Laser Surgery

SUMMARY

Purpose (indications)

  • wrinkles
  • skin pigmentation changes
  • skin laxity
  • acne scarring
  • recurrent skin cancer
  • decreased elasticity of skin

What It Does

  • rejuvenate its top layer of skin [epidermis]
  • increases skin elasticity
  • improves acne scars & other facial scars
  • provides "tightening" of skin in many patients

Technique

  • laser vaporizes top layer of skin
  • localize, regional, or entire area face can be treated at one setting
  • no incisions in skin
  • no bleeding and minimal drainage
  • a moist dressing [Vaseline] is applied to laser treated areas at end of procedure
  • during the procedure, moist towels are placed around laser treatment area
  • patient's eyes uncovered was special techniques paragraph

How Long It Lasts

  • changes in skin elasticity and pigmentation last approximately 5 to seven years, in most patients
  • changes in acne scars and other scars – permanent

Ancillary Procedures Commonly Performed In Conjunction With Laser Surgery

  • blepharoplasty
  • forehead
  • neck lift
  • midface lift


MORE INFORMATION


Traditionally the advantage to laser has been that the procedure can be performed very precisely as the laser beam can be focused to a pinpoint size. in addition, the laser beam seals the blood vessels, lymphatics and nerve endings. This means that there is virtually a bloodless field with little post-operative swelling and little post-operative discomfort. In addition to being able to perform surgery more precisely for all the above reasons, there is also less discomfort for the patient and a quicker convalescence. An additional advantage with the new high energy carbon dioxide lasers is the potential for stimulation of growth factors which accelerate wound healing. Considerable research is going on in this area but studies indicate that incisions heal as quickly with the laser as with traditional cold steel or scalpel techniques and may in fact heal more quickly.

The disadvantage to laser is that technically it is a complex piece of equipment. The laser beam can cause injury to other tissues if used inappropriately. The most common injury would be to the eye or the potential of some types of lasers to ignite the surgical drapes and cause a laser fire.

Various types of anesthesia are used for laser surgery. Infiltration local anesthetics such as xylocaine can be injected into the skin to anesthetize the skin before removing lesions with laser or before laser resurfacing. With certain types of lasers, such as the Surgipulse carbon dioxide laser used for skin resurfacing or the tunable pulsed dye laser the amount of discomfort is minimal. Some people would require no anesthesia. The discomfort would be that similar to the snap of a rubber band or a mild pinprick sensation. However, most people find even this uncomfortable. For that reason, we usually use a topical anesthetic cream called EMLA cream. This cream when applied approximately an hour and a half prior to the procedure provides adequate sedation in over 80 percent of patients. If there is discomfort, then the traditional xylocaine can be injected into the skin to provide additional anesthesia. Because the laser seals the blood vessels and nerve endings, in most cases, there is little or no discomfort following the surgical procedure and additional pain medication is usually not required.

Lasers have been utilized since the early 1960's. Recent advances such as laser resurfacing have been in existence for only the last several years. For that reason, long term effects are not known. However, the skin heals significantly within the first 90 days following a procedure and is completely healed 12-18 months following the procedure. For that reason, we already have a good idea of what final effects can be expected. In regard to laser resurfacing, studies have been performed by Beeson and Hanke at the I.U. School of Medicine which have compared the results of laser resurfacing histologically to those of various types of chemical peels for which long term results are already known. This extrapolation can provide some insight as to what we can expect regarding the long term effects of the lasers. These effects appear to be comparable to that of a medium depth chemical peel and in some cases to a deep peel and no adverse sequela is noted. Laser resurfacing seems to stimulate a new layer of dense compact collagen fibers and a renewed resurfacing of the epidermis (top-layer of the skin).

TYPES OF LASERS

There are many types of lasers. The type of laser depends upon the medium which is "excited" by the laser. Different mediums have different wave lengths which will penetrate at different depths into the skin. The mediums may be gasses such as carbon dioxide or argon gas or they may be solids such as copper or neodinium. The lasers used most frequently in facial surgery are the carbon dioxide laser, the tunable pulsed dye laser, and the NdYAG laser. The argon laser was used frequently in the past but has decreased significantly in popularity with the advent of the tunable pulsed dye laser which is used for vascular lesions.

1. Carbon Dioxide lasers.

The carbon dioxide is the work horse laser in facial surgery. It is used to make incisions in the skin for many types of cutaneous surgery. Recent advances allow it to be utilized to vaporize lesions on the skin and to vaporize the top layer of the skin and stimulate collagen growth in the deeper layers of the skin for facial rejuvenation[i.e. laser resurfacing]. While carbon dioxide lasers have been used for many years recent technological advancements in carbon dioxide lasers have resulted in high energy carbon dioxide lasers which are the lasers used for resurfacing and improved wound healing responses.

2. Pulsed-Dye Laser

This is a laser which was developed approximately 5 years ago. This laser is unique in that it was specifically developed to treat facial vascular lesions. It is based upon the principle that laser energy is absorbed by specific material at specific wave lengths. For example, hemoglobin absorbs a specific wave length of light. This laser causes a chemical and physical interaction with the hemoglobin in the blood and the lining of the blood vessels which causes the abnormal blood vessels to close. This laser is used to treat port-wine stains and hemangioma [blood vessel tumors]. This has been one of the most significant advances in dermatology. The treatments are virtually painless and are done on an outpatient basis with minimal recovery time. Typically no anesthetic or only EMLA cream is applied topically to the skin. The area of the vascular lesion is treated with the laser. For the next five to seven days the patient keeps an ointment such as Bacitracin ointment over the area. After this time, they can begin wearing make-up over the area. The area that is treated usually has a gray color which may persist for one to two weeks. Multiple treatments are usually required to remove the vascular abnormality. The indications for use of the pulsed-dye lasers are port-wine stains,hemangiomas, telangiectasias and rosacea. Recently, the pulsed-dye laser has been used to treat scars. Published reports show that the laser seems not only to remove the redness in the scars but also oftentimes has a flattening effect and causes the increased fibrous tissues and hypertrophied scars to decrease.