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Skin resurfacing lasers have been around since the early 1990’s. There are many different types, but the “work horse” laser, which has been reliable in eliminating sun damage and age related wrinkles, is the CO2 laser. Although still used extensively for severe wrinkles and sun damage, in its full ABLATIVE form it removes ALL of the skin thereby requiring a rather lengthy recovery measured in weeks and months. In the middle of the first decade of the 21st century, technology was developed which allowed the ablative CO2 laser beam to be broken down (fractionated) into small little dots of laser light much like the pixels of colored light which make up the image on a T.V. screen. The word Fraxel was created by the Reliant Corporation from the words “fractionated” and “pixel” to describe this process. Today there are many companies which make FRACTIONATED LASERS. The branding of the word Fraxel, however still belongs to the Reliant Corporation.
The bottom line is that these lasers do not remove all of the skin, but rather leave small little “islands” of intact skin in between each laser dot or burn. This provides the matrix for a much quicker recovery with less down time, meaning days rather than weeks or months. It also allows the surgery to be done with just a topical anesthetic applied to the skin about an hour before the procedure. Alas, there is a down side to all this great technology, and that is in the results. Fraxel or fractionated lasers only provide mild to moderate improvement with each treatment, working best on pigmented, sun damaged skin, and least on wrinkles. The procedure can be repeated a number of times which may increase its effectiveness over time.
When you meet your cosmetic surgeon, an extensive personal medical history will be obtained, asking specifically about previous sun exposure, smoking habits, wound healing problems, skin infections, and any medical issues which may adversely affect the outcome of your laser skin resurfacing. An examination of the problem areas and your goals will be discussed. This allows for appropriate surgical planning and expectations regarding the degree of improvement you can expect. Preoperative photos are taken. Finally, the procedure itself is described in detail along with the inherent risks and complications. Appropriate preoperative lab, tests, and general physical examination may be ordered based on your existing medical problems and for safety reasons. Written preoperative instructions are given along with a prescription for an anti-biotic and in many cases an antiviral.
One hour before the Fraxel/fractionated laser, a topical anesthetic cream is placed on the skin to be treated and covered with a plastic wrap. Some individuals will take an oral sedative as well but if they do so, they cannot drive themselves home. During the laser a cold stream of air is blown on the skin for comfort, however, most people will still feel a mild stinging sensation best described as being too near a 4th of July “sparkler.” Upon completion Vaseline is applied and you may leave.
Following the Procedure
Most people experience a burning sensation for 30 minutes to two hours after. It then stops and there is typically no further discomfort or pain. Pain medicines are prescribed as needed. Other than keeping a thin layer of Vaseline on the skin, normal activities and bathing habits may resume but showers are required instead of the bath tub. On day number 2 and 3 there is a significant degree of swelling. Starting on day 3 the small dots of lasered skin begin to peel off and this process is usually complete by day number 5, 6, or 7 unless you have a non-facial area treated. For example, the neck, chest, and other skin sites take longer to heal. It may take 6 to 8 weeks to see the final results.
Complications are rare, however, there are certain inherent risks connected to every surgical procedure and these should all be discussed with your surgeon prior to the procedure. All complications can be minimized by carefully following all of your doctor’s pre and post operative instructions.