A laser is a high-energy beam of light that can selectively transfer its energy into tissue to treat the skin. Lasers contain a material that produces and amplifies light. Two mirrors cause the light to reflect back and forth through this material. The result is a light beam that is collimated and intense. This light is either one pure color or several different pure colors. These properties which separate the laser from a light bulb, are important to the medical application of lasers.
Many procedures cannot be done without the laser. Likewise, many procedures are better performed without the laser. Even with the sparkle, pure color, and high-energy beam, the laser is not always the best tool for surgery. The choice of using a laser or other surgical methods is carefully made by the facial plastic surgeon. Your surgeon has the preference to consider the results, the possible complications, and the alternatives.
Many procedures can be performed with different lasers. The choice of the laser depends upon many factors, including the surgeon’s experience, the size of the area to be treated, and the expectations of the patient.
The use of lasers in medicine is complex, and your facial plastic surgeon is trained in the use of lasers and understands how and when to use a laser. Your surgeon will decide if a laser is appropriate, and which laser is best for the situation.
In medicine, physicians can use lasers to make incisions, vaporize tumors, close blood vessels, selectively reduce pigmentation, or even treat skin wrinkles. The laser makes it possible to change tissue without making an incision. A surgeon can treat birthmarks or damaged blood vessels, remove port-wine stains, and shrink facial “spider veins” without major surgery.
Is it any wonder that many facial plastic surgeons use lasers on a routine basis? They use the laser as a “light scalpel.” The tissue is left sterile, and bleeding is greatly reduced. When the laser is used to treat port-wine stains, no cuts are made. The laser energy penetrates through the skin to shrink the abnormal blood vessels that are the cause of these marks.
Lasers can be used to reduce wrinkles around the lips or eyes, even the entire face, softening fine wrinkles and removing certain blemishes on the face.
Lasers currently available for skin resurfacing include a high-energy pulsed carbon dioxide laser, a short-pulsed Erbium:YAG, and modulated (short-and-long-pulsed) Er:YAG systems.
The carbon dioxide laser skin resurfacing can achieve excellent clinical improvement of sun-damage, wrinkles, and atrophic scars. However, this resurfacing is associated with an extended healing period and, in some cases, prolonged redness that may persist for several months. Of greater concern is the potential for delayed permanent lightening of the skin seen in as many as 20% of patients when multiple-pass carbon dioxide resurfacing is performed.
The demand for less aggressive modalities for skin rejuvenation led to the development of the erbium yttrium-aluminum-garnet (Er:YAG) laser. Skin resurfacing with a short-pulsed Er:YAG laser is most commonly used for the improvement of fine wrinkles. For moderate sun-damage and wrinkles, modulated Er:YAG laser skin resurfacing results in greater collagen contraction and improved clinical results as when compared to short-pulsed Er:YAG systems.
Clinical improvement of severe wrinkles treated with a modulated Er:YAG laser can be impressive. Er:YAG laser systems may greatly improve scars caused by acne, trauma, or surgery. A variety of benign epidermal and dermal conditions respond favorably to Er:YAG laser resurfacing, including sebaceous hyperplasia, eruptive hair cysts, adenoma sebaceum, angiofibroma, hidradenoma, xanthelasma, and syringomas.
Fraxel is a new FDA-approved laser treatment used to treat wrinkles around the eye, age and sun spots, brown spots, acne/surgical scars, and skin resurfacing.
Fraxel precisely treats thousands of microscopic areas of skin, using pinpoint laser beams that penetrate beneath the skin’s surface to eliminate old, damaged skin cells. Fraxel treatment stimulates the body’s own natural healing process which replaces damaged skin with fresh, glowing, healthy skin. With Fraxel treatment, Dr. Moynihan can develop a treatment plan tailored to your skin’s individual needs, with two levels of results to be expected- immediate and progressive.
After your surgeon has indicated that a laser can be helpful in the surgery, your surgeon will explain the laser of choice and what can be accomplished. As with all surgery, the laser has its limitations. Often the results are spectacular. Your surgeon will give you the best judgment for the particular procedure.
Some surgeons may use local anesthetics to numb the treated area before the surgery. Surgery can sometimes be done in the surgeon’s office; other times the surgeries are performed in outpatient facilities at a clinic or hospital. Your surgeon will decide on the appropriate method, dictated by the nature of the surgery.
Because safety is a major component of laser use, your surgeon will describe safety precautions before the surgery. If you are treated with a local anesthetic, you will be required to wear protective glasses or goggles during laser use.
After the surgery, you will probably experience some swelling and skin redness for several days. Antibiotic ointments may be used during the healing process. It is important for the patient to follow all the post-operative directions of the surgeon, particularly in using sun block (when approved) and avoiding sun exposure.
The full impact of the laser may not be apparent for a month or two, especially with vascular deformities. Additional treatment sessions will not be scheduled until the healing process for a particular treatment is complete.
It is important for the patient to realize that lasers have specific applications. The facial plastic surgeon is experienced in the use of the laser and is the best source of information as to whether laser surgery is appropriate for your condition.
Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve congenital deformities or accidental skin injuries may be reimbursable in whole or in part. It is the patient’s responsibility to check with the insurance carrier for information on the degree of coverage.
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