The fine wrinkles on the face have been treated in the past by dermabrasion and chemical peel. These methods were associated with significant long-term pigmentation change and have not been favoured by most plastic surgeons. From 1994 the carbon dioxide laser has been used for the treatment of facial wrinkles. For the treatment of perioral lip lines, there is nothing like it in the world.
Lip lines are removed in a precise, rapid, bloodless fashion achieving excellent and permanent cosmetic results. Crows feet, lower eyelid wrinkles, and glabellar frown lines can be softened or eliminated. The most spectacular results, however, are seen in the treatment of aged or sun damaged facial skin. Full face laser resurfacing can remove 10 - 20 years of aging changes without surgery. It has also been shown to be effective in treating acne scarring, pre-cancerous and benign skin lesions as well as superficial benign pigmented lesions.
The UltraPulse, which produces pulses of laser light, rather than a continuous beam, has been shown to be associated with less risk of scarring.
The procedure is carried out under general anaesthetic. Small areas such as the upper lip can be treated under local anaesthetic. The outer layers of skin are removed using the laser. The underlying skin is stimulating into contraction and this tightens the skin and produces a more youthful appearance. Although the treatment has only been available since 1993 it seems that the changes are likely to be long-lasting. Studies on patients who have sustained flash burns to the face, (a similar, but less controlled effect to laser resurfacing) have shown that the treatment produces a PERMANENT CHANGE in the skin with return of some of the elasticity. There is the production of new collagen within the skin. However, the aging process will continue.
Before and after images of a 70 year old lady with marked sun-damaged skin. Photographs courtesy of Coherent Lasers.
The majority of the wrinkles on your face will be improved. Some patients feel that the results at one month are better than at three months after the treatment. The reason for this is that at one month there will still be a minor degree of swelling. This then decreases before the new collagen synthesis has begun. At four to six months the new collagen synthesis has progressed and there is an improvement in the result. All patients develop a transient erythema (red skin), similar to a sun burn, which will take from one to two months to fade. Some patients will develop a transient hyperpigmentation (darker skin) which will persist for up to four months. The will be treated with topical skin lightening preparations.
Very deep wrinkles may not be completely corrected by one treatment. Further treatment sessions can be carried out six months after the first. It has been estimated that the procedure can take up to ten years off the apparent age of the patient. This is probably permanent, but remember that the ageing process continues and factors such as smoking can accelerate the deterioration of the skin. A small but growing number of patients have had second treatments (for deep lines) with no increased risks or complications. It therefore seems likely that full face resurfacing can be repeated.
Like any operation that is carried out under general anaesthetic, there is a small risk of chest infection, particularly among people who smoke. There is a small risk that INFECTION could complicate the operation. You can minimise this risk by ensuring that you are free from cough, cold or sore throat at the time of your operation and, if you have any doubts, you should contact your surgeon. There is a minor risk of scarring. Any patient with a history of cold sores must be commenced on a course of antiviral therapy prior to the treatment. This can be in the form of Zovirax tablets or Bromelain from a health food store or chemist. This must be continued after the operation for a total of one week.
The laser treated area maybe different to the surrounding skin. It often improves with time but it may be necessary to use make-up indefinitely to cover it up. It is partly caused by change in the texture of the skin and partly due to the deposit of new collagen. The collagen is necessary to build up the wrinkle and rejuvenate the skin. This is your own collagen that is generated in response to the laser treatment.
It is important that your skin is in the best condition possible prior to the treatment. Your surgeon will provide you with a programme of skin care that you must follow very carefully.
Immediately after the treatment you face will be dressed with damp gauze. This will be replaced regularly. Your face will feel like you have had bad sun-burn. It will be moist and will take five to seven days to heal. You will then be left with erythema (red skin), similar to a sun burn, which will take from one to two months to fade. This redness can be disguised under make-up. There is a remote possibility that you may need to wear make-up every day when you go out.
It is important that you avoid exposing the treated skin to ultraviolet light (sunshine). A sun block must be used every day once the skin has healed and it is advisable to use sun block make-up.
Although the benefits of Laser Skin Resurfacing are rewarding, it is still not like a quick trip to the beauty salon! A prospective patient must understand that laser damaged skin needs time to heal. In my experience, most patients will experience some minimal discomfort for a couple of days following the treatment. More importantly, the appearance of the treated skin may be altered for several weeks following the procedure. Most patients will appear as if they have had a bad sunburn by the third or fourth day. This effect may last for up to a couple of months. If you have a job, or social obligations, that place you in the public eye, this is an important consideration. Regardless of who does your procedure, this healing process is a result of the depth of the wound created, modified by the individual patient's inherited ability to heal.