1. science
2. medicine
3. surgery

INTRODUCTION
We are pleased in your interest in C02 Laser Resurfacing. Surface facial
wrinkles, sun-damaged skin, lip creases and wrinkles, and acne scarring
can be damaging to a person's self-image. In many cases, an individual's
life can be enhanced through laser surgery to remove or improve skin
imperfections.
Through proven and advanced laser technology,
Dioxide Laser has revolutionized
sun-damaged
the treatment
the UltraPulse Carbon
of wrinkled,
scarred or
skin of the face.
The purpose of this manual is two-fold.
From a patient's perspective,
this manual will inform you about this procedure, as well as give
guidelines for the proper pre and post-operative
instructions.
We are interested
in the best possible result for you. Following
before
instructions
and
expectation
after
are
essential
in
determining
the
your
of this procedure.
After reviewing this manual, any questions you might have concerning
this procedure should be discussed with us.
I~:_·
I
A_B_O_U_T_T_H_E_P_R_O_C_E_D_U_R_E
Understanding your skin
We were all born with smooth, baby soft skin. As we go through
life
our skin becomes a road map showing the effects of where we have
been and what we have done. Even if we have taken care of our skin,
many of us are affected by childhood and adolescent disease while
heredity and gravity always take their toll.
Exposure to the sun, use of alcohol, smoking and less than optimal
nutrition
all accelerate the signs of aging. Moles, warts, keratoses, scars
from acne or facial trauma may further mark our skin and such
blemishes may adversely affect our self image.
Is skin resurfacing for you?
The most basic requirement for any surgery is good health. Other
requirements are more subtle and should be carefully considered in
discussions with Dr. Clariday. Expectations of surgery and of the
surgeon must be realistic. Skin resurfacing procedures cannot produce
perfect skin; rather the goal is to improve the appearance of the skin as
much as possible.
Skin type and color, ethnic background and age are important factors
that should be discussed prior to surgery. If you have dark skin or
problems such as allergies, previous burns, a history of poor scars or
radiation
exposure, you may need a special evaluation to determine
if
you are a candidate for this procedure. Also, if you have had episodes
of cold sores or blisters around the mouth, please inform Dr. Clariday.
Before deciding on a skin resurfacing procedure, Dr. Clariday may
recommend a skin care regimen to be started prior to the procedure
itself. If you have extensive damage from aging or an injury, more than
one treatment/procedure
may be necessary.
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....l1
A_B_O_U_T_T_H_E_P_R_O_C_E_D_U_R_E
·
Making the decision for skin resurfacing
Whether you seek skin resurfacing for functional or cosmetic reasons,
your choice of a qualified surgeon is of paramount importance. Dr.
Clariday will examine your skin to assess factors that could affect the
outcome of the surgery and to determine
the proper procedure for
your condition. You and Dr. Clariday will explore your attitude towards
surgery and discuss realistic expectations and risks. Trust is built
through these discussions and the agreement between surgeon and
patient is a prerequisite for a successful outcome to the surgery.
Understanding the surgery
The skin is composed of the epidermis and the dermis. Within the
dermis are two layers, both of which are constructed of collagen, long
fibers that loosen and stretch with age and sun damage. If the deepest
layer, the reticular layer, is damaged, scars will result. While the upper
layer of the dermis, the papillary layer heals from injury without
scarring. The UltraPulse laser improves the quality of tissue treated
with less risk and pain. It is the treatment of choice by many physicians
because resurfacing with laser is preformed with much greater control.
The UltraPulse laser in the hands of a skilled physician can initially
shrink the collagen to nearly one third of its size. As the collagen
shrinks, it contributes to a universal tightening of the treated areas,
ironing out fine lines and wrinkles, with an overall improvement of the
quality of the tissue. Superficial pigmented areas are wiped away. The
results, in many cases, are astounding. Statistically, one should see a
resolution of fine lines and wrinkles of up to 50-60%. Skin will look
firmer and smoother, with a more even complexion. One more added
benefit comes from the stimulation
new collagen formation
of new collagen.
In some instances,
is seen up to six months after the procedure.
ABOUT THE PROCEDURE
What to expect after the surgery
Immediately following the surgery, the technician will apply a dressing
to your skin. Swelling and "crusting" of the skin are normal. Ointments
will keep the sk·IT6~nd
will be applied for ten days following the
surgery. The redness of the skin that persists after the initial healing
phase will usually fade in about 4 to 6 weeks. Avoidance of extremes in
temperature and any activities that would cause stress to the healing
skin should be avoided. Following a healthy diet and a healthy lifestyle
is strongly recommended.
operative
instructions
It is imperative that you follow the post-
to the letter.
In one to two weeks after the surgery, new skin will emerge that is
pinkish, finer and less wrinkled. But it will take several weeks for all the
redness to vanish. Follow up care involves using sun block in order to
protect the skin while new pigment is created. Patients will notice that
the skin remains lighter for a long time after surgery but that condition
will usually subside when the skin's pigment level has been restored.
Facial resurfacing makes it possible to correct many facial flaws and
signs of premature
aging that can undermine self-confidence.
By
changing how you look, cosmetic surgery can help change how you feel
about yourself.
MOST COMMONLY
ASKED QUESTIONS
REGARDING
C02 FACIAL RESURFACING LASER SURGERY
The carbon dioxide (C02) laser has become a popular instrument in
facial cosmetic surgery. This laser delivers a very short pulsed light
energy, which allows clean, layer by layer vaporization of skin without
the spread of heat to the adjacent tissues. This gives Dr. Clariday
extreme precision with means minimal risk of scarring and faster
healing times than other techniques
such as chemical peels.
The C02 laser precisely removes tissues, layer by layer, permitting clear
definition of landmarks and optimal depth control-a valuable tool for
treating facial wrinkles, sunspots and scars from acne or old injuries.
1. What can laser surgery improve?
The C02 laser can significantly
reduce fine lines and wrinkles,
loose skin, scars from acne, sun damaged skin and so-me types of
pre-cancerous
skin conditions.
It cannot treat superficial
blood
vessels, red spots, melanoma or port wine birthmarks.
2. How does the laser remove fine lines and wrinkles?
The laser provides an ultra-high energy pulse that removes a thin
layer of skin by vaporizing the surface epithelium
and exposing
the underlying collagen layer. Once through the first layer, a
second pass is applied. This acts to tighten the underlying
collagen
of the skin which reduces the fine lines and wrinkles.
3. Can the laser remove age spots?
Yes, depending on the depth of the pigmentation.
spots, pigmentation
Freckles, sun
from pregnancy or heavy sun exposure are
removed well by the C02 laser treatment.,
4. How long does the surgery take?
Most treatment
sessions take between 45 minutes to an hour
depending on how much of an area needs to be treated.
MOST COMMONLY ASKED QUESTIONS REGARDING
C02 FACIAL RESURFACING LASERSURGERY
5. Will the surgery be painful?
You will be given pre-operative
medications
that will help with
anxiety and pain. Conscious sedation will be administered
your procedure/surgery.
during
6. Will there be pain following the surgery?
Pain levels vary with each individual
be discomfort.
Pain medications
patient. Yes, there is going to
will be prescribed prior to
surgery and can be taken for the first 5-7 days as needed.
7. What will the treated
The area treated
area look like following
the surgery?
by the laser will be very red and sensitive.
Weeping will occur as new skin is formed.
will depend on the age and health of your
discharge and crust may develop. Usually
crusting will have resolved from even the
The degree of redness
skin. A honey colored
after 7 to 10 days the
deepest areas treated
and the patient is left with only mild redness. Most female
patients at this state are able to resume makeup use.
8. How long will the treated
area remain pink?
The treated area will remain pink for generally one to three
months, depending on the depth of wrinkles treated and your
original skin color. Usually this is easily concealed by makeup.
Each few days the patient will notice some improvement; redness
and swelling are worse in the morning and after exercise.
9. When can I return to work?
Most patients take 7-10 days before returning to work. At this
point any mild redness that is still present can be concealed with
makeup. Because everyone heals at a different
may take a longer time before returning
rate, some people
to work.
MOST COMMONLY ASKED QUESTIONS REGARDING
C02 FACIAL RESURFACING LASERSURGERY
10. When can I begin wearing makeup? Is there a specific brand I
should use?
Normally patients can begin to wear makeup 10-14 days postoperatively. Remember, your complexion and skin tone will be
changing on a day to day basis. We suggest using a hypoallergenic skincare product and moisturizer that contain natural
products such as bee's wax and mineral oils. We will provide you
with a base/powder
from Jane Iredale Minerals that will be used
on the resurfaced area for the next 3 months to conceal any
redness that is still present.
11. Why is it necessary to have a gel dressing on the treated
area following surgery?
The gel dressing acts as a barrier protecting
contamination
environment
and trauma while maintaining
treated areas from
a moist
that promotes healing by absorbing drainage and
weeping. Drainage or weeping is our body's natural way of
healing after resurfacing surgery. Drainage or weeping must be
kept moist with the gel dressing in order to keep the area from
crusting. If crusting is allowed to develop, this will increase
inflammation and delay the healing process. The gel products help
the healing patient avoid the scab build up that can lead to
unsatisfactory
results.
12. What are the chances of scarring?
The chances of scarring are extremely low with the C02 laser. The
chances of scarring are much lower than with a chemical peel or
dermabrasion.
If scarring does occur, it is usually of a very low
grade; it is treatable
and is not a significant cosmetic problem.
MOST COMMONLY ASKED QUESTIONS REGARDING
C02 FACIAL RESURFACING LASERSURGERY
'--..•.:
13. What areas of the skin can be treated with the C02 laser?
This particular laser, because it is predominately absorbed by
water, is ideal for resurfacing facial skin (90% water). The best
results are seen with fine to moderate wrinkle (static wrinkles)
around the eyes or mouth, acne or chicken pox scars or benign
lesion.
14. Are there risks of pigmentation change with different skin
or pore sizes?
Yes, darker skinned individual
have an increased risk of
pigmentary changes after surgery. Most pigmentary changes are
temporary and a "patch" test behind the ear may be preformed
prior to surgery.
15. How does this type of surgery differ from chemical peels or
dermabrasion?
Advantages of laser treatment
include; more precise control, no
chemical or mechanical damage to the remaining tissues, more
consistent
results, less bruising and swelling and less risk of
scarring and pigment changes. There is also the benefit of
collagen shrinkage which produces the "face-lift
effect".
16 .. Can you have the C02 laser done if you've had a
dermabrasion or a face-lift?
Yes, with the approval of your doctor. Generally, we want you to
wait at least 6 months after a face-lift and at least one year after a
dermabrasion.
MOST COMMONLY
ASKED QUESTIONS REGARDING
C02 FACIAL RESURFACING LASER SURGERY
NOTE: If you have been using "Accutane" in the last two years,
you will need to see your dermatologist to get approval for the
surgery. "Accutane" is an oral vitamin A that stops production of
the sebum in the body, and has been associated with delaying the
healing and may cause scarring following a C02 laser treatment.
17. How long will the rejuvenation results last?
Results vary depending on skin types, pigmentation,
wrinkles and general skin care following
depth of
the laser treatment.
Results should last up to several years. Actually, new collagen is
produced that thickens the skin and may be more resistant to
aging effects.
18. Can I get the same results from a full face laser treatment
I would from a facelift?
The two procedures serve different
be an alternative
traditional
a
purposes. Full face laser can
for patients who medically cannot undergo
facelift procedures with acceptable results. But the full
face laser is used to only remove the static wrinkles.
19. Can I have the surgery done more than once in the same
area?
The surgery can be repeated after a period of six months to one
year.
20. Is the skin rejuvenation covered
by insurance?
No, it is considered strictly an elective/cosmetic
"beautification
procedure".
surgery or
INFORMATION
AND GUIDELINES FOR LASER RESURFACING
1.
You may experience some stinging when you apply water for
the first few days. This is normal. Do not skip the cleansing
or soaking steps. This step will sooth the skin and removes
the cellular debris.
2.
Some people experience a few break-outs after about three
weeks. It is not unusual to see a few whiteheads at this time.
If this happens, your doctor will recommend a product to
clear this up. Do not squeeze these pimples, it can leave a
mark on the skin.
3.
A small percentage of the people who have had laser
surgery will experience some hyperpigmentation.
This
appears on the skin like a dark brown color. This is not at
permanent
condition,
and can be treated by your doctor.
4.
Do not use facial scrubs for at least three months after
surgery. They are too harsh and can irritate the skin.
5.
Avoid astringents and toners with alcohol for the first 90
days.
6.
Do not apply self-tanning products to the skin after laser
surgery for at least three months. These types of products
can make the skin appear splotchy and uneven. It is better
to use a bronzing powder which can be washed off.
7.
Do not use bronzing gels. They can get into your pores and
give your skin a pitted look.
INFORMATION
AND GUIDELINES FOR LASER RESURFACING
8.
Do not go to tanning salons. The doctor will not be
responsible for any reactions your skin may have after laser
surgery if you use any machines which are supposed to tan
your skin. The UVA and UVB rays emitted by these machines
are many times greater than the sun. We suggest that you
avoid them all together.
9.
Try not to smoke while healing and for at least three weeks
after surgery, or try to decrease your frequency of smoking.
Smoking raises the carbon monoxide levels in the blood and
interferes
10.
with the healing process.
Do not use any products except those given to you during
the first three visits after your surgery. These products have
been formulates to promote healing and cover redness.
They do not contain perfumes or pore clogging ingredients
that could lengthen the healing process.
11.
Do not use any skin products prescribed by any other
physician without
prior consent of Dr. Clariday.
This includes eye drops.
12.
Retin-A is a prescription drug. Please ask Dr. Clariday how
long you should wait before returning to using the product
after your surgery.
13.
Do not apply hair color, perm or hair straightening
solutions
to the skin or face for six weeks after surgery.
14.
Do not apply any acne treatments
for six weeks after surgery
that are drying to the skin
INFORMATION
AND GUIDELINES FOR LASER RESURFACING
15.
Do not wax your eyebrows, upper lip or other facial areas for
three to six months after surgery. You run the risk of
removing your skin with the hair, leaving a scab. If the wax is
too hot, it can blister the skin, also leaving a scab and or
scar.
16.
Do not use hair depilatory
surgery.
17.
If you are on a prescription antibiotic for the skin, we need
to clarify why you are using it and how long you can be off of
the medicine. You will need to contact your physician to find
out his information
18.
products for three months after
before your surgery.
The normal time suggested by many physicians to return to
your glycolic or other alpha-hydroxyl
19.
acid is three months.
If you have been on an at-home program of 20% glycolic
acid, we suggest you drop to a lower percentage for three
months and work back up to a higher when you are healed
from your laser surgery.
20.
Avoid any glycolic peels unless suggested by your physician.
(
(
Appendix C
Laser Resurfacing:
Full Face
0
Per orbital (under eyes)
0
A
B
Purchase distilled water and white vinegar.
If you are having FF resurfacing have
enough food supplies for one week after the
surger .
Valtrex or valacydovir
Cipro-
Pre
Pre
Day
2
Day 1
Day
of
Surgery
Post
Day
I
3
2
3
4
5
6
X
X
X
tablets twice a day for 5 days.
C
D
E
F
G
H
I
J
K
L
M
No make-u , wear loose clothing,
Nothing to eat or drink after midnight if
you are havin anesthesia
Vinegar & distilled water soaks every 3 to 4
hrs. 3 Tbs. vinegar in I gal. distilled
refri erated water
Apply dressing to skin
Darvocet N 100 for pain or Vicodin for
oatients havin Full Face Resurfacin
Full Face resurfacing. Shower twice a day,
wash hair w/head tilted back. Next allow
water to run down face while gently rubbing
skin in circular motion with gauze.
Skin red and oozing
Stay out of direct sun. Wear hats and visors
First Post-op visit
Return for post-op visit and pictures
X
X
X
X
X
X
X
X X X
X
7
8
9
]0
months
Post-Op
I
POST-OP SUPPLIES AND MEDICATIONS
'----------
Please have the supplies listed below on-hand before your laser
resurfacing. They will assist in making your recovery more
comfortable.
soap (For hand washing)
•
Antibacterial
•
Gauze Pads (Non-sterile
for you)
•
Benadryl Allergy, 25mg (If restless or itching, you may take
I
large 4><4 s; we will provide these
two, then one every four hours thereafter.
Benadryl may
make you sleepy, so take with caution.)
•
Extra Strength Tylenol (May take two every four hours as
needed for pain)
•
Hydrocortisone 1% Cream (Maybe used for itching or
discomfort only as directed by your physician.)
• Antibiotics (We will call you in an antibiotic
prior to your
surgery day to be taken when you get home from your
procedure. Please follow all medication instructions!)
• Valtrex, SOOmg(This is an antiviral agent which you will start
taking the day of surgery. It is normally taken as SOOmg
twice a day starting the day before surgery and continued
twice a day for the following
six days.)
POST-OP SUPPLIES AND MEDICATIONS
------------• Vicodin (A pain medication we will call in for you prior to
your surgery. It should be taken no more than every six
hours after surgery as needed for pain. Most patients use
Vicodin only the first couple of days and then are quite
comfortable taking Extra Strength Tylenol for discomfort
thereafter. )
• Artificial tears (Maybe used as needed in the eyes to rinse
exudates and soothe eyes while swollen and not closing
well; W!! will also p r0¥ide-t1i Me: ftJl ~kk
•
Post-operative ointment-Aquaphor (A post-resurfacing gel
especially formulated to relieve post-operatively discomfort
and minimize redness. This will be provided by our office the
day of surgery.)
• Straws (To be used if swallowing
•
is a problem)
Bottled Water (For drinking, at least 640z. per day. Drinking
at least 8-10 eight oz. bottled water per day will enhance the
healing process by replacing fluids lost from oozing and as a
natural diuretic to help decrease swelling.)
•
Small- Water Mist Bottle (To be filled with the same cold
vinegar and water solution used to soak resurfaced areas .
. Mist resurfaced areas as needed to relieve burning
sensation between soaks.)
•
Reading Material/Videos
(It is important
occupied during the healing process.)
to keep your mind
I
---POST-OP SUPPLIES AND MEDICATIONS
•
XL Shirts (With button-up
fronts or large opening to slip over
your head easily)
•
Snacks/Healthy Foods (Foods low in sodium and high in
nutritional value. Foods high in sodium could put you at risk
for unnecessary swelling and discomfort.
nutritional
Foods high in
value will provide much needed vitamins,
complex carbohydrates and protein. A diet high in
nutritional value will promote healing
• Vitamin E (To be taken orally post laser resurfacing)
A.
400 IU twice a day starting the day after surgery for
patients who are not having a Blepharoplasty (eyelid
surgery).
B.
400 IU twice a day staring three days after for patient
who are also having a Blepharoplasty
(eyelid surgery).
Follow-Up Care:
Ten Days Post Resurfacing
How to take care of resurfaced skin ten days after Laser Skin Resurfacing:
1. Stop Vinegar and H20 Soaks
2. Start Skin Care as follows:
1. Cleanse
2. Moisturize
3. Sun-block
4. Make-up
1. Cleanse
2. Moisturize
3. Increased itching can be associated with very dry skin. Use Aquaphor at
night before bed for extra moisture and relief.
Recommended Products:
Cleansers:
Cetaphil'P'/Skinceuticals
Cleanser
Gentle
Moisturizers:
Cetaphil"
Aquaphor"
Neova Day Therapyr»
Sun-block:
CetaphilTM
Neova Day Therapy'Y
Skinceuticals UV Ultimate SPF30
Make-Up:
Jane Iredale"