Laser Skin Resurfacing

I saw a patient yesterday for a facelift consultation, but what she really needed to address her primary concerns was a laser skin resurfacing procedure. So how do you know which procedure is best suited for your needs?

Laser skin resurfacing corrects skin texture and sun damaged skin wrinkles, as well as hyper-pigmentation (age spots); surgical facelift procedures do not. Surgical facelift procedures re-position sagging skin such as jowling along the jaw line, deep nasolabial folds, or the classic “turkey neck” deformity. If you have skin wrinkles which persist after you’ve re-positoned the skin with your fingers (as my patients frequently do during their consultation!) then laser skin resurfacing is probably what is needed to correct those lines and wrinkles. Sometimes a combination of procedures must be done to fully address a patients unique needs.

The classic example of the type of wrinkles perfectly suited for laser skin resurfacing are the lines around the mouth or the fine crepe paper wrinkling under the lower eyelids. Deep fixed skin wrinkles on the cheeks and hyper-pigmentation from years of sun exposure are also excellent indications for laser skin resurfacing. So how does the laser correct skin texture , wrinkles and “age spots” which surgical procedures miss?

The type of laser which I have used for many years is Sciton’s dual head Erb-YAG. This laser has the ability to ablate (remove) the top layer of skin which immediately addresses the wrinkles, as well as hyper-pigmentation, but more importantly the second head creates a deep tissue thermal reaction (coagulation) which stimulates the body to lay down new dermal collagen and elastic fibers. It is this formation of new skin tissue which creates skin tightening and a smooth skin texture. It has been shown that simply removing the top layer of skin without the thermal component will not give a patient the long term improvement in skin texture or tightening.

It has been shown experimentally that if you were to take a sample of skin and examine it under a microscope before the laser resurfacing procedure and six months after, you would see a marked amount of new collagen and elastic fibers. These fibers would be orderly arranged in dense, compact layers just like in young, non-sun damaged skin. In other words, the laser literally rejuvenates the skin turning back the hands of time so to speak. Surgical face lifting procedures do not create these type of profound changes within the skin itself.

This particular patient wanted to address the lines between her eyes and at the base of her nose. In addition to the fixed lines in this area, her skin was severely sun damaged with areas of hyper-pigmentation scattered throughout. I recommended Botox injections for a simple, although relatively short term fix for the wrinkles between the eyebrows and at the base of her nose. Her particular wrinkles in this area would have benefited greatly by a surgical endoscopic browlift , but the Botox injections are relatively inexpensive (compared to the surgical endoscopic browlift) and she will see results in several days. Next week a full face deep dermal laser skin resurfacing procedure is scheduled. The area where the Botox has been injected will be resurfaced as well which will further reduce the wrinkles in this area.

She will also undergo autogenous fat transfer into the nasolabial folds of the cheeks and Marionette lines at the corners of her mouth to smooth and fill out these areas, which were also areas she pointed out that she wanted to correct. If the lines persist in the areas where Botox was injected , then I will inject fat into these areas as well to provide a more permanent correction.

This combination approach for this particular patient will give her the most profound improvement in the areas which she was most concerned while keeping the costs down. An endoscopic browlift and surgical facelift can always be done at a later date, but the wrinkles and skin texture changes from severe sun damage were her primary concern and this was fully discussed with this patient.

In addition to the above interventions, I highly recommended that a comprehensive skin care program be initiated once this patient has recovered. This would include a home program consisting of topical tretinoin, skin exfoliants, moisturizers, sun blockers , bleaching agents and regular in office chemical peels. While this sounds complicated, it really isn’t. I routinely customize programs for my patients depending on their unique needs. A comprehensive skin care program will ensure optimal long term results after any type of skin resurfacing procedure. This type of program will benefit all patients regardless of their age and help keep their skin in great shape.

Laser skin resurfacing is not a substitute for surgical facelift. Most patients I see have very specific concerns which are well suited for a surgical procedure, however, if it is skin texture you wish to improve then laser skin resurfacing may be what you really need. Often times a combination of procedures can be of benefit as was the case in this particular individual. A consultation with a surgeon experienced and trained in all aspects of facial rejuvenation procedures including laser skin resurfacing, surgical facelift procedures as well as non-surgical modalities can help you decide which procedure(s) will best address your concerns. Hope this helped . As always, thanks for your time. Tim Bradley, MD