The following is information regarding laser resurfacing surgery. I feel it is important that you review, understand and discuss with family and/or friends the following information before choosing to proceed with this surgery.
GOALS OF LASER SURGERY
The laser is a surgical tool which is used to resurface areas of the skin which have been damaged by surgery, trauma, acne or the environment. The goal of surgery is to remove the superficial layers of the skin so that irregularities can be smoothed out, areas of abnormal pigmentation removed and fine wrinkles tightened. In any given patient, these goals may be only partially met.
LIMITATIONS OF THE PROCEDURE
Laser surgery affects only the upper levels of the skin. It is not intended to replace fact lift, eyelid or brow lift surgery. The extent of treatment is limited by the thickness and overall quality of the skin. Loose skin, displaced fat pads, sagging muscles and deep facial wrinkles will not be affected by this surgery. Depending upon the nature of the skin problem, total eradication of the wrinkles, scars, etc. cannot be expected.
ALTERNATIVES TO THE PROCEDURE
In most instances the laser is being used to improve the appearance of facial scars or wrinkles or to reduce areas of blotchy pigmentation. The results are clearly cosmetic and if no surgery is performed, the condition will remain unchanged or possibly progress with time. Other surgical procedures available to treat these problems include dermabrasion and chemical peels. The results from these procedures may be similar to that of laser surgery although there are slight variations in the healing time, potential for changes in skin color and need for second procedures. Your physician will explain the differences between the various options to you.
SURGICAL TECHNIQUE / ANESTHESIA / RECOVERY
Laser surgery is designed to vaporize the upper layers of the skin which will produce a smoother healed surface with tighter tone. In some cases patients will require pretreatments to clear the skin of dead cells and allow the laser resurfacing to be more uniform. Pretreatments vary with individual patients, but may include the use of Retin-A or bleaching agents 4-6 weeks prior to your chemical peel. Your doctor may also suggest the BioMedic micropeel prior to your chemical peel in order to more rapidly prepare your skin. The initial response to the laser is similar to a brush burn with the treated areas being raw and weeping. Considerable swelling may also be associated with the procedure, particularly around the mouth and eyes. If the eyelids are treated, these may swell shut for 3-6 days. Swelling of the lips may make it difficult to eat solid food for several days following surgery. The treated areas will also develop crusts which when loosened during facial cleansing may produce small areas of punctate bleeding. Once healing has occurred (7-14 days), the skin will have a matte finish (rather than shiny) and will be very pink. The pink coloration will last for 3-6 months following surgery. Makeup may be utilized to camouflage the pinkness once the surface has completely healed. It is absolutely critical that the skin be protected from sunlight during the healing periods. A heavy sunscreen must be used whenever outside the house and absolutely no sunbathing or exposure to UV light in tanning salons is permitted while any pinkness in the skin remains. A 10-14 day absence from work is generally required. A postoperative skin care regimen is generally recommended in all patients. This will be described in greater detail depending upon the nature of your surgery and the characteristics of your skin.
On the day of treatment you will be asked to come with a clean face and no makeup. You will lie on a treatment table and your hair and chest will be covered with wet towels. Eye protection such as damp sponges or eye shields will be necessary. After the treated area is anesthetized you will feel no further discomfort from the actual treatment. After the treatment is completed your face will be coated with an antibiotic ointment. If the areas to be surgically treated are small, anesthesia may only consist of oral sedation and injection of local anesthetic. In more extensive cases or in those cases in which the physician considers it necessary, intravenous or general anesthetic may be combined with local injections. In all but the most exceptional cases laser surgery is performed as an outpatient. Following surgery you will be given extensive instructions as to the care of the treated area and long term plans for skin maintenance. In office treatment programs are available, as well as instructions for home care.
RISKS AND COMPLICATIONS
A local anesthetic is usually used to block pain during the treatment. However, there is some degree of discomfort (stinging, burning pain similar to a sunburn) for the first several days after surgery. The treated area requires several weeks to heal during which time there may be swelling, weeping, crusting or flaking. Once the surface is healed it is pink and may be sun sensitive for an extended period of time. In some patients the treated area may heal with increased pigmentation or a blotchy pigmentation. This may require treatment with special bleaching agents or Retin-A for 3-6 months following surgery. Sun exposure will also need to be limited during that time. In rare patients pigment changes can be permanent. Hypopigmentation or loss of color in the treated areas is a rare complication with laser treatment, but can occur and be permanent in a small percentage of patients. A sensation of skin tightness, itching and formation of tiny superficial cysts (milia) may occur for several weeks following surgery. In patients who have had a previous cold sore or herpes simplex infection there may be recurrence of the herpes lesions. This may require preoperative or postoperative treatment with an anti-viral medication. Some recurrence of wrinkles in the eye, lip and forehead region can be expected due to the significant movement of underlying muscles with facial expression. There is a small chance of scarring with laser treatment including raised, hypertrophic scars or very rarely keloid scars. Some patients may require injection of the thick scars with steroid or other topical treatment such as silastic sheets. The laser beam itself is a high intensity light beam which is actually quite controllable and safe. There have been very rare instances of heat induced injuries (burns) from the laser. There is a very small risk of harmful eye exposure during laser surgery and safeguards are required and used during all procedures such as special eye shields, moist pads and other protective eyewear. Because the risk of scarring increases as the depth of the laser treatment increases it is impossible to completely eradicate all surface irregularities. Therefore, there will be incomplete removal of wrinkles, acne scars and other surface irregularities.
Even though the risks and complications cited above occur infrequently, they are the ones that are peculiar to the operation or of greatest concern -- other complications and risks can occur, but are even more uncommon. Any and all of the risks and complications can result in:
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Additional surgery
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Time off work
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Hospitalization
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Expense to you.
On occasion, surgical revisions may be indicated following the original surgery. If planned or performed within one year after the original surgery and if insurance does not cover these revisions, there will be no charge by the surgeon, but a facility fee will be charged by the hospital for use of the operating room, as well as a fee from the anesthesiologist.
NO GUARANTEE -- The practice of medicine and surgery is not an exact science. Although good results are expected, there cannot be any guarantee nor warranty expressed or implied by anyone as to the results that may be obtained.
COMMENTS
If a smoker -- must be off cigarettes for 3 weeks before surgery and 3 weeks after surgery. There is a much greater risk for scarring, poor healing, hair loss and skin loss in smokers. Must be off all aspirin containing products for 3 weeks before and after surgery. (Check all medications with us. Some medications, such as Motrin and Advil may also affect clotting.) You must stop all herbal medications 2 weeks prior to surgery.
If there is any item on this consultation sheet that you do not understand, mark it and call the office. An explanation or additional information will be provided. Share the information that we provide to you with interested family members and/or friends. Our aesthetic coordinator, Connie Chudoff is available for any questions at 856-325-6768.