LASER PEEL The CO2 laser is a device used for regenerating the skin by removal of built-up excess epithelium on the skin surface, and for tightening the deeper dermal layers to help improve the tendency for wrinkling caused by laxity of this deeper layer. The other purpose of laser treatment is to remove precancerous lesions and sun spots on the skin that are both clinically at risk for developing into basal and squamous cell skin cancers, and also present an aesthetic eye sore. Lasers can also be used for purposes of destroying other skin lesions such as warts, and the application of another type of laser, the Argon, can be used for purposes of treating prominent blood vessels and capillaries. Not all patients are good candidates for laser treatment. Those patients who are olive complexioned, or who have racially darker complexions, make for poor candidates for laser treatment. Laser resurfacing will cause an initial increase in the production of skin pigmentation, i.e., melanin, which is spurred on by the inflammatory process from the laser exposure. Later, these stimulated melanin-forming cells become sparse in the area of treatment, and there is then a lack of pigmentation, which leads to a very pale field of treatment. This in the extreme, would give someone a mime-face appearance if improper patient selection is done for purposes of laser treatment. The ideal skin type for laser treatment is an individual who has a very pale complexion to begin with, and is known to burn easily with sunlight exposure, and hardly ever tans from being exposed to the sun. The next best candidate is that patient who is also pale complexioned, but when exposed to the sun, burns not quite as easily, and tans a little. The third category is that individual who may burn only in the extreme, and who tans readily. The fourth category is an individual who hardly ever burns, and who tans almost immediately with sunlight exposure. These latter two groups tend to make for poor candidates for laser exposure, as they tend to have a more olive complexion, in contradistinction to the first two groups. Those of Hispanic, Oriental, or African heritage, make for another group which in most cases, do not do well with laser exposure for the same pigmentation problems noted, i.e., considerable increased hyperpigmentation at the site of treatment, and potential for significant loss of pigmentation in the resolution phase of laser treatment for as much as up to 18 months after treatment. Laser therapy is intended to treat both the superficial and underlying structures of the skin. Ideally, the superficial surface of the skin can be overtreated with laser, thus causing considerable damage that may yield greater than a superficial burn. In these instances, there may yield problems with permanent scarring which will have to be treated aggressively with topical and injectable steroids. Patients who have had previous chemical peels, or laser treatment are more prone to have such injuries, as the skin is now thinner, and the deeper dermal layers of the skin more prone to injury. These previously treated cases are not precluded from laser treatment, but must be approached with some caution. Patients who undergo laser resurfacing need attention to skin preparation preoperatively. A course of skin toning is done prior to surgery with a combination of Retin A, skin bleaching agents (Eldoquin Forte), and moisturizing lotion. Immediately prior to laser resurfacing, patients will be placed 24 hours prior to operation, on prophylactic antibiotics, as well as a prophylactic antiviral agent (Zovirax). This antiviral agent is necessary in that cold sore eruption can occur at the edge of the lips following laser treatment, as a suppression of these viruses in dormant state, now become a cold sore. The resulting inflammation and scarring from the cold sore can be very detrimental. For this reason, it is imperative that the Zovirax be instituted particularly in those patients who have a history of such cold sore eruption. In addition to the antibiotics and antiviral agents, the patient is placed on a small steroid pack to act as an anti-inflammatory in the first 24 hours before and after surgery. This helps to minimize much of the swelling, which is often accompanied with laser treatment. At the time of the surgery, anesthetics are administered on the basis of the extent of treatment. Periorbital or forehead, or strictly perioral laser sessions are handled by intravenous sedation and local anesthetics to the area, followed by laser treatment. The patient is shielded at eye level with special protective glasses, and likewise with respect to the teeth and other areas of the face and neck that are not planned for treatment. At completion of laser treatment, the treated skin is covered with a material used in burn units to prevent discomfort at the burn site by attaching an adhesive dressing of Flexain. The Flexain is kept in place for approximately one week while the patient takes appropriate analgesics and sleeping medications throughout the recovery period. It is ideal if the patient is kept in an elevated position so as to again minimize the swelling or edema in the treated areas. Between 7 and 10 days, the topical dressing is removed, and patients are treated with Aquaphor for those residual sites that present as weeping or scabbing areas of the laser treated site. Subsequent treatment consists of use of bleaching agents, (Eldoquin Forte Cream) to prevent the onset of increased pigmentation, in addition to topical steroid cream and moisturizers. An outline of these products will be given to the patient in serial order. WE obviously do not wish to have any sunlight exposure during the immediate postoperative phase of treatment, as this may increase the irritability and redness to the sites treated. Sunscreen is obviously necessary as a cover after using the other prescribed medications for starting out one’s day. Cover-up make-up will be necessary for a period of weeks following surgery in terms of the redness that does occur after treatment, and the skin type of the individual. The usual downtime in terms of patients not being able to confront the public ranges at minimum of 10 days, and a maximum of three weeks. Again, this is particularly true of the intensity of treatment for the type of problem, i.e., deep wrinkles vs. superficial treatment of sunspots and pigmentation abnormalities. There will be a stinging sensation in the skin even after healing for sometime, which is related to the process of re-healing of the deeper dermal layers, and the nerves of the face. It is not unusual for patients to complain of an itching feeling, and dryness which is remedied not only with topical moisturizers, but aided as well, with over-the-counter oral antihistamines, i.e., Benadryl. This is a brief outline of laser treatment, and should afford you a means of some insights into the nature of this therapeutic modality, and please feel free to ask Dr. Kennedy, or any member of his staff, regarding other particulars regarding this technique.
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