I do this for treatment of ageing and sun-damaged skin in patients who don’t need a facelift. They have lots of lines, but little true sagging. I also treat mild to moderate acne scarring and some cases of skin pigmentation.
This operation has many different applications on the face. For every type of procedure, the preoperative and post-operative care is the same unless you are told otherwise. We can only successfully treat inactive lines that are present when the area is at rest. The post-op time is difficult, especially if the whole face is treated, with 2 weeks of care required — as the skin goes very red, swollen, and needs cleaning every 4 hours. However, full face resurfacing can give incredible results, literally taking 20 years off someone’s age.
Why don’t we have pictures of pre and post-op so that you can see the results? Good question. My view is that any doctor will only put up the very best results, showing incredibly smooth, young skin, through a mixture of the treatment, tricks of the camera and make up. It won’t be realistic, and any patient thinking about having this procedure will already have seen these sorts of pictures on the Internet anyway. My results are no better, or worse, than anybody else’s. So I take a more pragmatic approach, and ask that patients come to see me to discuss what this procedure, which often does have amazing results, can and cannot do for them.
The flash-scanned Carbon Dioxide laser. The laser in flash-scanned mode basically moves very quickly over the skin. Each point of contact is around 1 millisecond (1/1000th of a second). It vapourises away the outer layer of the skin – the epidermis. This on its own will give an effect like a chemical peel. In order to achieve tightening, the next layer of skin, the papillary dermis, also needs treating with the same process. This layer contains a lot of collagen, and the laser heats and damages this, causing obvious tightening, and a lifting, tone increasing effect on the skin. Essentially the laser is creating a first degree burn – it was how the technique was developed, as first degree burn victims were found to have dramatic skin rejuvenation once it had healed. There is no scarring when healing from first degree burns, as the skin appendages are intact (sweat glands, hair follicles, etc.), and new skin (epithelium) migrates out from these areas to form a new, fresh layer. It’s why laser resurfacing can’t be used on other parts of the body – there are not enough skin appendages, so healing occurs by scarring. Other lasers, such as the Erbium-YAG can also be used. This is less penetrating than the carbon dioxide laser, and has a more gentle effect. It heals more quickly, but the effect is not as marked. The adage “no pain no gain” works here (although it’s not actually a painful procedure post-operatively). The Carbon Dioxide laser remains by far the best system for a good result.
Pre operative procedure
Try to get your skin as un-tanned as possible before surgery. Therefore, do not sunbathe etc., once you have made the decision to go ahead.
Zovirax antiviral tablets are routinely given for 5 days during the period in which the treatment is carried out. This is to prevent cold-sore formation. Remove all make-up prior to surgery, and wash your face with simple (non-perfumed) soap and water a few minutes beforehand. Men should close shave the area to be treated. Those having general anaesthesia should be 6 hours from eating or drinking. Local anaesthetic cases can eat or drink what they like.
If you are having treatment around the eye, eye protectors are used. If treatment is not around the eye, wet gauze swabs will be placed over the closed eyes. The procedure will be painless once the anaesthetic has been delivered. After each pass with the laser (there may be up to 4), the skin will be gently cleaned with soaked gauze (painless!).
Post operative care
We have tried many different types of skin dressing – Vaseline remains the best. Initially, the skin will look fairly normal, and there is little pain. Over the next few hours, usually at home, the skin that has been treated will start to swell, redden, become slightly tender (painkillers will be supplied, although this rarely becomes very sore) and leak fluid – rather like when falling off a bicycle and scraping your knee on the road. This fluid and Vaseline should be cleaned off the skin every 4 hours during the day. Do it by using flannels and hypo-allergenic soapy solutions. Dab dry the treated area with a clean towel, then the Vaseline should be re-applied. This is to prevent scab formation, which will otherwise delay healing. During the night, set your alarm clock for one cleaning at around 3 a.m. If slight scab formation occurs, soak the skin for longer. This “washing” stage lasts for between 5 and 10 days.
(The reason this cleaning is recommended is that if the skin is left to dry at this stage, it will scab over as a natural dressing. This is perfectly reasonable in terms of healing, but does not look particularly nice and lasts for 3 or 4 weeks – better 7 days of washing).
Once the skin has stopped oozing (it’s dry), the underlying redness can be covered with your usual foundation. If you do not use make up, it is advisable to visit a beautician prior to treatment, explaining what you need, as the redness usually needs to be covered. You can return to work at this stage, although if possible 14 days total off work is optimal. Men should avoid shaving the treated area until cleaning has been stopped, then shave only gently with an electric razor for the next 4 weeks, before returning to a wet shave. The redness persists usually for between 1 and 3 months, fading gradually. As it fades to a healthy pink (at about 4 weeks) it becomes easier to cover up with thinner and thinner make up (foundation) during that time. Between 2 and 4 weeks post-op, apply 1% Hydrocortisone cream as supplied to the treated area every night. This helps accelerate healing by reducing inflammation. It will also help to reduce itching, which can be a nuisance. Persistant redness is uncommon, but has been known to last for up to 12 months.
You will be contacted 3 and 7 days after treatment to check that the dressings are being applied correctly, and that you feel confident that the treatment is progressing as expected. At all times your nurse and/or surgeon will be available for questions as and when they arrive. The final check with your surgeon will usually be 3 months postoperatively, when the effect will be established, any potential complications or problems can be dealt with then. The final effect is complete once the redness/pinkness disappears – at around 3 months.
Those patients with no history of Keloid scar formation or Accutane /Ro-Accutane treatments in the proceeding 24 months are very unlikely to scar in any way. (Those having been on Tetracycline antibiotic treatment should wait for 12 months before having this procedure). Pigmentation changes in the treated area (skin lightening or darkening) are a rare occurrence in Caucasian people (less than 10%), although quite common in those from Asia or with darker types of skin. Hyperpigmentation (skin going darker) usually lasts for around 6-12 months. Hypopigmentation (skin going lighter) is more of a problem, and may on occasion be permanent. Demarcation lines around the lower jaw, between the untreated neck and the newly treated face, can be a problem – every effort is made to make sure this doesn’t happen.
Sunbathing on the treated area is not allowed for the first 12 months after surgery. If going out into bright sunlight during this period, factor 50 sunblock, which incorporates Titanium Dioxide, if possible, should be used over the treated area, and adjacent skin (otherwise this will tan and make the treated skin look pale by comparison).
Pre- and Post- operative photographs will be taken. These remain our property. They may be used for publicity purposes with the patient’s consent.
Only those patients with unreasonably high expectations of the end result will be in any way disappointed with this treatment.