Patient Brochure

Patient Brochure

The Laser Resurfacing is an ablative fractionated laser procedure. A laser resurfacing could be described either as superficial or a deep ablative. The term ablative is indicating that the laser beam penetrates into skin layers, breaking its entirety while punching it in multiple micro-holes. Depending on the energy density the ablation depth can range from affecting upper epidermal layers only to deep to the layers of the dermis. The meaning of ‘fractionated’ presumes so that the laser radiation is delivered in portions and with the help of a scanning attachment (the head) the ablative micro perforating holes in which skin layers evaporate, are applied to the skin. These micro-holes are applied with a certain density, consistency, and intensity.
The superficial resurfacing (ActiveFX *) removes epidermal pigmentation resulted from sun and photo damage. It is often; as such resurfacing is being described as a laser peeling with an emphasized effect on the skin surface. Performed, it effectively removes epidermal melasma, sun-induced pigmentation, brightens the skin as overall, and could also smooth out any fine lines around the eye area. As with the superficial resurfacing the laser ablation is done over a relatively large focal spots (up to 1.3 mm) yet, remaining within the epidermal level. The recovery process hence is shortened, unlike as with the deep ablative laser resurfacing.
As with the deep CO2 laser resurfacing (DeepFX*) effectively and durably are being removed and corrected any fine lines, medium to deep wrinkles, acne scars, as well as stretch marks and scars resulted from coarse correction burns, surgical intervention or any other causes. The laser operator works within higher power densities while treating smaller (less than 0.150 mm) focal spots unlike the superficial resurfacing. At the time of vaporization the surrounding healthy tissue shrinks due to a thermal coagulation retraction of the dermal extracellular matrix formed around and each ablative channel. All cellular and extracellular structures evaporate at the center of each ablative channel, while the formed cavity is being immediately filled with exudation plasma. While in the process of epithelization new connective tissue (collagen and elastin) structures are being synthesized and stimulated to correct and restore surface structure and volume of all treated skin area. Deep lines, wrinkles, any acne scars, as well as stretch marks appear visibly smoothed and narrowed with just the very first procedure. In cases of deeper scars and persistent wrinkles the procedure is being repeated with the applied working ablative dose adjusted at the discretion of the physician.
Patients generally feel a burning discomfort during and after the procedure yet, it is usually well tolerated as no anesthesia is being required. The feeling straight after the procedure resembles sunburn like sensation and subsides within two hours. This particular method gives a low rate of complications, although, since a violation of the skin integrity (ablation) is present there is some risk of subsequent infection (impetiginisation). However, risks of side effects are thoroughly minimized as with the new laser systems operating now on smaller focal spots and short pulses. When using RF CO2 laser aroused sources deep ablation is being achieved through lower energy densities in narrowed ablative channels, thus allowing greater density of perforation, and respectively one more efficient resurfacing with a shortened recovery time. A rejuvenation effect of a deep laser resurfacing occurs immediately after the very first session - skin wrinkles, fine lines and other imperfections are visibly smoothed. It is reported skin tightening and largely eliminated superficial pigmentation, dishromia, as well as most of the visible capillaries. The rejuvenation results post a well-performed resurfacing could be defined as rejuvenation for the following at least 5 to 15 years. Once a deep resurfacing is being administered, afterwards a superficial laser resurfacing could be also performed, in order to permanently remove any leftover pigmentation or any slight residual pigmentation hues resulting from the selected deep resurfacing ablative micro-holes. The effect of the procedure is permanent and largely reduces the appearance of new wrinkles. After a few years another procedure can be performed to enhance the rejuvenating effect. Upon removal of severe acne scars several procedures are usually held every other month. A laser resurfacing procedure is done during late fall and winter season (pls., note: at the end of month of March the procedure is no longer recommended until next fall season).
* ActiveFX, DeepFX са запазени марки на фирмата Lumenis Inc.
Conduct of Recovery and Care for the Treated Area:
Conduct of Recovery and Care for the Treated Area: Immediately after treatment the scanned area fades due to vasoconstriction and vascular obliteration in partial areas around the zones of ablation. Subsequently, there is a pinkish coloration or redness of the treated area noted, with mild to moderate plasma exudation, as well as some punctate bleeding on the spots where an ablative channel has punched a large capillary vessel. There is, at this early stage, some uncomfortable burning sensation and tension due to some moderate edema, which can be reduced by locally applying cold compress in the first few hours after the procedure, is done. Prevent the area from getting wet. It is possible, so a more expressed swollen reaction would also arise further - usually after the first few days. It is desirable at that time to limit intake of any salty foods as well as alcohol, in order to reduce the edematous response in areas with loose connective tissue - around the eyes and upper cheeks. The treated area tends to form crusts (scabs) after the first day. During the first week it is recommendable using epilotonic and hydrating fluids, physician prescribed. Crucial are first three days post procedure. At the end of the first week formed crusts start to peel off. After the second day post procedure moisturizing emulsions (i.e.Eudermol 0) can be applied if appointed by the doctor to soften the formed crusts yet, skin should not be scrubbed but lightly tapped with a gauze pad. Self- attempts to mechanically remove the crusts shouldn’t be made. When at the end of the first week crusts start to peel off by themselves the area can be splashed with lukewarm water then, gently tap-dry. Again, an epilotonic and/or a hydrating cream is applied gently; once all crusts are permanently off the area can be washed with lukewarm water as with no soap and afterwards must be treated with moisturizing cosmetics. After crust removal the reconstructed area is appearing smooth and slightly pink in color with a subtle ablative perforation pattern which usually resolves within two to three weeks disappearing gradually and completely after a month. The residual laser ablation pattern clears off and smoothens. During this period treated area could be easily masked by slightly adjusting light makeup. After the procedure is done, the overall treatment effect keeps increasing during the following four months due to the organization of newly synthesized collagen. During that period, the treated area should be kept replenished with medical cosmetic products, applying rigorously appropriate topical photo protection with SPF50. It is suitable using a silicone-based facial cream for at least six weeks..
Worldwide dermatology practice recognizes the CO2 fractionated laser resurfacing as the ‘gold standard’ as being the most effective therapeutic and cosmetic treatment. Disadvantages of the method are associated with the need of a one-week recovery period post ablation, and the possible complications. The widely promoted recently developed methods for non-ablative laser rejuvenation where the patient can be carried out without any interruption from the social environment are considerably less effective - even though after performing multiple sessions.
The tension (lifting) of the skin, as well as the polishing (resurfacing) of the skin after a deep ablative laser resurfacing is due to two reasons:
- The coagulation shrinkage of dermal extracellular matrix in the area surrounding the ablative channels- which is easily seen by the visual skin tightening during the actual scanning process, as well as straight immediately post the laser procedure;
- A formation of new collagen in the already shrunk dermal mariks; stimulation of collagen synthesis in the ablative holes during the first weeks as well as organizing and modifying the collagen in the following four months.
A visible rejuvenating and smoothing skin pattern is established straight after the very first procedure and has a profound and lasting effect. Since after undergoing treatment skin shrinks, there shows a manifested tightening (facelift) effect which boosts the overall remodeling and rejuvenating look as a whole. Unlike surgical face lift which pulls skin wrinkles away, a resurfacing procedure tightens the skin and renews its entire volume. The numerous connective tissue ablative holes serve as one reinforcing skeleton that keeps skin tight while ensuring a lasting rejuvenating effect from a CO2 laser resurfacing procedure. Such laser resurfacing could be combined with other aesthetic surgical procedures such as for example: a facelift, hyaluronic fillers or Botox. It is desirable so such supplementary procedures be performed after the resurfacing procedure to help in correcting deep expression frown lines. Also, it is not recommended combining a deep laser resurfacing with a dermoabrazio procedure because of the adverse effects arising from improper dermoabrassion, and may actually distort the real laser resurfacing outcome.
Early and Late Reactions. Limitations and Risks Associated with the Procedure:
A laser resurfacing with a CO2 laser is an ablative procedure, and thus emergence of any temporary swelling and crust formation tend into leading to patients’ discomfort in their appearance, hence, it is better for the patient being away from work and their social environment for up to two weeks. This is especially true when performing the resurfacing over the entire face. When only limited areas of the face are treated and then appeared to be swollen, the formed crusts in the treated area can be masked with makeup thus adjusting the patient of not being detached from their social environment, if necessary. Usually on the drier skin types edema is somehow slighter.
Unsatisfactory result: The procedure may turn out to be ineffective enough, and should be repeated with different parameters - depth and density of ablative channels. .
Hyperpigmentation: it may show up to two months after epithelisation. It occurs more frequently among patients with darker skin (types III and IV by Fitzpatrick) when the treated area is being exposed to sun during the recovery period, and/ or when administered topical retinol products. Before administering a resurfacing it is required so any use of vitamin A / retinol / in facial cosmetics to be stopped completely in order to prevent further appearance of unwanted pigmentation. Any aroma fragrances, perfumes, cosmetic products and facial cosmetics containing perfumes should also be avoided during the whole recovery period for at least two months after the laser procedure, since those may induce photosensitivity reaction hence inducing pigmentation of the skin treated. Hyperpigmentation occurs rather compulsory after visiting a tanning bed during first few months after the procedure. Strictly avoid exposure to direct sunlight for at least three months after the procedure. It is especially risky visiting ski resorts. During this period any outdoors stay requires applying sunscreen with a high SPF - 30/50.
Depigmentation (bleaching): Such adverse reaction is more common to IPL photorejuvenation procedures or photoepilation where an overdose destroys epidermal melanocytes in a large degree. Usually such side reaction occurs when an IPL treatment area has been additionally damaged after increased sun-tanning pigmentation. Rare and temporary condition after a deep laser resurfacing. Physical fractionated equipment damage melanocytes in very small areas - in the spots of ablative wholes (0.1 to 0.15 mm) as the surrounding epidermis remains intact. Depigmentation may rather occur in an overdosed superficial laser peeling which generally works with large-diameter focal spots (0.3-1mm). In very few instances, this kind of side effect may occur if followed a more pronounced diffused infectious process (impetiginization).
Edema: Prevention and reduction of swelling immediately after the procedure requires applying cooling packs. It is desirable to redo those at home few hours after the session. Prevent the treated area to remain dry. Swelling is common especially around the eyelids, upper cheeks, and forehead. It goes away for a few days. Most often, a significant swelling may occur during the first three days post procedure. The swelling is less if in those days the patient sleeps with a body position reclined. Avoid use of salty foods and alcohol!
Herpes: This manipulation may induce an appearance of herpes simplex eruption, especially when treating the perioral (around the mouth) area in patients with underlying infection. For prevention purposes, various anti-herpes products (i.e. Acyclovir, Izoprenozin) can be assigned several days before the manipulation..
Impetiginization: While in some rare cases it may be a considerably severe inflammatory reaction, it needs to be managed promptly. Listed above side effects are typically related to an infection of the treated skin area. Prophylactically, topical antibiotic ointments and/or powders are to be applied, and in case of a suspected or present infection an orally taken antibiotic with marked skin accumulation (Azithromycin) can be assigned.