Laser face resurfacing

 

Preoperative preparation for laser face resurfacing

Patients undergoing laser skin resurfacing require intensive preoperative preparation and postoperative care. On the need to prepare the skin, there are still conflicting opinions. Some surgeons recommend pretreatment with hydroquinone, isotretinoin or glycolic acid. Others do not apply any formal preparation for the procedure. Most agree that sun protection is important before sanding. Insolation can lead to the activation of melanocytes and cause the development of hyperpigmentation.

[1], [2], [3], [4], [5], [6]

Laser face resurfacing: technique of operation

Cosmetic units of the face should be marked before the treatment. It is important to carry out markings in the sitting position, since the skin is displaced in the supine position. Marking in this position may result in incorrect marking of the edge of the lower jaw. In order to prevent the appearance of permanent tattoos, it is not possible to draw marking lines on denudated skin. Along the boundaries of cosmetic units (that is, the edges of the sockets, nasolabial folds), grinding should be smoothing. When treating the entire face, the edges should be smoothed along the lower jaw to create a natural transition to the untreated skin of the neck.

Installations of laser energy and power are much less important for tracking the depth of treatment during each pass than clinical tasks. When polished with a carbon dioxide laser, after penetrating the papillary layer of the dermis, the skin becomes pink. Most surgeons between laser passes remove leftover tissue with wet wipes. When using an erbium laser, the marker for penetration into the papillary layer is the appearance of point bleeding. With a deeper penetration into the dermis, bleeding points increase.

Since the oily-hair unit has an hourglass shape, an increase in pore diameter occurs as the ablation deepens. Moreover, different skin thicknesses in cosmetic units require a given number of passes and specified settings. Obviously, for the thin skin of the eyelids, a smaller depth of penetration is allowed than for the thicker, replete with cheek skin. Also, the individual characteristics of patients require a less aggressive approach on thin, dry skin, as compared with deep ablation of thick, oily skin. For example, the damaged skin of a 65-year-old woman will transfer less laser energy than the skin of a 25-year-old man with acne scars. Very often, pathological changes (wrinkles or scars) extend deeper than the safe treatment zone. Another important goal of laser resurfacing, usually determining penetration into the reticular layer of the dermis, is to destroy photodamages, wrinkles, or more skin tightening.

[7]

Complications of laser face resurfacing

Temporary postoperative hyperpigmentation is often observed within 2-6 weeks after surgery. This darkening is caused by the sun and is usually well cleaned in the absence of insolation with hydroquinone, retinoic acid and topical application of soft steroids.

On the other hand, hyperpigmentation can be long and unpredictable. This complication usually develops delayedly, in a few months. Fortunately, it happens only in 10-30% of patients.

Scarring, which is the most frightening problem, begins with permanent hyperemia, which gradually becomes compacted and nodular. Topical treatment by administering injectable steroids, applying a steroid-soaked bandage or applying ointment steroids is highly effective. Certain areas of the face, such as the zygomatic eminence, upper lip and lower jaw, are prone to hypertrophic scarring.

The occurrence of a viral infection is manifested by intense pain. It can develop, despite the prevention of low doses of antiviral drugs. Infection is usually observed 7-10 days after the procedure, during the completion of re-epithelialization. Exacerbation of herpes requires intensive treatment with doses applied to herpes zoster. Bacterial infection can also cause pain and significantly increase the risk of scarring. Moreover, if the dressing is not changed for more than 24 hours, or if an insufficient wound toilet is performed while changing the dressing, a secondary fungal infection may develop. After laser resurfacing, contact dermatitis on ointments such as Neosporin, Polysporin and even petrolatum develops much more often. Contact dermatitis requires the discontinuation of the use of the drug that causes it and the topical use of steroids of moderate strength, as well as systemic administration of steroids. Careful attention to the patient's skin type, treatment areas, and laser exposure parameters can significantly improve the surgical outcome while minimizing potential side effects. Moreover, with careful and careful observation in the postoperative period, one can anticipate and reverse almost all undesirable outcomes and complications. The most important action in the postoperative period is the constant encouragement and encouragement of patients.

Postoperative care

As recognized by dermabrasion specialists, semi-hermetic dressings, such as Vigilon or Flexan, have significantly reduced the re-epithelialization time to 5-7 days by maintaining the humidity required for epithelial cell migration. When using these dressings, faster healing is noted, less pain, less scarring and a decrease in erythema than in open or dried wounds. Most surgeons change these dressings daily for 3-5 days. It is also possible to wound openly using fat-soluble ointments.

After completion of reepithelization, insolation should be avoided until postoperative erythema is completely gone (usually 2-3 months). Unflavored moisturizers increase skin moisture, avoiding contact sensitization. Local steroids of class I and II can also be used to reduce postoperative erythema. They need to be applied briefly. To hide unwanted redness after completion of reepithelization, you can use a hypoallergenic, acne-free makeup. Usually, the bright red color of postoperative erythema is neutralized by a green or yellow base.

[8], [9], [10], [11], [12], [13], [14]