Skin Resurfacing

What is the procedure and how is it performed?

Skin resurfacing is a surgical procedure in which areas of damaged, discolored, or wrinkled skin are removed layer by layer. After surgery, during the healing process, new skin forms to resurface the areas where the procedure was performed. Prior to the use of the laser, the skin was removed by a hand-held, rapidly spinning, abrading device.

When this device is used the procedure is usually referred to as dermabrasion. When using the laser the procedure is more often called skin resurfacing. In any case, the basic goal of removing layers of skin to be replaced by new skin is the same. The laser removes skin by using a beam of energy that vaporizes (removes) the layers of skin in a more controlled fashion. The procedure is almost always done as an outpatient under local anesthesia with sedation. The length of the procedure depends on the amount of skin surface being done but rarely last much longer than an hour.

Why is this procedure performed?

Skin resurfacing can be done for many reasons. It is most commonly done to remove the fine wrinkles around the mouth and the eyes. It can be used for removal of scar tissue from acne or trauma. It is frequently used to remove pigmented areas of the skin like age spots or melasma (melasma is an area of darkened skin that can result from birth control pills or pregnancy). If you have naturally dark skin you may not respond as well to resurfacing done for pigmentation. As with any cosmetic procedure it is important to have realistic expectations. The goals, limitations, and expectations of the procedure should be discussed openly and in detail with your surgeon.

Skin resurfacing for wrinkles is not permanent. The aging process of your skin will continue and results will gradually fade over time. Except for the removal of some types of scars or pre-cancerous lesions, resurfacing is considered a cosmetic procedure and is not covered by insurance. If you have to work out doors you may not be a good candidate for this procedure because of sun exposure. If you have taken Accutane (a prescription for acne) you can not have this procedure until 18 months after taking the medication. If you have a history of herpes simplex infections you should be treated for this condition pre- and post- surgery since the procedure may cause an outbreak.

What should I expect during the post-operative period?

You should have someone available to drive you home after surgery. The surgeon will have applied an ointment to keep your skin moist and promote healing. Some surgeons apply a light dressing over the skin. During the first few days you will feel some mild swelling and discomfort. Take pain medicine as prescribed by your doctor. Except for going to the bathroom, stay in bed with your head elevated or in a comfortable chair for the first day or two. In the first few days it is also a good idea to avoid hot baths or showers. If you still have bandages in place, keep them dry. Using a cold compress will help during this time. Once the bandages are removed your face may look very pink or flushed.

This coloration will last about two weeks. Your surgeon will give you specific instructions on how to wash and care for your face. It is not unusual for scabs or crusts to form on the face. You should not attempt to pick these away. After the first few days you can gradually resume normal activity but avoid bending or straining. Avoid any strenuous activities for a few weeks. You should not apply makeup for two weeks, unless otherwise directed by your doctor. Some types of mineral based make-up are acceptable to use. You should also avoid any sun exposure until all the color of your face has returned to normal. If you have to be out in the sun after that it is important to apply a strong, broad spectrum sun block.

What are the risks and complications of this procedure?

Just as there may be benefits to the procedure(s) proposed, medical and surgical procedures also involve risks. These risks include allergic reaction, bleeding, blood clots, infections, adverse side effects of drugs, heart attack, stroke, and even loss of bodily function or life, as well as risks of transfusion reactions and the transmission of infectious disease, including hepatitis and Acquired Immune Deficiency Syndrome, from the administration of blood and/or blood components.

There are also particular risks associated with the procedure(s) proposed. These risks include but are not limited to:

Failure to heal properly: This is more likely in those who smoke.
Inadequate results/Need for repeat procedures
Bleeding
Hyperpigmentation: This means increased color in the skin. The redness of the skin is called erythema. It usually fades away after two weeks but in some cases the skin continues to be very red and, in some cases, itchy. This may require treatment with steroids and antihistamines.
Hypopigmentation: This means an abnormal lightness of skin color. It is caused by destruction of cells in the skin that produce color called melanocytes. This is more likely to occur in patients who have darker skin. These color changes may be permanent and untreatable.
Infection: Persistent pain, increasing redness and/or low-grade fever may be signs of infection and may require treatment with antibiotics.
Scarring: Delayed healing may lead to the formation of abnormally thick tissue instead of normal skin resurfacing. This is called hypertrophic scarring. This requires aggressive treatment and may eventually require a second procedure to excise the scar tissue. Some of the scarring may be permanent.

Before you agree to any operative procedure it is important to remember that each patient is different and that the outcome of any surgical procedure can never be guaranteed. You should understand that there may be complications that have not been mentioned and that it is not possible to anticipate all complications or to answer each and every question. Again, you should be aware that in the practice of medicine unforeseen and unexpected risks or complications not previously discussed may occur. You should also understand that during the course of the proposed procedure(s), unforeseen conditions may be revealed requiring the performance of additional procedures, and such procedures may need to be performed.

Keep in mind that there is no substitute for an open and honest discussion with your own surgeon/physician regarding this procedure.

You should also be given any available treatment alternatives to this procedure by your doctor, some of which may include medication. Be sure to discuss any questions or concerns with your doctor

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