The CO2 Laser is an exciting development in eyelid plastic and reconstructive surgery, and it is being utilized for resurfacing to reduce wrinkles as well as for incisional purposes. When treating wrinkles, the CO2 Laser is utilized with the aid of computers. The Laser is programmed to precisely vaporize the outermost skin layers and limit the heat damage to the deeper skin layers. The underlying collagen reorganizes, the skin gets tightened and fresh skin then regenerates. The Laser does this by emitting short bursts of light energy.
When using the CO2 Laser for incisional work, precise cutting can be done with the added benefit of eliminating bleeding. This reduces surgical time and patients heal more quickly with less swelling and discoloration.
The Factional Laser can also be used for skin resurfacing. This laser has a more shallow depth of penetration and there is less thermal damage. The Fractional Laser is better suited for those who have fine wrinkles, for neck resurfacing, and patients with darker skin tones. However, there may be more than one treatment session due to it being a less powerful eyelid.
The best candidates for CO2 Laser Resurfacing have light to medium colored skin.
The main indication for Laser Resurfacing is to treat eyelid and facial wrinkles. Deep wrinkles, particularly those arising from muscle activity, are less effectively eliminated with the use of lasers. Other indications for Laser resurfacing include scars from acne, trauma, or for removal of certain lesions (syringoma, actinic keratosis). It should be noted that the CO2 or Erbium Laser does not affect age spots, tattoos, or hair removal.
Laser resurfacing can be done in conjunction with Blepharoplasty as well as Ptosis (drooping eyelid) surgery. Usually, the procedure is done with local anesthesia, although the anesthesiologist can supplement that with IV sedation if requested. The procedure is performed in a fully accredited ambulatory surgical center with the utmost concern and safety for our patients.
Preoperative Considerations
A comprehensive evaluation in our office must be done initially to fully evaluate the patient. Evaluation of the patient for Laser Resurfacing determines what type of Laser should be used and which areas can be effectively treated. A comprehensive history and a customized evaluation will be done on the initial consultation. Once a candidate for Laser Resurfacing is established, then preoperative skin preparation (Retin-A, Renova) may be utilized. An antiviral such as Acyclovir (Zovirax, Famvir) is taken orally a few days before surgery. Particularly those patients with a history of herpes simplex (fever, blisters, cold sores, or canker sores.)
Postoperative Considerations
Following Laser Resurfacing, it is important to keep the treated areas clean to prevent infection. Lots of skin lubrication with Vaseline, Aquaphor and topical antibiotics are employed. Oral antibiotics may also be included as well as a short course continuation of oral antiviral agents. Analgesics and sedatives may be needed for the first 48-72 hours. The skin will initially go through a swollen, exudative phase with crusting occurring. Vinegar soaks may be utilized to keep the crusts soft. This usually lasts 7-10 days with CO2 laser and 4-6 days with Erbium Laser-treated skin. After the initial exudative phase, the skin is red but gradually returns to normal color. This is dependent on the area of skin treated the amount and depth of treatment and the type of Laser. It is important to avoid prolonged sun exposure and to use sunscreens post-laser resurfacing. CO2 Laser redness lasts 1-4 months compared to 2 weeks to 2 months with Fractional Laser.
The patient can shower and bathe at any point in time postoperatively. It is advisable to use a lot of ice compresses for the first 48-72 hours. Makeup is allowed when the exudative phase passes. Usually, a green concealer is good for covering the post-laser redness. We have makeup specialists who assist with post operative care.
