Sydney Laser Resurfacing

Aesthetic Surgery Centre obtains very good results when treating acne scarring with Laser Resurfacing process...

In the past, skin has been "rejuvenated" by chemical peeling and mechanical dermabrasion. These methods are unpredictable as the depth of wrinkle removal is difficult to control.

Collagen injections and Botulinum Toxin injections have their role in wrinkle treatment.

Laser resurfacing has very good results when treating acne scarring.

Recent technological advances have enabled the use of the powerful carbon-dioxide (CO2) lasers (which have a wavelength of 10,600 nanometres) to deliver char-free ablation (i.e. free of scarring and pigmentation) by moving the high powered focused beam rapidly by a microprocessor controlled opticomechanical device, and hence enabling a short exposure time at each position.

More recently, erbium:YAG lasers have also become available for laser resurfacing. They have a wavelength of 2940 nanometres, and the bursts of energy are delivered by very short pulses. The erbium lasers produce less post-operative erythema (redness), because the penetration is not as deep as the CO2 laser.

In the three to six months following the operation, the remodelling of collagen (structural protein of skin) will continue, and hence the process of skin softening is ongoing.

Pre-operative considerations

During your initial consultations, our doctors or trained staff will carefully explain the procedure to you. We need to assess your needs, the areas that you want resurfaced, and the extent of the correction to your skin that you require.

The type, depth, and power of the laser treatment, will depend on a variety of factors, which include:

• The type of damage (e.g. scars, wrinkles, acne)
• The extent of the damage (i.e. only around the mouth, or the whole face)
• The type and colour of your skin
• Where you have had any previous peels (whether they be chemical, laser, or dermabrasion)
• Whether you suffer active acne
• Whether you have had any previous operations to your face (e.g. eyelid surgery)

We will also need to know whether you have suffered from cold sores or shingles (herpes virus), and whether you have received roaccutane treatment for acne (within the previous two years).

Preparation prior to surgery

Skin preparation

This is mandatory in hyperpigmented or dark skinned patients, optional in others, and needs to be commenced two to four weeks prior to surgery. The use of Retin-A 0.1% at bedtime (if tolerated) helps to stimulate the collagen production in the skin.

Antibiotics and anti-virals

Anti-viral medication should be taken as prescribed. Please note that this medication is quite expensive, but can be claimed back from most private health funds. Patients with a history of herpes will start the anti-viral medication the day prior to surgery. Antibiotic tablets may be prescribed as well, commencing on the day of surgery, and continued for seven days.

Prior to surgery

You should eat a light breakfast on the day of surgery and if you are on any medication, take as normal.

How good will the results be

Laser resurfacing works. Histopathologically, re-epithelialisation (renewal) of the skin will improve its smoothness. Skin defects (wrinkling) can be graded as type I (minimal) to type III (marked lines). Improvement will always increase by at least one grade (e.g. type I to smooth, or type III to type II).

With aesthetic procedures, it is important to realise that different people react differently to exactly the same improvement (eg. you may be most pleased, but your neighbour disappointed).

It is our philosophy to under-do, rather than over-do a procedure. If a laser resurfacing is performed too deeply, there is the possibility of scar formation. We never want this to happen. If a laser resurfacing is not deep enough, then we can do it again, and then you will be even happier with the results! Touch-ups are best done about three months after the procedure, whilst the collagen is still being remodelled.

When do I use the Carbon Dioxide (CO2) laser and when do I use Erbium laser?

Many studies have been conducted, or are underway, comparing the effectiveness of one type of laser over the other. Further studies have been conducted combining the two lasers in one single procedure, or combining the use of laser with TCA chemical peels.

Because the erbium laser has a wavelength of 2940 nanometres, it has ten times the affinity for water. Each pass produces only 20 microns of tissue ablation, and hence four to five passes are needed to ablate the epidermis of the skin that has a thickness of 100 microns. This compares with the CO2 laser where tissue ablation is much deeper, being 150-300 microns per pass, with a larger volume of damage to the areas surrounding the ablation (called “thermal necrosis”).

This explains why the recovery period for both epithelialisation and post-operative erythema (redness) is shorter for areas that have been resurfaced with the erbium laser. It also explains why the CO2 laser is considered more effective for deeper wrinkles.

Because its effects are less deep, the erbium laser does not cause collagen shrinkage in the dermis of the skin (below the epidermis) and some studies have shown that this is necessary for better long term effects. Also erbium does not cause coagulation of the deeper blood vessels, where CO2 lasers do; and for this reason mild post-operative capillary oozing for the first few hours may result in an alarming appearance.

In your consultation, the merits of using the carbon-dioxide (CO2) or the erbium:YAG laser will be fully discussed with you.

Possible complications of laser skin resurfacing

Erythema (redness)

Mild redness of the operated region is normal for about 8 weeks following the procedure, but is effectively concealed by makeup once the skin has healed after 10 days.

In some cases, it may be prolonged for several months or be more pronounced than normal.

Redness of the operation site is necessary. In fact if there is no erythema, then there will be a poor effect to the treatment. Abnormal localised erythema may herald early scarring. In such cases intralesional steroids (triamcinolone 10 mg/ml) may be injected.

Hyperpigmentation of skin

This is an irritating complication, but will eventually clear in all affected patients. It rarely occurs in people with fair skin. If you tend to hyperpigment on your scars or where you scratch yourself, you must inform the centre prior to the procedure. High-risk patients are pre-treated with creams.

Hypopigmentation of skin

This complication is most frequent in lighter skin types, and greater depth of the laser resurfacing. It may occur as late as six months after the procedure and is due to dermal fibrosis. The use of the erbium laser has been claimed to reduce this complication.

Hypertrophic scarring

The most dangerous areas for this to occur are peri-orally where there is most motion of the face. Hence in such areas the surgeon is careful not to resurface too deeply.

Demarcation line

These may occur surrounding the geographically treated zones. They will become minimised with time. To minimise these from occurring, the whole face may be resurfaced, or those regions not resurfaced are peeled immediately after the laser resurfacing with 25% TCA.

Milia

Milia are little white dots that appear on the skin. If they appear, they are treated with cortisone cream.

Infection

The open raw skin following the resurfacing can provide an excellent medium for the growth of fungus (candida), bacteria (usually pseudomonas) and virus (typically herpes zoster). We give prophylactic antibiotics and antivirals to all patients, which are used for seven days. Herpes zoster is related to chicken pox, and possible scarring that can occur may be so significant, that we ensure all patients take prophylactic antiviral drugs.

Bacterial infection is more likely if you have active acne, but we medicate patients with antibiotics if necessary to prevent this from happening.

Ectropion of the lower eyelid ("turning out")

The elasticity of the skin of your lower eyelid is observed pre-operatively. If it is lax, you may require a tightening procedure (called a canthoplexy) to prevent this severe complication from occurring.

Bulging of the lower lid

Laser resurfacing causes tightening of the skin of the lower eyelid. This may unmask the fact that there are protruding fat pads, which may give a “tired” effect (these are called “fat bags”). A blepharoplasty or “eyetuck” may then become necessary to remove these fat pads.

Mood changes

It is a known (but infrequent) phenomenon to experience several days of depression following any cosmetic procedure. Your post-operative checks are very important to exclude the onset of any of these above complications. Should this occur immediate treatment will then commence.

Post-operative instructions

• Dressings, creams: the postoperative care of your skin is a mandatory part of the actual treatment. The procedure is carefully explained to you after the operation, and is described on an information sheet given to you when you leave our Day Surgery.
• Post-operative visits: we like to review (or have contact with) you the day following the procedure, then after one, and three weeks. In fact, at any time, if you have any queries or problems, we would like to see, or hear from you.
• Makeup: may be used following re-epithelialisation (7 to 10 days). If your skin is erythematous (red), you can apply a green makeup (called a concealer) to neutralise the red colour, and then your normal makeup.

Please note that this information is for illustrative purposes only. Always ask your Cosmetic Surgery Specialist first!

For more than two decades, The Aesthetic Surgery Centre has built a reputation as one of Sydney's best Cosmetic Surgery clinics, employing experienced doctors and surgeons and knowledgeable beauty specialists. From major cosmetic surgery operations to non-surgical treatments, our highly skilled team is always committed on delivering professional advice and personalised guidance. So, if you are looking for operations prices, cost and fees information or before & after cosmetic surgery pictures, contact us… or make an online enquiry today.