Skin Resurfacing

Laser resurfacing delivers heat to the deeper layers of skin where collagen exists.  The heat causes collagen to reform, thus resulting in tighter, smoother skin.  Initially, all the lines and wrinkles are gone due to swelling.  After swelling resolves, some of those lines/wrinkles return.  Collagen reformation occurs over several weeks/months; therefore, the skin continues to improve in appearance after laser resurfacing.  Proper skin care is essential to maintain/enhance results achieved with laser resurfacing.  Some very deep lines may still benefit from filler after laser resurfacing.

There are several great lasers in the market to address sun-damage skin and lines, wrinkles.  I tend to favor a fractionated CO2 laser.  I will do this procedure on its own or in conjunction with other facial plastic surgery, such as a facelift.  While I can't say there is one "best" laser, I can say that, in my experience, this fractionated CO2 laser provides reliable, predictable results.  The laser I currently use is the DEKA DOT fractionated CO2 laser.

Traditional CO2 lasers treat the skin in its entirety. Therefore, there is a lot of heat generated to the skin, resulting in prolonged healing period and redness of the skin. In an effort to decrease the healing period and redness of the skin, fractionated CO2 technologies were developed. The fractionated CO2 lasers (such as the DOT and FraxelRepair) deliver treatment in a microscopic pattern so that some areas of skin are treated while leaving other areas untouched. This decreases the amount of heat delivered to the skin, thus minimizing the healing period and redness of the skin. These fractionated CO2 lasers can be tailored to your desires and downtime, meaning that we can "dial down" the system if your downtime needs to be short. In such a case, you would probably benefit from a series of treatments. However, if you can tolerate one week of social downtime and are of the appropriate skin type, we can increase the treatment parameters to give an effective single treatment. As always, skin care is essential in the skin resurfacing patient. We work very closely with you in the healing period and weeks/months to follow to ensure that you use quality skin care products that not only protect the skin following laser resurfacing, but also enhance those results.

Posted by Rami K. Batniji, M.D., F.A.C.S.

Yes, there is good scientific evidence that supports the use of a pre-treatment regimen prior to your laser resurfacing, particularly if it is a deep (reticular dermis level) resurfacing and if you are darker in complexion. Studies have suggested the benefit of a retinoic acid prior to deep resurfacing may expedite the healing process. The addition of hydroquinone may also be of benefit. A recent study in the medical literature used a regimen that included proper sunscreen, 4% hydroquinone in the morning, and tretinoin in the evening for 1 month prior to the procedure. It is typically beneficial to resume this regimen approximately 8 weeks after the procedure

Some patients may develop milia when using Aquaphor. There is an alternative to Aquaphor that does not contain petroleum. It is called Un-Petroleum Jelly by Alba. It contains beeswax, moisture rich coconut oil and soothing, protective vitamin E. For more information on this product, please visit the following website: http://www.albabotanica.com/?id=66&pid=152

The 3 procedures you are reading about perform skin tightening in a non-invasive fashion. All of these systems deliver heat to the deeper layers of skin to create collagen formation, and thus skin tightening. Since the heat is delivered to the deeper layers of skin, there is no downtime associated with these procedures. In other words, these procedures are different from laser skin resurfacing procedures in the sense that there is no peeling of the skin. You may benefit from a series of treatments with either of these modalities and you may also benefit from maintenance procedures. Ultherapy uses ultrasound. SkinTyte uses laser technology. Elixis uses radiofrequency technology.

Posted by Rami K. Batniji, M.D., F.A.C.S.

You are correct in thinking that tanning salon use and smoking contributed to changes in the appearance of your skin. First, I recommend avoidance (if possible) of both. Smoking may increase the risks of skin resurfacing, such as poor wound healing and increased scar formation. Second, I recommend hydration; smoking and tanning both dehydrate the skin, resulting in increased appearance of lines/wrinkles. Third, proper skin care regimen is essential. Fourth, sunblock. Fifth, you would benefit from skin resurfacing to address the facial wrinkles. Fractionated lasers are an excellent option for individuals with fine lines and wrinkles. Depending upon the severity of the lines, you may benefit from "turning up" the intensity of a fractionated laser to achieve the most benefit. The DOT CO2 laser is an excellent option for this. Finally, if there are deeper lines around the mouth, proper dermabrasion (not microdermabrasion) may be the most effective treatment option; however, this is associated with a significant downtime and recovery period.

Posted by Rami K. Batniji, M.D., F.A.C.S.

Some of the results of laser resurfacing are immediate. Following laser resurfacing, the skin is swollen. As a result of this swelling, there is less appearance of fine lines/wrinkles. As swelling resolves (approximately 2 weeks after procedure), some of those lines/wrinkles may return in appearance. However, as collagen reformation occurs over the next 6 weeks to 6 months, you will see continued improvement of appearance of skin, especially when incorporating proper skin care products.

Posted by Rami K. Batniji, M.D., F.A.C.S.

Laser skin resurfacing is an excellent option for you to address fine lines/wrinkles, texture issues, pigmentation, and sun-damaged skin. I recommend you take approximately 7-10 days off from your social calendar. This social downtime is due to the fact that you will not be able to wear make-up during the peeling process of the skin. The peeling process is usually complete by the seventh day. After peeling, you may experience persistent redness that lasts for weeks; however, you can wear makeup to hide areas of redness once the peeling is complete.

Posted by Rami K. Batniji, M.D., F.A.C.S.

You have a few different options. One option is skin resurfacing with a fractionated laser. Another option is a chemical peel with 88% phenol. Both of these resurfacing options will address the loose, sagging wrinkles of the lower eyelids. Some things to consider before these resurfacing procedures are performed include your skin type and the laxity of the lower eyelid support. Another options is a skin pinch, which is a surgical procedure to trim the excess skin. Again, lower eyelid support is important to evaluate prior to this procedure. If lower eyelid support is not very good, I would perform a lateral canthopexy to further support the lower eyelid in conjunction with these procedures. Some other things to consider include Botox to address crow's feet and an eye cream to address dehydrated skin; we recommend IS Clinical eye cream for this condition.

Posted by Rami K. Batniji, M.D., F.A.C.S.