening. However, there is a long and painful recovery, and full- face resurfacing is a major procedure and usually requires general anesthesia. Use of the CO2 laser has been declining recently because of the frequent side effects of scarring and permanent loss of pigmentation.

Dermabrasion

This is an old technique now performed infrequently. The procedure generally involves actual grinding of the skin with a rough surface device. While still useful on limited areas such as scars, the whole face dermabrasion is infrequently applied.

Erbium Yag Laser Resurfacing

The technique we frequently employ is a laser which produces a wavelength of 2940 nm and is of short pulse. The depth of a single pass is 10 to 30 microns depending on settings. The energy produced is between 2 and 6Jcm/2. This produces a very controlled vaporization of the upper layers of the skin with minimal epidermal injury or damage. The energy is directed at the water molecules in skin and is far more efficient than CO2. Little associated damage is produced making for very precise skin peeling per pass. Deeper removal of skin can be achieved by multiple passes and results similar to the CO2 laser can be seen. The result of this is the removal of skin layer by layer. Erbium lasers can be used on the tissue of the neck because of the precision. This is an area rarely treated by CO2 because of the attendant risks of complication. Each treatment will cause underlying collagen contraction of up to 14%. This contraction aids to emulate and simulate a virtual non invasive/non-surgical face lift in addition to the aesthetic treatment of wrinkles, irregular pigmentation and sun damage. The same treatment can be used around the eyes and upper lip without the telltale line of demarcation characteristic of more aggressive lasers or chemical peels. The result for the patient is an improvement of the skin which is frequently dramatic with minimal downtime. The procedure can be performed without anesthesia, is brief, and the patient can resume normal activity immediately after the treatment. We suggest that 3 to 4 treatments spaced 2 to 3 weeks apart will give the best results.

What are the indications for treatment with Erbium Yag Laser Resurfacing?

Fine wrinkles, aging spots, surface pigmentation, roughness

What should I expect during treatment?

Without any anesthesia, there is a stinging during treatment which is usually well tolerated. Topical anesthesia can be and usually is used which makes the procedure easily tolerated. We can provide sedation on request.

What should I expect following treatment?

Following treatment, there is a burning sensation like sunburn which is accompanied by redness. This subsides within hours and can also be controlled with cool packs and surface preparations. There are newer products available which we can supply which sooth the skin and mask color changes during healing. Recovery lasts for about 5 days during which there is shedding of the outer skin.

How many treatments are required?

A minimal number of 3 treatments is recommended to achieve the best results. Occasionally 4 are indicated. You will receive improvement with only one treatment.

What should I do before treatment?

You may be given a prescription for a surface preparation to use for 2 weeks to 2 months preceding the actual laser resurfacing if there is severe damage. We feel that setting the skin on the path of renewal will give better results. You should avoid any sunlight or UV tanning at least 2 weeks preceding treatment. Please remove any skin preparations including makeup and moisturizers prior to your appointment. We strongly recommend ceasing smoking prior to treatment.

What should I do following treatment?

We will give you additional information but please avoid sunlight which can cause severe damage as well as significant blotchy pigmentation. You can use a topical ointment (Preparation H) or Vaseline and keep the skin moist and protected. Do not peel the skin when shedding occurs which may cause scarring or infection. We can provide you with a product which soothes and protects as well as masks the area of treatment.

What are some precautions I should take?

Avoid the sun. Use high SPF products if you really have to expose your skin. Don’t use your usual cosmetic products which may cause sensitization or allergy. Do not use topical antibiotic preparations unless directed to do so. Keep the skin moist, covered and clean.

What complications can occur?

You can develop a viral infection or eruption with herpes simplex or herpes zoster. If you are at risk or have a history of lesions we will pretreat you with antiviral medication. Call this office if you feel an eruption is in progress. Bacterial infections are possible but rare. Pulling at the skin or a lack of proper care can increase your risk. Scarring can develop under certain conditions and hyper or hypo pigmentation can be a risk especially for darker skinned individuals.

What conditions are not treated well with Erbium Laser Resurfacing?

Deep wrinkles, red spots, deep pigmentation.

What are contraindications for Erbium Yag Laser Resurfacing?

Healing disorders such as diabetes, chemotherapy or connective tissue disorder

Pigmentation problems such as melasma or vertiligo

History of hypertropic or keloid scar

Use of the following medications: blood thinners, oral or injectable cortisone in the previous 2 months, Accutane within the past 12 months, any medication which causes sun sensitivities.