CO₂ Laser Resurfacing

Patient Forms and Instructions:

• CO₂ Laser Resurfacing Consent Form
• What to do prior to Treatment
• What to do on Day of Treatment
• Post-Operative Instructions

Why the skin looks old.

There are basically two main elements to the appearance of the skin, its tightness (or tone) and its smoothness (or texture).  Aging results in a decrease in the tightness of the skin that causes wrinkles and lines and so on.  The surface is also affected by aging and sun damage and each can result in discoloration, roughness, large pores, and so on.  Therefore, techniques designed to rejuvenate the skin are typically targeted at improving its tone and/or its texture.

How can you improve the skin’s tone or texture?

There are essentially three main types of skin rejuvenation: thermal, chemical, and mechanical.

Thermal rejuvenation involves the use of a radiofrequency device to heat the skin causing a reaction that can lead to tightening of the skin, but the surface layers remain intact (and aged and sun-damaged).  This is good for tone, but has little effect on texture.

Chemical rejuvenation involves applying chemicals to the skin resulting in a peeling of the surface layers, resulting in a reduction in the appearance of age spots, but with very little deep tightening of the skin.  This is good for texture, but has little effect on tone.

Mechanical rejuvenation employs a laser, which can achieve multiple effects (both skin tightening and resurfacing, good for tone and texture) through a single treatment yielding the best combination of all available techniques for the most effective rejuvenation of the skin and dramatic improvement in appearance.  Laser resurfacing is a form of mechanical rejuvenation.

So why choose laser resurfacing?

Laser resurfacing has a marked advantage over thermal or chemical techniques as it results in both skin tightening and resurfacing whereas all other modalities achieve primarily one or the other of these, but not both.  This is good for both tone and texture.

So laser is best, but which laser to choose?

There are indeed several laser-based skin treatments available.  However, we strive to only offer the highest quality services and as with all of our surgeries and skin care products we desire to offer the most effective and rewarding treatments to our select patients.  Therefore, we are proud to introduce the first and only Lumenis Encore Ultrapulse Carbon Dioxide (CO2) Laser to the Panhandle region (we do in fact have the first and only such laser in this region to the best of our knowledge at the time of this writing).  This device has been considered the “gold-standard” against which all other devices have been compared for many years.  Dr. Mills used this technology exclusively in Jacksonville, and is now very proud to bring it to the Panhandle region’s most discriminating consumers.  However, we also pride ourselves on working cooperatively with all other surgeons in our region to provide the best possible care to all patients, not just our own.  Therefore, we will be inviting other surgeons to utilize this exciting technology as well over time.

So what does it do?

A CO2 laser uses a wavelength of 10,600 nm, which makes water molecules the effective target of the laser energy.  The water within the skin is rapidly heated causing heating of the deep dermis, which stimulates fibroblasts to form new collagen and elastin helping to increase skin turgor and thickness (tightness and tone).  At the same time the surface of the skin is ablated, which allows for new cells to repopulate filling in the treated areas with new cells that have not sustained sun damage and aging.

What can it treat?

CO2 laser skin resurfacing is effective in evening out skin textures and colors and eradicates potentially pre-cancerous sun-damaged cells.  This technology is useful for the treatment of rhytids (wrinkles), solar lentigines (sun damage), age spots/liver spots, large pores, actinic keratoses, scars including acne scar treatment and burns, stretch marks, and telangiectasias or "spider veins".

Where is it performed?

It can be performed as a stand-alone treatment either in the office with a variety of anesthetic options including topical numbing creams, local anesthetic nerve blocks, and/or oral sedation.  It may also be performed in the operating room under IV sedation (which carries increased costs of the facility and anesthesia fees).  In addition to being an effective stand alone treatment, it is also most frequently combined with facial plastic surgery including eyelid surgery and facial or neck liposuction.  Following these types of procedures, the overlying eyelid or facial skin may look wrinkled or deflated and laser resurfacing can significantly tighten the skin causing it to contract and smooth over the new contours.

It also nicely complements face lifts and brow lifts because the extra tightening delivered by the laser means that the surgeon doesn’t have to pull the skin as hard.  This creates a more natural appearance as opposed to the “over-done” facelifts we’ve all seen where the surgeon tried to overcompensate for the aged skin by pulling so hard that the patient develops that “wind-tunnel” appearance.  Think of it this way, two techniques applied at half strength work better and give much more natural results than one technique pushed beyond its limits.

What’s this “Fractional” word mean?

“Complete” resurfacing was first done with a CO₂ laser.  This means that when treating a given area of skin, 100% of the area was treated, sloughed, and had to heal.  The resulted in significant “down” time and infection risk, as the entire face was basically an open wound.  More commonly now, laser resurfacing is done with a “fractional” delivery system.  The term fractional means that the laser energy is applied over a given area of the skin in a random pattern of tiny spots such that only a fraction of any given area is treated, the density of which may be controlled by the surgeon.  Several hundred or thousands of laser pinpoints may be used per square inch, leaving healthy skin in between the ablated areas, to allow for more rapid healing (less “down” time) and a dramatically lower risk of infection and scarring.

What are “Active”, “Deep”, and “Total FX or Max FX”?

Active FX is the term for the treatment setting that ablates the skin superficially using a “large” spot size, as opposed to Deep FX, which is the term for the treatment setting that ablates the skin deeply, but with a very small spot size.  Deep FX-treated areas will likely have some pinpoint bleeding and weeping, but will provide more tightening effect (increase in skin tone), whereas Active FX-treated areas will have much less downtime and show improvements in smoothness, colors, pores, etc (improved texture).  When compared to a chemical peel, dermabrasion or other forms of light-based treatments such as IPL, a CO2 laser allows the surgeon to customize the surgery not only for each patient but also to each area of the face.  We take advantage of this by providing “Deep FX” laser treatments to the periocular (around the eyes) and perioral (around the mouth) and “Active FX” laser treatments to the rest of the face.  Combining both techniques in the areas of greatest concern (typically the eyes and mouth) yields what is known as “Total FX” treatment, and provides results against which all other techniques are measured.

Can it help me even if I don’t want resurfacing?

What else can it do?

Can it be used for eyelid or facial surgery?

CO2 laser energy may also be used to make incisions and can result in: faster surgical times (less anesthesia risk), less post-operative swelling and bruising (faster recovery), more precise incisions with less collateral damage (less inflammation around the scars), and smaller scars once healed.

The laser is also used to remove and contour the eyelid or facial fat resulting in an improved appearance following eyelid or facial plastic surgery.  Even though insurance companies may be paying for your surgeon to remove your excess eyelid skin during a blepharoplasty, for example, no insurance company pays for the fat excision or contouring that is the real power of eyelid rejuvenation.  However, the laser can achieve excellent results in eyelid rejuvenation even without adding on resurfacing simply by allowing your surgeon to better remove or contour the eyelid fat, which sets the shape of your eyelid once healed after a blepharoplasty.

Please inform us if you’d like your eyelid incisions performed with the CO2 laser instead of scissors or a scalpel (additional fee applies for use of the laser).  This may be used whether your eyelid surgery is “functional” meaning that insurance is covering your surgery because your eyelids are blocking your vision, or “aesthetic” meaning that you are having surgery for purely cosmetic reasons.  Either way, the CO2 laser technology may benefit you, your appearance, your health and safety, and provide better results than the older techniques utilized by most surgeons.