A major component with aging is the loss of tone and turgor of skin. This leads to wrinkles, or rhytids. The old school of thoug t in the treatment of this skin laxity was to just pull harder on skin during facelifting which often led to distortion of normal facial anatomy and expression.
Later, chemical peels became vogue and they for the most part helped with skin texture, but just did not affect the underlying collagen structure to significantly improve tone. With the advent of the CO2 laser in the 1990s and facial laser resurfacing, Cosmetic Surgeons were for the first time capable of affecting skin tone. The downside was that the first generation of lasers were fully ablative meaning the they went too deep and patients had long recovery periods and occasionally complications.
The current generation of fractionated (not “Fraxel”) lasers have the distinct benefit of providing much better tone improvement but without the prolonged recovery and complications are minimal. The improvement in pigmentation, skin texture (smoothness) and skin tone (laxity) are dramatic and if patients follow our tried and true protocol to the letter, they have safe and predictable results.
Laser skin resurfacing successfully treats sun-damaged skin, facial wrinkles, and scars. For cosmetic procedures, specially designed lasers produce a beam of light capable of removing unwanted tissue, such as scarred, lined, wrinkled, and otherwise imperfect skin. The laser vaporizes skin cells by emitting bursts of radiation that are absorbed by water in these cells. Laser light penetrates to a very precise, controlled depth, making the procedure safe and predictable while reducing the risk of scarring or pigmentation problems. Laser resurfacing is bloodless and may be performed under light sedation. Laser resurfacing leaves the skin smoother and more natural looking.
Depending on the goals of the procedure and the laser used, many cases require only one treatment. The initial redness fades in a few weeks to a light pink, which can be concealed with makeup. The pink discoloration usually disappears in one or three months but in rare cases can last longer.
Laser resurfacing can be used as an alternative to chemical peel and dermabrasion. The benefits of using this technique are that there are less pain and a faster recovery time. Drs. Carlotti has successfully treated over one thousand patients with this technique. Nevertheless, each patient presents with a unique skin type, texture and goal for rejuvenation or removal of precancerous sun-damaged skin.
Therefore, as much as there is tremendous science behind the application of the laser, judgment on the part of the surgeon with regards to the power (density) of the beam applied to the skin, the number of passes and the areas to be treated is ART rather than science. The complications of laser treatment are almost universally caused by the inexperienced surgeon, improper post-operative management of the patient or non-compliance on the part of the patient.
The laser is used to reduce tiny wrinkles, acne scars, and other minor skin imperfections, especially around the mouth and eyes. It can improve sun-damaged and acne scarred skin, problems that often cause concern to both men and women. The collagen or the scaffolding to skin loses its elasticity as we age. The most remarkable application of the CO2 laser is that it can restructure the interlacing of the collagen fibers of aged, sun-damaged skin and renew the elasticity and smooth tone of the skin. This has been especially enhanced with the new technique of the fractionated laser, specifically known as Active FX or Deep FX. Active FX techniques are used for less severe facial wrinkling and hyperpigmentation. Deep FX is used for skin that has less tone and more pigmentation problems.
In most cases, only one laser treatment is needed. The advent of Laser Seal, a silicone “mask” applied like “frosting on a cake” over the treated areas of the face has dramatically improved healing time and created a virtually painless recovery. The Laser Seal mask is applied to the patient’s face before they leave the operating room and remains in place for 4-6 days. Upon removal of the mask, there may be minor crusting around the lips (where the mask won’t adhere due to lip movement) and along the forehead hairline.
The patient will begin showers in a tub-shower three times a day with a gentle spray to the face from 3-5 feet from the spicket. Within 2 weeks the facial skin is well healed and the patient may apply a mineral-based makeup such as Jane Iredale to cover any residual pinkness. The discoloration usually disappears in one or three months. The goal of laser resurfacing is to enhance facial appearance.
Expectations by the patient must be realistic, and results should be anticipated as improvements rather than total corrections. Results of the surgery depend on many factors such as the size, shape, and location of the imperfection and the patient’s heredity, age and general skin condition.
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