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Superficial changes that occur within the skin such as wrinkles, surface irregularities and differences in pigmentation can now be treated by a variety of methods. These methods are continuing to improve and change nearly on a daily basis. These modalities include chemical peels that are present in several different forms and, therefore strengths. Dermabrasion or superficial sanding of the outer layers of the skin has been widely used for some time. The newest modalities include laser resurfacing most notably with the CO2 laser. The newest type of laser to be used for this purpose is the Erbium laser. As stated, these modalities continue to change and improve. The basis for each of these treatments whether by chemical or heat production (laser), or mechanical (dermabrasion) is to create an injury to the skin. This will be to varying depths with the more powerful treatments causing the deeper injuries. The skin then repairs itself, by the healing process. Collagen, one the main components of the skin, undergoes changes, which cause the skin to tighten, and the wrinkles to lessen. As with any surgical procedure there is the risk of injury in excess of what is necessary, and permanent, and unwanted changes may occur.
Surgery Anesthesia The procedure is performed under general anesthesia or under heavy sedation and local anesthesia as an outpatient. The type of anesthesia will depend on the particular treatment that your plastic surgeon and you have decided upon. For example, laser resurfacing of the entire face is normally performed under general anesthesia, while a relatively mild alpha hydroxy acid peel may be performed under no anesthesia at all. The anesthesiologist and the surgical facility, if necessary for your procedure, will bill separately for their services. Duration of Surgery The operating time will vary depending on the patient, the extent of the procedure, and the type of treatment used and whether any additional procedures are performed. Before Surgery It is imperative that aspirin or products containing aspirin not be taken at least 3 weeks prior to surgery. Also refrain from any herbal supplements, as some may have an effect on increasing bleeding during the course of surgery. Remove all makeup and mascara from your eyelids. If you wear contacts lenses, it would be preferable that you wear glasses when you arrive to the surgery center. You should shower well on the day of surgery prior to coming to the surgery center. It is okay to brush your teeth the morning of, but do not swallow any water.
After Surgery Depending on the procedure and its extent, either no dressing or a light dressing over the face will be necessary. 1. In certain circumstances you will be required to treat your face periodically while at home with solution or ointment (Vaseline) recommended by your plastic surgeon. 2. Ice packs are applied to the sides of the face to help reduce discomfort and swelling. There is usually a moderate amount of redness, swelling and crusting after skin resurfacing. 3. You should try to sleep with your head and shoulders elevated to help reduce the amount of swelling. 4. Initial discomfort is controlled with oral medication. 5. You may wash your face with a mild soap and water, starting 24 hours after your procedure. Return to Normal Activity Depending on the procedure selected you may return to work the same day, or in the case of laser resurfacing 10 days to 2 weeks You may drive when driving does not cause pain, or when you are no longer taking pain medication Photographs Photographs are taken at the time of your consultation. These are important aids in the preparation of surgery and become a permanent part of your record. Postsurgical photographs are also taken. Swelling and Redness Swelling and redness of the face and any site following resurfacing is normal. During the first 1 to 2 weeks your face will feel and look swollen. The swelling will start to subside after the first postoperative week. Again, this will depend in large part, on the type of resurfacing modality you choose. In the case of laser resurfacing, redness or erythema, may persist for as long as 3 months. It should, however, diminish considerably by about 6 weeks. The redness is a signal of injury to the thick, deeper layer of the skin, the dermis. Too little redness may signal that not enough injury was produced to eradicate deeper wrinkles. Too much, however, may result in excess scarring. Medications and topical cover-ups are available to either decrease the redness or to cover it up so you are able to get back to your daily routine sooner and without evidence of having had a procedure. CO2 Laser Resurfacing Preoperative and Postoperative Regime
Complications HYPERPIGMENTATION This usually appears 2 to 4 weeks following skin resurfacing with the laser. It is more likely to occur in patients with darker skin types. If untreated it may take 6 months or longer to resolve. There are both pre and post procedure topical preparations which are used to decrease the hyperpigmentation or alleviate it if it should occur. ACNE Following skin resurfacing the skin produces excess sebaceous material, which consequently may increase the incidence of acne. To counteract this normal response of the skin to injury we use a post procedure skin care regime, which minimizes the use of heavy occlusive skin preparations. In addition, some skin preparations are used post procedure to decrease or eliminate the acne should it occur.
Dr. Morales Recommends Theraderm Skin Products for his patients before and after surgery.
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