Advice and information on acne scar treatment products & options

Lasers: Uncovering Younger Looking Skin
Lasers are used to help uncover the fresher, younger looking skin that we never knew we had.  They allow us to remove the sun damaged, wrinkled and dull upper layers so that when you are fully healed all that remains is a younger, smoother and rejuvenated appearance.

What Is a LASER and How Does It Work?
LASER is an acronym for Light Amplification by Stimulated Emission of Radiation. Or according to Merriam-Webster's Medical Dictionary: 

[laser: a device that utilizes the natural oscillations of atoms or molecules between energy levels for generating coherent electromagnetic radiation in the ultraviolet, visible, or infrared regions of the spectrum]. 

Light energy is changed into a tight, intense beam of monochromatic radiation capable of delivering large amounts of power or heat.  All lasers possess a lasing cavity consisting of two mirrors placed parallel to each other. One of these mirrors is partially reflective and between these mirrors is a lasing medium or conduit which can be either a gas (CO2 or Halide, etc.), solid (Alexandrite or Ruby) or liquid state. 

An external power source is directed into this medium, granting energy to the lasing cavity which causes the light amplification process by exciting this medium.  From this level of excitation, it may return to its resting state or if it is struck by a photon, releases two photons of the same energy and wavelength in time with one another.  Some photons strike other excited atoms and  the photons not parallel to the long axis of the cavity are then lost as heat.  The small percentage that are given off parallel to the long axis form an energy wave which strike the mirrors and reflects back and forth, back and forth and so on  Unlike ordinary light, laser light is collimated, monochromatic (uniform wavelength), coherent (in tune with each other) and uni-directional.  Therefore, light striking the epidermis may be reflected, transmitted to deeper tissues, scattered or absorbed.  The laser effect occurs when absorbed light is converted to heat, resulting in coagulation of the targeted tissue and depending upon the medium used the particular desired effect is gained. For example, alexandrite for darker tattoos of black or blue ink, black spots, darker hyper-pigment, CO2 for tightening or the epidermis, etc. Here is some information from the Yale Medical University Core Curriculum regarding CO2 laser resurfacing and rhytids (wrinkles). The definitions of some possibly unfamiliar words have been provided for your convenience and to help you understand. These definitions are in blue.

"In a study of 259 patients, Alster et al assessed the efficacy of high-energy pulsed CO2 [: a heavy colorless gas that does not support combustion, dissolves in water to form carbonic acid and is formed esp. in animal respiration and in the decay or combustion of animal and vegetable matter] lasers in treating facial wrinkles.  Responses to treatment were assessed at 1, 4, 8, 12, and 24 weeks postoperatively.  On average, the investigators found a 90% improvement with periorbital [around the eyes] wrinkles most responsive to the therapy (93%).  Wrinkles which were more severe and caused by excessive muscle movement such as forehead wrinkles had the least improvement (86%).  Persistent erythema [: abnormal redness of the skin due to capillary congestion (as in inflammation)] and hyperpigmentation are the most common complications but these usually resolve after several months.  Other potential complications include acne, milia [: a small pearly firm noninflammatory elevation of the skin (as of the face) due to retention of keratin in an oil gland duct blocked by a thin layer of epithelium --called also whitehead;] , dermatitis, infection, and hypertrophic scarring.  Most complications are related to postoperative care.  Weinstein et al recommend the use of Flexzan, a semiocclusive biosynthetic dressing made from polyurethane foam in the immediate postop period.  This is applied after the face is dried and usually changed at 24 hours to remove wound exudate [: exuded matter; esp : the material composed of serum, fibrin, and white blood cells that escapes from blood vessels into a superficial lesion or area of inflammation] .  The face should be gently, but thoroughly cleansed with preservative-free tap water and perfume-free cold cream.  The face is carefully dried with a cool hair drier or low-energy laser to enable the dressing to stick better.  This dressing is left for 7 to 10 days.  The patient then showers, washes the hair, and returns to the office with wet dressings which are removed with baby or bath oil.  Usually the skin is completely healed.  A few small areas may be incompletely healed and will need reapplication of small sections of Flexzan. Antiviral medication is started 24 hours before the procedure while antibiotics are started the morning of the surgery.  These are usually continued until reepithelialization [: restoration of epithelium (a membranous cellular tissue that covers a free surface or lines a tube or cavity of an animal body and serves esp. to enclose and protect the other parts of the body, to produce secretions and excretions, and to function in assimilation) over a denuded area (as a burn site) by natural growth or plastic surgery] is complete.  After reepithelialization, the skin should be treated with oil-free, perfume-free cleansers and moisturizers.  A tinted titanium dioxide UVA blocking sunscreen should also be used to minimize hyperpigmentation."  Yale Medical University Core Curriculum - Lasers

What Is Laser Resurfacing?
Laser resurfacing (or laser peel, laser rejuvenation, laser surgery), is the act of using a carbon dioxide (CO2), erbium, pulse dye or other laser to remove wrinkles, discolorations, age spots, and sun damaged skin or stimulate your body's fibroblasts to "grow" collagen to treat the wrinkle from within. The laser is passed over the treatment area to eradicate wrinkles around the eyes and mouth or anywhere you have unsightly lines, hyperpigmentation or blemishes.  Lasers are an effective way to remove those superficial lines that make you appear aged. Plus, laser resurfacing is a considered a safer, less invasive procedure say than deep TCA peels or Dermabrasion. However, laser resurfacing is not for everyone.

Resurfacing with a laser is considered ablative (such as CO2) and non-ablative lasers (NLite) are basically thermescent fibroblast stimulators that treat a wrinkle from the inside out rather than literally removing it. Ablate literally means to "remove" [: to remove esp. by cutting, abrading, or evaporating]. Non-ablative being that there is no "resurfacing", per se, but rather the heat-induced fibroblast stimulation to thicken the underlying collagen structure. With ablative lasers, the skin surface will appear red and weep afterwards as the top layer(s) has been removed. With the non-ablative there is little downtime, perhaps just a little swelling or pinkness.

Available Types Of Lasers 
There are many types of lasers which address the variety of complaints one may have.  Please read below for a sampling of the various machine types on the market.  We will, of course, not have every machine listed.

Carbon Dioxide Laser (CO2 (including UltraPulse Laser Systems): (technically: carbon dioxide gas lasing device) This is the most common. We will use the CO2 to demonstrate the explanation of the surgery itself. Unfortunately CO2 lasers aren't for everyone. They can be used to eradicate excessive or irregular scarring from a prior procedure although care must be taken when determining a candidate. Hyperpigmentation and hypertrophic scarring may occur in persons who are prone to such or in persons of ethnicity (Italian, Asian, African, African-American, Greek, etc.)
Spot test: usually required and strongly suggested.
Longevity:  If it is for photo-damage or photo-damage induced wrinkles, you will only continue to get photo damage if you frequently subject yourself to UV light exposure or spend a lot of time in the sun without a proper sunblock or hat, etc. Discuss with your surgeon his longevity percentages. 
Approximate Cost: $1,500 - $6,000.US

Cool Touch 1320 Laser: (technically: thermescent Nd: YAG 1320 LASER) This is also a selective dermal heating type of procedure such as NLite. This laser supposedly can be used on any skin color, any skin type, and on any part of the body without the risks of hypo- or hyperpigmentation or the healing times associated with conventional lasers. It is considered a non-ablative lasing device. Outer skin and sensitive nerve endings with a unique cooling spray, then use precise laser pulses to stimulate cells called fibroblasts which produce the natural collagen that is the foundation of your skin. As the collagen layer thickens, skin tone and elasticity improve.

According to a lecture by Dr. Robert A. Weiss, the assistant professor of dermatology at the University of John Hopkins School of Medicine in Baltimore, Maryland by on non-ablative treatments:

Thermescent CoolTouch 1320 treatments are usually performed 3-4 times at one month a part although you will not see results until the 2nd or 3rd treatment. Also the improvement may appear immediate although this is due to edema (swelling), etc. The patients sometimes use moist gauze or goggles. It was reported that 50% of the patients opt for an EMLA cream (topical anesthetic).

As with NLite, this type of laser delivers the amount of infrared energy to trigger a thermal wound response but without the harmful effects to the epidermis. In other words, the laser heats up where your dermis/epidermis meet, thereby stimulating your collagen production and correcting the rhytids (wrinkles) from within. The difference with CoolTouch 1320 is that the cryogen spray cools the epidermis allowing the penetration of the Nd: YAG to depths of 200-400 microns in the dermis layer with a surface temperature of no more than 44º to 48º Celsius (111.2º to 118.4º Fahrenheit). Improvements were seen on rhytids (wrinkles), acne scars, pore size reduction and "crepiness".  Also it was mentioned that the subcision (undermining of scar bands under an acne pock) was beneficial to the patient when treated with the CoolTouch 1320 as well. 

Spot test: usually required.
Longevity: If it is for photo-damage or photo-damage induced wrinkles, you will only continue to get photo damage if you frequently subject yourself to UV light exposure or spend a lot of time in the sun without a proper sunblock or hat, etc. Discuss with your surgeon his longevity percentages in average cases. 
Approximate Cost: dependant upon area and practice.

Er:YAG Laser (Erbium): (technically: Erbium: yttrium aluminum garnet) This LASER is at a wavelength of 2940 nm and is absorbed by superficial layers of the epidermis. When "Q-switched", the laser is emitted in pulses which evaporates or "blasts" the damaged or unwanted tissue away. The pulsing actually lessens the heat on the skin emitted by the LASER so there is less damage.
Spot test: usually required and strongly suggested.
Longevity:  If it is for photo-damage or photo-damage induced wrinkles, you will only continue to get photo damage if you frequently subject yourself to UV light exposure or spend a lot of time in the sun without a proper sunblock or hat, etc. Discuss with your surgeon his longevity percentages in average cases. 
Approximate Cost: Approximately $3,000.US for a full face treatment.

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NLite: (technically: class IV medical, non-ablative HeNe flashlamp pumped, pulsed-dye LASER) ICN Pharmaceuticals' NLite is a class IV medical LASER, specifically designed for non-ablative removal of rhytids (or wrinkles) and collagen rejuvenation.  Ablative lasers are more damaging and invasive - they remove quite a chunk of your skin in order to "resurface" it - actually removing the wrinkle along with it's surrounding skin. Whereas, the yellow light of NLite passes right through the epidermis without damaging it, thereby stimulating your own dermis to produce its own natural collagen. We have a separate section on this laser so please Click Here for more information on NLite.
Spot test: usually required, $75.US 
Longevity: It is natural collagen and will age like natural collagen - since this is a newer laser its long term effects are not yet known. However it is believed that you will not have as deep of lines as you would have without ever having the treatment. If it is for photo-damage induced wrinkles, you will only continue to get photo damage if you frequently subject yourself to UV light exposure or spend a lot of time in the sun without a proper sunblock or hat, etc. Discuss with your surgeon his longevity percentages in average cases. 
Approximate Cost: Approximately anywhere from $800. to $1,800.US for full face and neck. For specific areas, it costs approximately $10.US per pulse with a minimum of $100.US at some offices
Approved: The SLS NLite Non-ablative Wrinkle Reduction device was approved by the FDA for use on peri-ocular wrinkles (wrinkles around the eye). Although NLite is used effectively elsewhere.

EpiStar Diode Laser System: (technically: infrared diode laser) "The EpiStar Diode Laser System, which can be used to remove hair and to treat vascular and pigmented skin lesions such as birthmarks. The EpiStar system, manufactured by Nidek of Fremont, California, uses an infrared diode laser to treat a 2-millimeter to 5-millimeter area of the skin in a random scanning pattern. The device's thermoelectric cooling system cools the skin to 5 degrees Celsius, protecting the area from heat exposure and minimizing patient discomfort."

"Most laser systems use a gas such as carbon dioxide to cool the skin during the procedure, but the EpiStar system does it electronically by blowing cool air onto the skin site... The EpiStar laser includes a touch screen display and interchangeable hand pieces for different treatment sizes." (Reuters - Aug. 2000)

Spot test: usually required and strongly suggested.
Longevity: permanent, unless you develop another lesion, which has nothing to do with the prior lesion. If it is for photo-damage, you will only continue to get photo damage if you frequently subject yourself to UV light exposure or spend a lot of time in the sun without a proper sunblock or hat, etc. Discuss with your surgeon his longevity percentages. 
Approximate Cost: dependant upon area and practice.

Smooth Beam Laser: This is more like CoolTouch Laser than NLite with its miniburst of cryospray to cool the epidermis and the subcutaneous levels before the laser pulse to hinder damage. NLite does not need cryospray and passes harmlessly through the epidermis and subcutaneous levels without pain. It seems that the SmoothBeam must have the cryospray burst or the proteins coagulate and the tissues are damaged - not to mention it is more painful if there is no cryospray. Although technically dissimilar, the Sooth Beam Laser may produce the same type result as the NLite system because of the thermal wound response they create.
Spot test: usually required.
Longevity: If it is for photo-damage induced wrinkles, you will only continue to get photo damage if you frequently subject yourself to UV light exposure or spend a lot of time in the sun without a proper sunblock or hat, etc. Discuss with your surgeon his longevity percentages. 
Approximate Cost: dependant upon area and practice

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Dye laser VStar® : (technically: Pulse Dye Laser) Brought to you by Cynosure, this laser isn't exactly a resurfacing laser, it is a laser designed for spider veins, redness, broken capillaries and other types of vascular lesions. This machine is capable of 4 pulse lengths for varying cases.
Spot test: usually required.
Longevity: unknown, as this is a newer laser - reportedly permanent 
Approximate Cost: dependant upon area and practice

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Genica V® (technically: photo-flash lamp-pumped pulsed dye photo laser) Also brought to you by Cynosure, this laser is yet another vascular lesion removal system. A treatment area usually takes under a half an hour. Purpura is apparent after treatment. These bruises will subside within 7-10 days.  Patients report "stinging" sensations and seldom need sedation.  However, for patients without a high pain threshold tropical anesthetics can be sued. It is reported that the treatment affects depths up to 1,5mm.
Spot test: usually required.
Longevity: unknown, as this is a newer laser - reportedly permanent 
Approximate Cost: dependant upon area and practice

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Depilase YAG Laser/"Depilase YAGLASE": (technically: High Power Long Pulse Nd:Yag laser system) Brought to you by Depilase North America, this system was designed to remove both vascular lesions and even hair. The unique factor regarding this laser is that it can be used on dark skin types. Whereas, most other lasers, are contraindicated in some ethnic skin types.
Spot test: usually required.
Longevity: unknown, as this is a newer laser - reportedly permanent 
Approximate Cost: dependant upon area and practice
Contact Info: DEPILASE North America, LLC  Phoenix, AZ  Tel. 602.257.4113 
Website: http://www.depilase.com

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Q-switched Nd:YAG laser:  (wavelength 1064 and 532nm) This laser is manufactured by ConBio. This system can remove general pigmentations and for darker pigments, such as professional tattoos which may be blue or black, may take between 8 and 12 sessions,
Longevity: unknown, as this is a newer laser - reportedly permanent 
Approximate Cost: dependant upon area and practice. Packages can be bought for more difficult cases - decreasing overall costs to the patient.

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Long-pulsed Nd:YAG laser (VersaPulse®): Manufactured by Coherent, this laser system is also for vascular lesions and has proved very effective in removing such complaints as facial flushing, redness, broken capillaries, telangiectasia (Teel-ann-ject-AZE-yah) which are purple or blue veins on the face, hemangiomas (sacks of red, purple or blue blood vessels resembling a blister, also known as strawberry hemangiomas) and more.
Spot test: usually required
Longevity: unknown
Approximate Cost: dependant upon area and practice

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Eximer laser (including XTRAC™): Brought to you from PhotoMedex. This system is the first FDA approved lasing system beneficial to suffers of Vitiligo and Psoriasis.  Sessions may be from 3 to 30 depending upon your case.  Visit their website for more information.
Spot test: usually required
Longevity: unknown
Approximate Cost: dependant upon area and practice
Contact: Tel: 1-877-44-XTRAC  Email: mgensel@PhotoMedex.com
Website: http://www.photomedex.com 

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Long-pulsed alexandrite laser Apogee 9300®: This laser is brought to you by Cynosure and is specifically for hair removal of the face, neck and other areas.  You may need up to 15, averaging at 10 treatments before permanent results are seen.  However, permanency has not been reached for leg and the back areas.
Spot test: usually required
Longevity: unknown
Approximate Cost: dependant upon area and practice

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Are You a Candidate For Laser Resurfacing?
Not everyone is a candidate for laser resurfacing. If you are prone to keloids, hyper or hypo pigmentation or do not react well to burns or excessive scarring due to minor cuts and abrasions, laser resurfacing is not such a good idea. The laser is a type of burn as it literally evaporates the top layers of skin to reveal younger-looking, fresh skin beneath. If you scar badly when you are burned, the results of laser resurfacing could be disastrous. Also, if you have ethnicity (i.e. Greek, Italian or African-American, etc.) in your biological family, you may be prone to hyper or hypopigmentation resulting from the procedure. An "ideal" patient would be of white European descent with elastic, non-oily skin.

For some ethnic patients, The Erbium, pulsed dye, Depilase YAGLASE and NLite laser may be a safer choice although every case is individual and only a qualified surgeon who is very skilled with a LASER can make this diagnosis. 

Communication is crucial in reaching one's goals.  You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are.   Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

You must be mentally and emotionally stable to undergo an cosmetic procedure.  This is an operation which requires patience and stability in dealing with the healing period.   There is sometimes a lull or depression after surgery and if there is already a pre-existing emotional problem, this low period can develop into a more serious issue.  Please consider this before committing to a procedure.

What to Expect At Your Consultation
First and foremost, only choose a surgeon specifically trained in laser resurfacing and who is well-educated on the subject. Not all cosmetic surgeons know how to perform laser surgery. There are techniques to be followed and levels of experience differ with each surgeon. 

After checking a surgeon's background and credentials, you will make an appointment for a consultation.  You will meet with this surgeon and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take. This is very important. Visit the Aspirin & Supplement List for more information. Your skin will be examined and the elasticity will be determined. You will discuss your complaints and concerns and discuss the various techniques and lasers available to you.  

You will disclose your full medical history and will discuss your realistic expectations. Make sure you give your surgeon full disclosure. This is very important, if you do not alert your surgeon to your specific ethnic background.  The surgeon should discuss in detail the procedure and its risks and complications and what to expect during the procedure. You will also discuss the available anesthesia that will be used for your procedure. Most Laser Resurfacing procedures are performed under Light Sleep Sedation or General Sedation although some surgeons may use Local or Regional only - some even topical anesthetics. 

You will discuss what areas should be treated as sometimes only around the eyes, lips and perhaps the forehead will be resurfaced. You will discuss fees and may take before photos of the area to be treated, but usually this is reserved for a pre-operative visit a few days before the procedure. 

You may also come to the conclusion that perhaps dermabrasion or a light - medium chemical peel may be ideal for you instead of laser resurfacing. If you are honest and speak your mind and desires at your consultation, you surgeon will be able to visualize what it is that me or she may do to achieve that. The surgeon may even recommend that you have 2 or 3 sessions instead of a very deep peel all at once.  Discuss with your doctor your target depth and downtime you will experience at the different depths as well. Even though you may wish to have a lighter peel for lighter recovery - it may not give you the results that you desire. 

If you would like more information on Consultations or a list of questions to ask your surgeon please visit the Consultation Help Page. If you should choose to book or reserve a surgery date you will usually give a deposit to hold your surgery date. Most times if you cancel a few days beforehand, this amount is non-refundable. After paying your deposit and scheduling a surgery date, you will also schedule a pre-operative appointment...

Your Preoperative Appointment
This appointment addresses more questions you may not have thought to ask at the initial consultation, such as more surgical details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure.  Just as your surgeon will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-operative instructions and speak about the recovery period instructions and what to expect in the months ahead. You will be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs and perhaps a box or directions for gaining a box of SinEcch - a pharmaceutical grade form of Arnica montana.  Would like to know more on the benefits of Arnica montana?  Perhaps you will be instructed to obtain Bromelain or other types of remedies, although many surgeons would rather have you not take ANYTHING other than your prescription medications, please do not go against your surgeon's wishes. Remember, always ask your doctor before taking any of these products. 

Please do not hesitate to address any concerns that you may have during this time and even after your pre-operative appointment. If you remember something when you get home or the next day or even the day of surgery - don't be afraid to ask. 

Preparing For Your Treatment
You should be given a pre-operative information packet that explains everything you should do and know before your surgery date.  The packet should include a list of all the medications you should not take starting usually at 2 weeks before your surgery. These medications will include, but are not limited to, aspirin containing products, stimulants, seratonin supplements, etc. Would you like to view a typical Medication & Supplements List? We have a printer-friendly version as well, Also, if your surgeon advised that you may take Arnica montana, Bromelain, Vitamin K, etc. for swelling and bruising you should either have this in your packet or begin shopping for your necessities.

Very Important: If you have a history of cold sores, herpes or other viral infections please disclose this to your surgeon!  After laser treatments, chemical peels and dermabrasion - viral anomalies may spread and severely disfigure the treatment area.  You will be placed on anti-viral medications beforehand and continue during the healing phase. Bacterial infections are also a severe risk and even water-borne or plant-borne bacterial infections can severely scar your treatment area.

It is quite possible that you will have "blood work" performed. This is normally an extra out-of-pocket expense that the patient must participate in to check your white and red blood cell count and check for disease or disorders beforehand. If you are a female they may take an extra vial for a pregnancy test. Some surgeons ask that you have physical. This can be yet another out of pocket expense so ask at your consultation what will be needed when you are quoted a price.

So many things to do... so little time. Surgery will be here before you know it so visit the Preparing For Surgery page and relax. This section contains, printer-friendly pre-op lists, tips and advice as well as things you must do to prepare for your big day.

How Laser Resurfacing Is Performed
Laser Resurfacing can last from 30 minutes to more than an hour. 

First, you will have monitoring "pads" attached to you so that the surgical team can properly monitor your vital statistics before, during and after your operation.  When you are brought to the operating room, electrodes will be "plugged" into these pads which are connected to the monitoring equipment.  

Once you are on the operating room table, you will then be given your choice or your surgeon's preference in anesthesia as discussed prior to your surgery date.  If you had been given an oral sedative or valium prior you will have less anxiety.  They will more than likely insert an IV for a saline drip to keep you hydrated and have a vascular "doorway" for anesthesia, antibiotics, and other medications.  If you haven't been given a sedative, it is more stressful for some patients.  If you feel that you may experience anxiety inquire beforehand regarding an oral sedative.  Having an IV inserted feels sort of like blood being drawn, but for a shorter period of time.  It's the initial placement of the IV that may sting a bit.  Some people get heir IV placed in the crook of the elbow, some the hand - it all depends upon your veins though.  So if your veins are not very prominent this can be a problem. You are then brought to the O.R. if you aren't on the table yet.  After the needle is injected into the vein it is pulled out and a little plastic tube is left in your vein.  This is called a "catheter".  The  catheter is taped to your skin so it is not accidentally knocked or pulled out and is ready to be used as a sort of entryway for anything the surgical team deems necessary for your body.  This is usually done before you get into the actual O.R. - by a nurse - and you have a saline bag hooked up to you.  The medications will usually be given with a drip system with this saline. As said before, the saline will keep you hydrated both during and post-operatively.  

If you have chosen an IV Liquid Sedative, they will insert a hypodermic into your tube that you are attached to or they attach the bag of it with a drip system to add a few drops every few seconds and when they spring open the stopper and it starts heading towards your body.  The the effects of the anesthesia are felt soon after injection or opening the stopper - a few seconds in fact.  It may feel similar to a sensation of "heat" entering your arm or hand at the catheter site.  It then feels as though it is creeping up your arm - then it "jumps" from your shoulder to a metallic-like taste under your tongue and then you are blissfully anesthetized.   The anesthesiologist or surgeon will then determine if you are sedated properly, your stats are stable and if you are ready for the surgery to begin.

Your face is then scrubbed with betadine to remove bacteria such as Staph. The surgeon then passes the laser over the area to be treated. This could take anywhere from a few minutes to an hour and a half for very deep facial or body resurfacing. Some patients need 1 or 2 very either light or very deep passes. Some surgeons adhere to utilizing several light passes only. Although, with some lasers the skin cannot be passed over the treatment area again. Several light passes result in a blended area where the laser did not pass rather than leaving a demarcation. This way there is no tell-tale obvious line. The laser literally evaporates the targeted areas of skin. It is almost magical as the targeted, damaged skin disappears leaving only a faint trace of "smoke and steam" and revealing undamaged, pink skin as a result.

If you have specific complaints such as lines and wrinkles of the forehead or crow's feet and lip lines. The surgeon will concentrate on these areas a little more for deeper penetration. Some surgeons may limit the laser's penetration to the epidermis (the uppermost areas of your skin) for the very lightest and medium of peels. Although when the damage is anchored deeper the laser can be set to penetrate the upper layers of the reticular dermis. The reticular dermis is [: the deeper layer of the dermis formed of interlacing fasciculi of white fibrous tissue]

After the skin resurfacing is complete, your surgeon will cover your face with either a thin film of Bacitracin or antibiotic burn cream like, Silvadine or even BurnJel by Water-Jel Technologies. Although BurnJel can only be used for light peels. Some surgeons use a second synthetic breathable skin to protect the newly surfaced tissue during its healing process. There are several experimental coverings that are undergoing testing.  Some will even provide you with or suggest that you get a hydrogel-type masks or sheeting such as HydroGOLD™ by BioDermis.com

EXTRA! A relatively new and exciting burn bandage is made from cotton and purified chitin, called chitosan, (a polysaccharide), which is extracted from the exoskeletons of crustaceans (crab, shrimp and lobster shells). Incidentally, Chitosan is also an ingredient in controversial "fat magnet" pills and supplements.  Below is from Youngdeok Chitosan:

"Chitosan is a natural product derived from Chitin, a polysaccharide found in exoskeleton of crustacean like crabs and shrimps, in the crusts of the insects like beetles, gold bugs, and grasshoppers, and in the cell wall of bacteria and fungi like molds and mushrooms.

Crab's shell consists of Chitin substance, Protein, Calcium carbonate which are all boned together very strongly to become a hard and stable crust.

Therefore, pure Chitin (acetylamino-polysaccharide) is extracted by removing protein and calcium carbonate from crab's shell. Through the process of deacetylization called purification, Chitosan (amino-polysaccharide) is obtained from Chitin by getting rid of acetyl radicals.

Chitosan-Oligosaccharide is obtained by an enzymatic hydrolysis of chitosan using chitosanase. Compared with Chitin and Chitosan that has poor solubility and absorbability into our body, Chitosan Oligosaccharide is absorbed perfectly. "  http://www.youngchito.co.kr/eng/default.asp 

Some bandages consists of several layers, the main layers consisting of the purified "crab shells" (chitosan) as well as a synthetic barrier that whisks away moisture and fluids from a weeping, healing wound. An outer layer of cotton gauze absorbs the fluids. The gauze pads can be changed but the synthetic skin and chitosan covering stays to protect the wound. The chitosan are actually absorbed harmlessly into the body and excreted. Miraculously, the crab shells have a superior antibacterial property unheard of in any relative substance. Reportedly, no known fungus or germ can adhere to it's surface. When the bandage is removed - perfect, "flawless" skin appears. 

You are then gently awakened and brought into the recovery room where the recovery nurse will monitor your vital stats until you are ready to be released. This is dependent upon the individual but may take up to two hours. Your face may feel tight and quite tender as the anesthesia wears off. You may even feel emotional or upset - this will depend upon your body's reaction to anesthesia. You may also experience "rigors" or shivering. This may feel uncontrollable and is usually from the medications - more than likely if epinephrine is used (a  vasoconstrictor). The recovery nurse usually has wrapped you in a warm blanket but if not, request one. It certainly makes things more tolerable.

Some patients feel nothing different although if you have had General you may feel a little sick - hopefully your surgeon gave you something to lessen this. Your prescribed medication should alleviate this pain and discomfort. However, if you believe your pain to be out of the ordinary once you get home, call your surgeon or the on call staff immediately. You will be driven home by your spouse, significant other or friend as you will not be able to see, much less drive yourself home.

The Long Road to Recovery
You may be groggy from the anesthetic and or oral medications and probably won't remember much of the first day or two if you were sedated. You will have to take it easy and sleep on two pillows to keep your head elevated for 7-14 days - or however long your surgeon suggests. When you wake up you will notice that your face will look even more swollen in the first 3 days. But, as the days go on the swelling will dissipate. There may be bruising, but this will go away, as well. So make a mental note of this or you may be shocked into a depression. Bruising and swelling are a normal occurrence in most invasive procedures.

There will be redness and slight discomfort post-operatively. Your surgeon will have instructed you on the proper care of your treatment area as well as prescribed you the necessary antibiotics and pain medications to help alleviate your discomfort. Take your temperature on time and regularly. An elevated temperature could mean an infection. Take those antibiotics ON TIME. And don't forget if you are taking birth control that some antibiotics can interfere so in the event that you do have relations, use another form of protection as well. The swelling can be alleviated with ice packs. You may be instructed to apply ice, gel masks and vinegar soaks on your treatment area for the first 48 hours. According to Yale Medical University regarding a facial burn from either Laser or any heat source.  Some words may be unfamiliar so their definitions have been provided, in blue, for your convenience.

"Cooling decreases WBC [:white blood cell] adhesion, increases perfusion [: an act or instance of perfusing; specif : the pumping of a fluid through an organ or tissue], decreases protein denaturation [b : to modify the molecular structure of (as a protein or DNA) esp. by heat, acid, alkali, or ultraviolet radiation so as to destroy or diminish some of the original properties and esp. the specific biological activity], and prevents excess production of thromboxane [: any of several substances that are formed from endoperoxides (: any of various biosynthetic intermediates in the formation of prostaglandins or (: any of various oxygenated unsaturated cyclic fatty acids of animals that have a variety of hormone-like actions (as in controlling blood pressure or smooth muscle contraction)), cause constriction of vascular and bronchial smooth muscle, and promote blood coagulation]. Cooling must occur in the first 30 minutes after the burn.". Yale Medical University Core Curriculum

Your healing time totally depends upon the depth of your treatment. You can expect to be down for at least 1-2 weeks. Your skin will feel like a major sunburn. It may weep and need dressing changes and additional ointments which will be supplied by your doctor directly or by prescription. You will wear these bandages for about 5 to 7 days. You will more than likely have them removed by your doctor on day 5 but this could be longer if the penetration was pretty deep. After your bandages are removed your doctor will go over with you the proper care for your treatment area such as cleansing and applying ointment. You will notice crusty formations; DO NOT PICK AT THEM OR PULL THEM OFF! You will scar as a result - probably more than before your treatment. But, don't worry, they usually subside by day 10. 

You may be given a bovine mucopolysaccharide ointment or cream, this is a cow-derived cartilage extract that has the anti-inflammatory properties of 1-2% hydrocortisone. It accelerates epidermal healing and stimulates the production of prostaglandins and interleukins.   The ointment and cream act like a steroid application without the risk of steroid induced atrophy or telangiectasia formation.  The product is CX-10 Ointment and CX-5 Correction Cream, manufactured by Donell Inc. in NYC.

Laserfade Gel

Laser Fade contains the same beneficial ingredients as Scar Fade plus a rich blend of antioxidants including Vitamin K, Vitamin E, and Co-Enzyme Q-10.Laser Fade helps reduce the appearance of post laser erythema and scars and creates a soothing micro-membrane which calms inflamed capillaries.Plus, protects skin with an effective hypoallergenic UVA/UVB sunblock SPF15.Apply sparingly twice a day. A small drop is gently massaged onto the skin or scar. Use for eight to twelve weeks or until improvement is no longer noticed.

You will have to use sun block faithfully! Your skin is very susceptible to damage by UVA/UVB radiation (the sun). This includes artificial sunlight like tanning beds as well as simply driving to the store or around town all day in your car. Believe it or not you do get sun exposure when you drive around. You should not use using AHA's, Vitamin A (Retin A) or exfoliants. Your skin is very fragile in its healing stage - which could last for months.

Your skin will heal and become very smooth and young looking. The pinkness will subside as will the tenderness. You may be pink for up to 5 months or more, depending on your skin's ability to "bounce back". You must take care of your skin in order to keep it looking vibrant and fresh. Although, no procedure can keep your skin from aging - it can give you a young, relaxed appearance and buy you some time.

At about 2 weeks or as soon as there is no weeping and no crusting (but please ask your doctor first) you can safely wear cosmetics to cover the redness.  There are special cosmetics one can buy to offset the redness or you can experiment on your own with what you have.  BIOSKINCARE is an effective product for post laser treatment. 

Risks & Complications Associated with Laser Resurfacing
Ascertain that your surgeon discusses all of the risks and complications with you at your consultation. There could be allergic reactions to the anesthetic. Just make sure that you disclose your medical history and this is very important - your nationality. If you are susceptible to Keloid scarring or have active skin infections or afflictions such as herpes outbreaks, you may not be a good candidate for Laser Resurfacing. 

Very Important: If you have a history of cold sores, herpes or other viral infections please disclose this to your surgeon!  After laser treatments, chemical peels and dermabrasion - viral anomalies may spread and severely disfigure the treatment area.  You will be placed on anti-viral medications beforehand and continue during the healing phase. Bacterial infections are also a severe risk and even water-borne or plant-borne bacterial infections can severely scar your treatment area.

If your skin is olive, black, brown and even yellow-toned - take care in your choice of resurfacing measures. Even Dermabrasion and chemical peels can cause noticeable damage to ethnic skins. You should request a "spot test" if you or your doctor are uncertain. You can never be too careful.

There is also the risk of bullae (blisters), infection, thicker scar tissue of the treatment area and hypopigmentation as well as hyperpigmentation, as said before. You must also be very careful if you have taken Accutane within the past year and a half (12-18 months). Accutane causes dermal thickening and can cause increased scarring.

The Average Prices Laser Resurfacing:  
The approximate prices for laser resurfacing may vary significantly due to region and practice.  Average prices may be $1,500 - $6,000.  Not including medications, and post-operative supplies.