Laser Skin Resurfacing

Q: Do you do thermage? Cost?

A: I don’t perform Thermage. There are several reasons for this.

Thermage is meant to use radiofrequency waves to specifically heat and contract collagen. The end result should be a tightening of the facial skin.

Some patients do get results. However, there are reports of the dissatisfaction rate being as high as 50% for Thermage. That’s too high for me. The number one complaint is that patients do not feel they have had a significant improvement.

Another factor is the discomfort associated with the procedure. Originally, Thermage treatments involved fewer treatments with higher energy levels. Despite being medicated, many patients reported that their procedure was rather uncomfortable. There’s been a recent treatment protocol change that involves lower energy levels, with presumably a greater number of treatments. Still, I believe that there is still significant pain during treatment, and it appears that many patients still don’t seem satisfied.

I prefer to perform treatments that I feel will improve 80-90% of patients. Maybe things may change with Thermage, but at this time I don’t feel it’s best for my patients.

Q: How do I take care of my skin before and after a laser treatment?

A: It depends partly on the laser.

Care for your skin is important both before and after laser skin resurfacing. When patients undergo ablative laser skin resurfacing (such as CO2 and Erbium:YAG laser skin resurfacing), after care is more involved and lengthly. As a result, many patients are opting for fractionated skin resurfacing, which usually requires multiple treatments and has less dramatic results. The great thing about fractionated skin resurfacing is a lower incidence of side effects and much less, if any, downtime.

Proper skin care is important before your procedure. Here are guidelines I recommend:

  • Patients should stop use of retinoic acid products (e.g., Retin-A, Tazorac, Differin, Renova) for at least 2 weeks before their procedure.
  • Patients must not have taken Accutane, which is used for acne treatment, for at least 1 year prior to treatment.
    Avoiding the sun is best. Untanned skin is easiest to treat, and less likely to encounter side effects from resurfacing.
  • If possible, it’s best to stop aspirin therapy at least 1 week prior to skin resurfacing to reduce risk of bruising. To a lesser degree, ibuprofen (Motrin, Advil), naproxen (Aleve), other Non Steroidal Anti-Inflammatories, Ginkgo, St. John’s Wort, and Vitamin E can increase risk of bruising.

After patients undergo fractionated laser skin resurfacing, many doctors recommend the following:

  • Moisturize your skin at least twice daily. For the first 7-10 days after treatment, skin may be particularly dry. If skin is dry, using a moisturizer up to 4-5 times daily will help keep moisture in your skin.
  • Use sunblock! Even if you’re not out in the sun, a sunblock with an SPF of 30 or higher should be applied once in the morning and once mid-day while your skin is red.
  • Avoid the sun! If you’re skin is already red, sun exposure will just make skin redder, more irritated, and more likely to blister, hyperpigment, or even scar. Stay in the shade, and wear a wide brimmed hat.
  • If you have been treated with an ablative CO2 or Erbium laser, there are more steps you’ll need to take to protect your skin and allow it to heal:
  • Oozing, weeping, crusting, and scabbing often occur after CO2 laser skin resurfacing. To minimize this, you may be directed to wash your face with a vinegar and water solution. After the vinegar wash, you may be advised to use an antibiotic ointment.
  • Your doctor may want you to take Valtrex or a similar antiviral to reduce the occurrence of cold sores. Your prescription may be for seven to ten days.
  • Swelling of the treated area is normal. Ice 20 minutes at a time for the first few days helps to decrease swelling.
    You need to avoid sun exposure if there is significant redness to the treated area.
  • If there is scarring from a deep resurfacing, you may be advised to avoid sun exposure for up to 12 months. If you can’t avoid the sun, sunblock with an SPF of 30 or higher is best, and should be reapplied every 2 hours. Stay in the shade, and wear a wide brimmed hat.
  • Don’t pick at crusting or scabbing - this can result in a scar.
  • Oil free make-up is best after the early healing phase has passed. Avoid makeup use when there’s oozing, crusting, weeping, or irritated skin.

Expect redness to last for months with a CO2 ablative laser. Redness can last for up to 6 months. The duration of redness is usually less with an Erbium ablative laser.

Always make sure to consult with and receive treatment from a medical doctor who’s experienced in laser skin resurfacing for best results!