Skin Resurfacing: Laser Surgery, Chemical peels, Dermabrasion
With inevitable aging and accumulated skin damage there is gradual development of facial wrinkles and photoaging or sun damage. Factors which accelerate skin damage include excessive exposure to the sun, overactive facial expression muscles, cigarette smoking, stress, poor nutrition and skin disorders. More people are seeking facial plastic surgery and cosmetic procedures to reverse the effects of sun damaged and aging skin.
Skin resurfacing could improve the look of your skin and subsequently your self-confidence. This information aims to give you some guidelines on procedures available at Perth Facial Plastic & Cosmetic Surgery. Successful facial plastic surgery can result if
there is a good rapport between you and Dr Pham. Trust, based on realistic expectations and exacting medical expertise, develops in the consulting stages before surgery. Dr Pham can answer specific questions about your specific skin problems at consultation.
Skin Resurfacing Can Be Used For The Following Conditions:
- Wrinkles - especially fine wrinkles - around the eyes, lips, cheeks and forehead
- Blemishes and uneven skin
- Sun damaged skin
- Pigmentation (freckles, hyperpigmentation)
- Benign skin lesions - keratoses
- Scar improvements - acne, chicken pox, traumatic or surgical scars
- Facial rejuvenation - sagging eyelids
Understanding the procedure
The skin is composed of the epidermis and the dermis. Within the dermis are two layers, both of which are constructed of collagen which are long fibres that loosen and stretch with age and sun damage. If the deepest layer, the reticular layer, is damaged, scars result, while the upper layer of the dermis, the papillary layer, heals from injuries without scarring.
Skin resurfacing essentially involves removing the superficial skin layers up to the deeper dermis layer. This causes the growth of new skin cells and underlying collagen which in turn leads to smoother, firmer and healthier skin.
Methods of Skin Resurfacing are:
- Chemical peel
- Laser
- Dermabrasion
Chemical peel - Dr Pham or his staff apply one of several chemicals to the skin. Glycolic acid is the mildest. TCA (trichloroacetic acid) or Hetter Peel can be used in varying strengths for longer-lasting smoothness. The deepest peels are done with phenol.
Before any peel, the face is first thoroughly cleansed with a solution to remove oil and to prepare the skin for deeper penetration. As the chemical is applied, the epidermis is removed, and the chemical penetrates into the first layer of the dermis.
Dermabrasion - is a surgical technique whereby some deeper scars and wrinkles can be smoothed. Dr Pham uses a local anesthetic and/or a freezing agent to render the skin numb. Using a high speed rotating brush, Dr Pham then removes the top layer of
skin to the appropriate level. The size and depth of scars and the degree of wrinkling determine the length of the surgery.
Laser surgery - A laser is a high-energy beam of light that can selectively transfer its energy into tissue to treat skin and tissues. It is used to resurface facial skin with wrinkles caused by excess sun exposure, "crow's feet," and acne scarring. The high energy amplified light waves of a substance (eg carbon dioxide (CO2), Erbium) vaporise the top layer of skin instantly, with minimal bleeding and minimal trauma to the surrounding skin. Lasers can also be used to incise the skin or tissues, vaporize tumours, close blood vessels, selectively reduce pigmentation and remove hair.
There are many different lasers which are used medically and some are specific for certain conditions. Many procedures cannot be done without the laser. Likewise, many procedures are better performed without the laser or are as effective as a laser. It is a tool and the choice of using a laser as against any other surgical method is carefully evaluated by Dr Pham so that the best outcome can be expected.
Decision to have Skin Resurfacing
The most basic requirement for any surgery is good health. Other requirements are more subtle and should be carefully considered in discussions with Dr Pham. Expectations from the surgeon and surgery must be realistic. Skin resurfacing procedures cannot produce perfect skin; rather the goal is to improve the appearance of the skin as much as possible.
Skin type and color, ethnic background, and age are important factors that should be discussed prior to surgery. If you have dark skin or problems such as allergies, previous burns, a history of poor scars (hypertrophic or keloid), or radiation exposure, you may need special evaluation to determine if you are a candidate for these procedures. If you have had episodes of cold sores and blisters around the mouth, past and current medications including Roaccutane, Retin-A, previous electrolysis and chemical peels please inform Dr Pham.
Before undergoing a skin resurfacing procedure, Dr Pham may recommend a skin care regimen beforehand. If you have extensive damage from aging or injury, more than one procedure may be necessary.
The Procedure
Dr Pham will discuss options and risks of each resurfacing technique and will inform you of the most suitable procedure for you. You will also receive information relating to each procedure. Please note that neither dermabrasion nor chemical peels can correct sagging skin or halt the aging process. Furthermore, resurfacing may lighten skin colour and you must make a commitment to use sunblock.
Skin resurfacing can be performed under local anaesthetic, sedation with local anaesthesia or general anaesthesia depending on the extent and your choice. After a thorough medical history, Dr Pham will advise you where the procedure will take place and the costs for the procedure. Most skin resurfacing procedures are day procedures.
Dr Pham may also suggest other surgery, either before or after your resurfacing procedure in order to enhance your overall appearance.
During surgery, if you are under local anaesthetic or sedation you may hear the laser or dermabrader noise. Your eyes and some parts of your face will be protected.
PREOPERATIVE (Before surgery) INSTRUCTIONS
- Start skin program if applicable
- Dr Pham recommends prophylactic anti-viral treatment for cold sores / Herpes Simplex for all types of skin resurfacing procedures especially if you have a prior history. You should start the treatment 24 hours before surgery and continue for 7 to 10 days after.
- Please cease Aspirin, Aspirin-containing products, Plavix and non-steroidal anti-inflammatories (such as Ibuprofen) for 10 days prior to and two weeks following your surgery. If you are on any medications that affect bleeding (such as Warfarin) please notify Dr Pham.
- Smoking tobacco and alcohol increase anaesthetic and surgical risks. Please cease them for three to four weeks prior to and four weeks following surgery. They cause delayed wound healing, skin necrosis and other complications.
- Please notify us of all your routine medications and significant health history. You can remain on your daily medications, except for blood thinners unless instructed otherwise.
- Arnica, a natural herb that significantly decreases bruising, can be taken before and after surgery along with Vitamin C (ascorbic acid), which helps promote healing.
- If you are having a morning procedure you must not eat or drink after midnight the evening before. If you are having an afternoon procedure you must not eat or drink after 6.00am on the morning of surgery. You may, however, take your normal medications and brush your teeth.
- Please shower and remove any make-up and nail polish before arriving for your procedure.
- Unless you are remaining in hospital someone will need to drive you home after surgery and stay with you that evening.
- If you have any concerns please call the office (08) 9322 1960. Remember, we are all here to give you the best possible care.
POSTOPERATIVE RESURFACING INSTRUCTIONS
Immediately following skin resurfacing, Dr Pham may apply a dressing to your skin. Swelling, weeping, itchiness and "crusting" of the skin are normal, and ointments to keep the skin supple should be applied for seven to 10 days following surgery. Swelling typically peaks on days 2-4 after the procedure then gradually improves. The redness of skin that persists after the initial healing phase will usually fade in about 4 weeks. Do not pick at the crusts as this may increase wound infection.
We recommend a soft diet, avoidance of extremes in temperature and any activities that would cause stress to healing skin for 3 to 4 weeks. It is imperative that you follow the post-operative instructions provided by Perth Facial Plastic & Cosmetic Surgery. Should you experience any increase in redness or itching in the days after surgery, notify the office immediately.
One to two weeks after surgery new skin will emerge that is pinkish, finer, and free of many wrinkles. But it will take several weeks for all the redness to vanish. Follow-up care involves using sunblock (SPF 15 or more) and avoiding sun exposure in order to protect the skin while new pigment is created. This is recommended for 6 months or more after the procedure. You can apply make up after 10-12 days. Use only the cream recommended by Perth Facial Plastic & Cosmetic Surgery. Patients will notice that the skin remains lighter for a long time after surgery, but this will usually subside when the skin's pigment level has been restored.
Final results following skin resurfacing are not apparent for up to 3 months following surgery. We request that you please follow-up with us for at least 6-12 months for assessment and postoperative photographs. Remember to maintain a healthy lifestyle and please continue a good skin care program for the best long term results.
Please Inform Dr Pham's office or the hospital where the procedure was performed if you have the following:
- High fever, chills or a temperature of more than 38 degrees
- Heavy bleeding from the wounds
- Severe pain or tenderness
- Significant redness, or discharge around the wounds
If you have any concerns you can contact Dr Pham's office on 9322 1960. Remember, we are all here to give you the best possible care.
Risks of Surgery
Modern surgery is safe but does have risks. Complications can occur despite the highest standards and world's best practice principles used by Dr Pham.
It is not possible to list all the risks but you should be informed of the common side effects and benefits so that you can make an informed consent. Dr Pham will discuss these in greater detail at consultation. You should write down any particular questions or specific concerns.
The potential risks are
General risk of surgery
- Wound infection or breakdown - may require antibiotics
- Bruising and swelling
- Bleeding, seroma and crusting
- If you had a general anaesthetic: Chest infection, Sore throat from the breathing tube, heart problems, blood clots (lower legs or lungs) or breathing difficulties.
- Slow healing especially in smokers.
- Pain and itchiness
Specific Risks
- Herpes cold sores, pimples and whiteheads, acne outbreak
- Persistent swelling and inflammation
- Inflammation of surrounding areas such as the eyes - conjunctivitis, may require antibiotic eye drops.
- Scars that become raised (hypertrophic or keloid), pink and sometimes itchy. May take 12 -18 months to settle and may require steroid injections.
- Changes to skin pigmentation - lighter (hypopigmentation) or darker (hyperpigmentation).
- Asymmetry and contour irregularities including depressions or wrinkling of the skin
- Subjective dissatisfaction with the final outcome
- Allergic reaction or skin sensitivity to skin creams and sun.
- Some patients have trouble sleeping or feel depressed.
- Anxiety regarding staying indoors or avoiding public places during the healing period.
Insurance does not generally cover procedures that are performed purely for cosmetic reasons. Surgery to correct or improve major deformities or accidental skin injuries may be reimbursable in part. It is the patient's responsibility to check with his/her health insurance fund for information on the degree of coverage.
Please contact us for your consultation on Rhinoplasty / Nasal Reshaping or other cosmetic surgery and non surgical cosmetic procedures
Gallery - Before and After Photographs >>
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