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How is Laser Resurfacing Performed?

Laser skin resurfacing uses a carbon dioxide (CO2) laser to remove skin layers by vaporization rather than with chemicals or a sanding device. Dr Shah is able to specify the amount of energy transmitted to the skin's surface by the laser beam and control the depth of penetration.

What kind of conditions can Laser Resurfacing treat?

Any of the following conditions may indicate that you might be a good candidate for Laser Resurfacing.

• wrinkled or sun-damaged facial skin
• vertical wrinkles around your mouth, such as those that cause lipstick "bleed"
• "crow's feet" lines around your eyes and perhaps some skin laxity in your lower eyelid area
• fine wrinkling of your upper eyelids
• brown spots or blotchy skin coloring
• certain precancerous skin growths
• acne or chicken pox scars
• superficial facial scars from a past injury

Like the other resurfacing methods, the laser is effective in treating wrinkles, blotchiness or age spots, and scars from acne or other causes. It can be used on the entire face or specific areas. Certain other characteristics of your skin, such as its thickness and texture, may influence whether you are a good candidate for laser resurfacing. Some patients may benefit from the laser's mild "tightening" effect on the skin, particularly in the lower eyelid area where the skin often becomes somewhat loose as a result of aging.

Doctor Consultation: what to ask about laser skin resurfacing

In addition to History and a Physical Examination, the following will be performed.

Skin Evaluation: You should be carefully examined to determine which resurfacing technique, or combination of treatments, will provide you with the best results. Your skin type, the severity of any sun damage, the extent of uneven pigmentation and the depth of skin imperfections will be evaluated. Fine lines, coarse wrinkling or deep acne scarring each may require a different approach to treatment.

Medical History: You should come to the consultation prepared to discuss your medical history. This will include information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries, and medications that you currently take. Be sure to tell your plastic surgeon if you have ever had x-ray treatments of your facial skin such as those used in the treatment of acne or if you have had a prior chemical peeling procedure. Current or past use of AccutaneT, as well as Retin-AT and other topical skin preparations, must be reported to us. For your safety, it is important that you provide complete information.

Getting ready for Laser Resurfacing

We may may place you on a pretreatment program during which you will apply special creams, lotions or gels to your skin for a few weeks or longer. You may also be given certain oral medications that you should begin taking prior to your treatment. We will provide you with additional instructions.

You should arrange for someone to drive you home after the procedure and probably assist you for a day or two.

During Laser Resurfacing

Medications will be administered for your comfort prior to the treatment. Frequently, local anesthesia alone or combined with oral analgesics is used for patients undergoing skin resurfacing procedures.

After Laser Resurfacing

When the treatment is completed, your resurfaced skin may be covered with petroleum jelly or other protective ointment. In some cases, dressings, tape or a bandage may be applied.

Recovery from Laser Resurfacing

It is important to realize that the amount of time it takes for recovery varies greatly among individuals. We will probably see you on multiple occasions in the first two weeks.

First few days: Laser skin resurfacing will produce redness and swelling to varying degrees. Depending on the post treatment regimen selected by your plastic surgeon, a scab may or may not form over the treated area. You will be advised about cleansing your skin, as well as if and when you should apply any ointments. In the case of men who have undergone resurfacing procedures, shaving must be delayed for a while. It is essential that you follow our instructions and avoid doing anything that might interrupt the healing process.

Within 7 to 10 days: New skin will have begun to form. After the initial redness subsides, your skin may be pink for several weeks to months. Camouflage makeup usually can be used within a couple of weeks, but we will advise you.

Depending on the type and depth of your skin resurfacing, straining, bending and lifting should be avoided during the early period following your procedure. For deeper resurfacing, you should be able to return to work within a week or two.

Results: what to expect from Laser Resurfacing

Because of the persistence of skin pinkness following many types of resurfacing procedures, it may take months before you can fully appreciate your new look. Most patients feel that the results are definitely worth waiting for and, in the case of deeper treatments, the benefits are relatively long-lasting. More superficial resurfacing treatments may need to be repeated periodically in order to maintain their benefits.

Your skin will, of course, continue to age. Also the type of wrinkles caused by movement of your facial muscles will eventually reappear. Some wrinkles may recur sooner than others, depending on their location as well as the type and extent of your resurfacing treatment. Despite this, you can expect that improvements in skin quality and texture achieved by resurfacing will make your complexion appear younger and fresher for many years to come..

Laser Resurfacing side effects

The subject of risks and potential complications of laser resurfacing is best discussed on a personal basis.

Potential risks include:

• infection
• abnormal healing
• allergic reactions
• if prone to herpes, possible eruption
• raised or thickened scarring
• unanticipated skin color changes or skin blotchiness

Following all resurfacing treatments, it is important that you avoid direct or indirect exposure to the sun until all the redness or pinkness of your skin has subsided. Even after that, it is advisable for you to protect your skin by regular use of a sunblock and, whenever possible, a wide-brimmed hat. If the area around your eyes has been treated, you should wear good quality sunglasses when outdoors. After some types of skin resurfacing treatments, you may need to be careful about exposing your skin to chlorinated water.

You can minimize certain risks and help to maintain the results of your skin resurfacing treatment by following the instructions given to you.

Laser Resurfacing cost

Laser Resurfacing cost can vary widely due to the nature of the laser used and the area being treated.

Labels: C02, Laser Resurfacing

As you age the following things take place in your skin:

1. The amount of collagen produced is diminished and the type of collagen changes from a more youthful type of collagen to an older type of collagen. The production of collagen never ends.
2. The Elastin in your skin decreases in content as well as production. But it also does not completely stop being produced.
3. The Melanin granules (colour/pigment in your skin) in the upper layers of your skin coalesce into pocket, we call them freckles, sunspots or brown spots.
4. The cells of the skin age and more dead layers of skin pile up in the upper layers of the skin.
5. Skin cancer risks go up because of environmental influenced - sun, pollution.

What you can do to correct these problems:

1. Retin-A - increases collagen production, slows the loss of elastin, decreases the production of metalloproteases, cause the dispersion of melanin granules, reduces the rate of topical skin cancers, exfoliates the dead skin layers and improves acne as well. the down side to retin-a is complinace - you have to start at a low concentration and move to the highest concentration as your skin allows.
2. Hydroquinone - Bleaches the sunspots and retards the production of melanin.
3. Sunblock- Zinc Oxide sunblock is the best.
4. Some of the Laser Facials can be very effective as well.
5. Anti-oxidants - Obagi or the Alyria are the best available.
6. Avoiding sun-worship and healthy eating with drinking lots of water are requisite to good skin health as well.
7. . In my practice I use the Mixto SX laser for skin resurfacing (but many good options exist) and have had great (often amazing) success improving the health and appearance of my patients skin, beyond what Retin-A and skin care had done. Over 3-4 months, the laser treatment leads to increased collagen production with improved firmness and tightness of the skin

Labels: Collagen

Is there a difference between the UltraPulse CO2 laser /Fraxel repair /Pixel /Mixto/DOT lasers? I'm confused by all the different names and think the doctor will try to sell me on whatever machine he has- without it necessarily being the best for me. How can I know I'm doing the best treatment?

There are a lot of laser devices out these days and you do have to do your homework to keep things straight. There are basically 3 categories of lasers: 1) Fully ablative that includes CO2 and Erbium lasers, 2) Fractional Ablative lasers that include Mixto, Fraxel Repair, Lumenis Total Fx (these are both fractionated CO2), Pixel, DoT and others, 3) Fractionated non-ablative lasers such as Affirm, or Fraxel Restore

The main difference between these categories is the amount of downtime that goes along with them. The Fully ablative lasers require 1 treatment and will require 2-3 weeks to heal and possibly some redness beyond this time frame. The fractionated ablative CO2 lasers usually only take 1 treatment and reduce the healing time to about 1 week. The nonablative fractional lasers require 4-5 treatments but only have 1-2 days of redness for healing.

The other main consideration is results and what the treatment is for. A basic rule is that the more aggressive the laser, the better the results and the more the downtime. All lasers are indicated for wrinkles, acne scars, pigmentation, and sun damage. For wrinkles, more aggressive treatments are better.

This is some basic information to help you along. The other questions you should ask are what are my options. If the practice only offers one laser and one laser for everything then you should be wary. If options are presented to you with variable results and healing times then it is reasonable. Any serious laser practice will offer options or combination treatments. For example, our practice has multiple lasers for various applications so that we can offer options to patients depending upon their needs and lifestyle (healing time tolerance).

In terms of the CO2 laser, it is not the machine that is important, it is the kind of experience that your doctor has in dealing with the machine. CO2 machines are powerful and they do give wonderful results. But your physician has to have experience in the use of the particular machine.

Labels: C02, Fraxel, Laser Resurfacing

Obagi is a company that was founded by a dermatologist. Its main products use a retin-a and hyrdoquinone product line that allow for good penetration of the product. The Blue peel is a TCA peel that uses a blue dye to allow better visualization that the product is evenly distributed on the skin.The Obagi Blue Peel is a light to medium depth TCA (trichloracetic acid peel) that can be applied in the office. The 'blue' is a carrier pigment that allows the physician to see where the chemical has been applied and to ensure even distribution.

The goal is to lighten pigment spots and reduce fine wrinkles. It typically has a burning sensation that lasts for a few minutes after application.

The recovery time is between five to seven days depending on the depth of the peel and results desired.

Multiple treatments can be used to treat mild acne scarring, but other modalities (fractional resurfacing) are often times more effective.

Labels: Hyperpigmentation, Obagi Blue Peel, Peel

What to look for in laser hair removal?

Laser hair removal has come a long way since the first laser for hair removal received FDA clearance in the mid 1990’s. Older generation lasers were slow, very painful and worked only on individuals with very dark hair and very light skin. Today, lasers can work on all skin colors and some lasers are even safe for treating tanned skinned. Lasers for hair removal can be performed on any (yes, any) area of the body.

When considering a hair removal laser treatment, people should consider the following questions:

1) Is this laser Health Canada approved for hair removal on my skin type and hair colour?

There are several lasers for hair removal available. No one laser is ideal for every individual. Depending on your skin color and hair color, some lasers will be more effective than others.

The Ruby Laser: This is the "original " hair removal laser. Its deep red color at 694nm is very well absorbed by the melanin pigment in hair, making it an excellent choice for fine and light hair. However, because melanin is present in the skin as well, the Ruby laser cannot be used on patients with skin that is not very light, including tanned skin. Because of this limitation, slow repetition rate, and relatively small spot size, Ruby lasers have become less popular for laser hair removal in recent years. We do not use the ruby for hair removal at BC LASER. We use it for tattoo removal.

The Alexandrite Laser: This laser produces reddish light. With its large (up to 18mm) spot size and high repetition rate, the Alexandrite laser is the fastest hair removal laser, and is suitable for rapid treatment of large body areas in patient with light to olive complexion. An entire back can be treated in less than 30 minutes. We tend to use this at BC LASER for light skinned people.

The Diode Laser: This laser, consists of a high power laser diode emitting infrared (invisible) light at ~800-808nm. The longer wavelength allows deep penetration into the skin and safety for darker skin types, but with less efficacy for lighter and finer hair. A smaller spot size means a longer treatment. That may mean a more expensive treatment. A longer treatment may also increase discomfort and a need for topical numbing

The long pulse Nd:YAG: This laser can be used on all skin types, including tanned skin. Large spot sizes and fast repetition rates allow large areas to be treated quickly. Then disadvantage is less effective clearance for fine and light hairs than some other hair removal lasers.

IPL devices are not lasers, because they emit non-coherent light of many different wavelengths. However, because most of the light energy is in the shorter wavelengths, treatment of darker skin types is less effective than with the appropriate laser. The disadvantage here is that these IPL treatments require many more treatments and can cause darkening of the skin.

2) What is the spot size of the laser? A larger spot size offers not only the advantage of faster treatment, but also additional safety and efficacy. As spot size increases, a lower percentage of the delivered light energy scatters outside of the treatment area, increasing the depth of pentration, and allowing a lower energy setting to be used for treatment.

3) What type of cooling system is the laser equipped with? It is important that a laser have consistent cooling in order to ensure patient safety and comfort.

4) Is there a physician on site? Although complications with new lasers for hair removal are rare, in the event of a complication, you need to know who will provide medical attention.

5) Are treatments sold in a package or one at a time? Because every person will respond at a slightly different rate, and some individuals will require more treatments than others for complete clearance, most laser centers will offer individual sessions.

6) Are complimentary consultations and spot tests available? You should be able to meet the technician and experience a pulse or two before committing to a treatment.

Labels: Laser Hair Removal

"People always say I look angry or worried because I have wrinkles on my forehead. Which wrinkle treatments will get rid of these forehead lines?"

Different forehead wrinkles require different treatment modalities
Forehead wrinkle treatment depends on the underlying cause and extent of damage to the skin.

Dynamic wrinkles are those that are present only during animation (active movement of the face) and are best treated with Botox. Botox will temporarily stop the underlying frontalis muscle from pulling on the skin and creating the furrows and wrinkles. A typical treatment will last three months.

Static wrinkles are those that are always present even when the face is at rest. If these creases are deep, a combination of Botox to stop the primary culprit (frontalis muscle) and a filler material (e.g. Restylane, Juvederm) to fill the dermal defect are quite useful. Filler materials are temporary as well lasting six months or more.

More aggressive and longer lasting treatments include Fractional laser resurfacing that work well on static wrinkles as well as a forehead lift in which the frontalis muscle is weakened.

Every individual requires a customized approach to meet their goals and expectations within their budget and recovery time constraints.

Labels: Botox, Fillers, Wrinkles