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LASER RESURFACING



Laser Resurfacing is a procedure employed by a plastic practitioner which aims to improve the skin’s quality and correct various defects. Laser Resurfacing is a specialized chemical peel technique, which uses advanced laser technology to remove the outer layers of skin. It would be sensible to focus on these two words (Laser and Surfacing) in order to better understand the application of this plastic operation.

LASERS
Lasers comprise a category of appliances which have extremely variable standards amongst themselves, and as such are designed for a number of different purposes. It is a common belief that there is only one type of laser with universal applications. However, this is untrue, as laser technology is just that, a type of technological appliance. This technology provides the basis for the design of various appliances, each of which has one or more applications.

In medical practice, lasers are mostly employed for their discernment. This means that, as they utilize a certain type of energy, they also accomplish a very specific task when applied, leaving other cells intact.

Lasers are also distinguished for their accuracy, as far as the operation’s placement is concerned. Very delicate and accurate work can be performed, depending on the laser’s wavelength and intensity, which will be adjusted according to its technical standards.

RESURFACING
This term essentially refers to the practice of peeling, and involves the removal of some surface-level skin layers, carefully selected and up to a specific depth. This triggers the organism into stimulating the healing mechanisms.
This then leads to:

•    The production of new skin layers of better quality than those removed.
•    Smoother skin.
•    The stimulation of the fibroblasts, which causes the reproduction of collagen, of better quality than that currently extant.

The peeling technique has been in use since antiquity. We could even term it as the most ancient technique of cosmetic surgery. As such, it is a tried and tested method.

Its effectiveness is certain. This procedure, which essentially aims to recreate the skin, had undergone a long period evolution, and is now performed using the most modern techniques and equipment, such as laser technology.

Lasers simply imitate the older version of the technique, i.e. the removal of surface-level layers of skin, which stimulates the production of collagen. The difference is that this procedure is much better regulated, meaning that we can penetrate the skin to our desired depth with great accuracy, as well as distribute heat at our preferred intensity and pattern.

The distribution of heat has been verified to result in a tightening of the skin, reproduction of collagen, and a generally improved skin texture. In addition, the technique can be used to smooth out scars, acne marks, or any other irregularities on the surface of the skin. In simple terms, this application works in a similar fashion to the use of sandpaper to smoothen out a rough surface.

WHERE IT IS USED
This technique’s main applications are the following:
•    Improving skin quality and shallow wrinkles.
•    Smoother skin, improving the appearance of open pores.
•    Improving scars and acne.
•    Correcting discolorations, spots, freckles, etc.

LASER TYPES
Essentially, lasers used in resurfacing can be divided into two categories: CO2 Lasers and Er:YAG Lasers. These two categories are then divided into two further subcategories, where on the one hand we have lasers which can achieve an even distribution of thermal energy, and on the other we have fractional lasers, which concentrate thermal energy into very small pixels. Even energy distribution has the advantage in some cases, according to the surgeon’s discretion, but on the other hand fractional lasers require a shorter recuperation period, which is often desirable.

The surgeon is the best judge as to which is type of laser is best suited to each case.

PENETRATION DEPTH
Surface-level peels obviously yield minor results in comparison to deeper peels, but require little to no time for recovery. For this reason most patients select surface-level peels, in spite of the minimal results. Of course, this choice entails a number of repetitions, determined by the surgeon in consideration of the patient’s particular needs.

Deeper peels do not require repetitions. In most cases, a single application is sufficient, and the results are quite durable (lasting up to a few years). Deeper peels require a longer recovery period, which, as mentioned above, depends on the depth of penetration and the laser’s type. For example, the application of a CO2 laser to a significant depth would require a recovery period of approximately two weeks. When using an Er:YAG laser to a significant depth, on the other hand, the recovery period would last approximately ten days, whereas an operation employing a fractional laser would require only a week for a full recovery.


LASER RESURFACING


THE PROCEDURE
This procedure must be undertaken during the winter months, and in particular it is advised that deeper peels be done between November and February. Peels closer to the surface can be done at any point of the year. Of course, the season the patient chooses for their operation should be determined by the degree to which they are exposed to the sun in the course of their daily activities. As such, many patients who do not expose themselves to sunlight at all can even undergo a peel in the summer months. Other patients, who spend a significant amount of time outdoors even in winter, may be unable to undergo the operation even during the winter months.
Things are much simpler when it comes to surface-level peels. The procedure only takes a few minutes, and the patient may then apply make-up and return to their daily activities (work, personal obligations, etc.) without any restriction.

For deeper peels, it is not recommended to return to daily activities until two weeks after the operation. The face will have to be treated using moisturizing cream quite frequently; it is also important to wash often. Once the healing process is complete, the patient may apply make-up once more, though the use of sunscreen will be required for a few months.

RESULTS
When a lighter peel is performed, one is able to observe a gradual improvement in skin texture, freckles and other blemishes. The degree of improvement for scars and acne is minimal.

Deeper peels result in a very visible improvement in the skin’s smoothness, and freckles are usually improved to a great extent. The degree of improvement for scars and acne is considerable, ranging from 50% to 70%, depending on the depth of penetration and the type of scarring. In such cases, one application is sufficient to see improvement. If the patient so wishes, they can of course repeat the operation after a few months, in order to further build on the results. The scars can never be completely erased, however, no matter how many repetitions are undertaken.

A basic advantage of laser technology is the reduced chance of complications, particularly when the practitioner is skilled in its use. This is due to the preciseness of laser equipment, as well as the presence of sections of healthy skin, which aids the use of fractional lasers.

Of course, as in any other medical matter, there is no rule of thumb which applies to all patience, and as such the choice of the best technique and equipment should come from a thorough discussion with the practitioner. A plastic surgeon knows what is most appropriate for each patient, and the patient must explain their personal needs and daily obligations to the surgeon, so as to aid them in deciding how to pursue the best possible results.

As has been explained above, the peel is a tried and tested method which has its roots in antiquity, and has been further improved thanks to laser technology. Thus, the already verified results of peeling have been further built upon thanks to the application of lasers, and provide patients who have chosen to undergo this procedure with great satisfaction.