Many years ago, when I was a medical student, an old professor of pediatrics told us half jokingly: “The definition of an adult is a child which has degenerated”. After 15 years as a physician, I would tend to agree at least as far as the skin is concerned. We usually start out at birth with nearly perfect skin.
As children, we suffer our first cuts , burns, abrasions, then we get chickenpox and superficial skin infections. A few years later, puberty ravages the skin with acne eruptions, often leaving permanent damage. We continue to age and the skin starts to show signs of ultraviolet light damage from too much sun tanning and exposure to the elements, manifesting ugly brown agespots or warty growths and loss of skin elasticity due to loss of collagen causing the appearance of wrinkles.
Actinic keratoses are thickened areas of sun damaged skin that may become cancerous after a few years.During all this time the genes we inherited from our parents and ancestors also manifest themselves by growing moles, “beauty marks”, xanthelasma (superficial deposits of fat), syringoma (little bumps around the eyes) , sebaceous hyperplasia (small growths of the oil glands with a tiny hole in the center) , nevi, seborrheic keratoses and a whole bunch of unwelcome growths that are cosmetically not very appealing.
For years patients have sought treatment through surgery, dermabrasion, chemical peels and recently through CO2 lasers for resurfacing. The mechanism of actioninvolves removing the surface of old , damaged skin causing the deeper layers of skin to grow a new epidermis with increased amounts of collagen underneath, and giving the skin an improvement in color, texture, improvement of wrinkles, acne scars and superficial growths and a more youthful appearance. Those methods are still in use today but they have their drawbacks:
Dermabrasion is a difficult and not easily available technique, usually needing general anesthesia and operating room time in a hospital and is very difficult in the delicate skin around the eyes and mouth. The current CO2 lasers can yield very good results in expert hands, but have lost popularity in Quebec due to many negative media reports concerning side effects. I personally took two laser training courses for two different types of CO2 lasers but I chose not to use them in my practice, because they cause important thermal damage to the skin (a burn) and there are many reports of delayed healing, persistent redness of more than six months, and permanent pigmentary changes (post inflammatory hypo pigmentation), where treated skin becomes permanently lighter than untreated skin.
Finally we have a new laser: ERBIUM. It produces energy in the mid infrared invisible light spectrum and this energy is 10-15 times better absorbed by water in the skin than the energy from CO2 lasers. This has several consequences: since this laser energy is so well absorbed, it instantly vaporizes skin and tissue so precisely that surrounding skin is hardly affected . In other words you could say this is a “cold laser” because it does not burn the skin . Because of this, the pain factor and side effects have been greatly reduced, while the degree of precision and control is significantly enhanced . Only a few microns of thickness are removed at each laser pass. The healing process lasts one or two weeks so the procedure is suitable for relatively young and working persons who cannot afford a lot of down time.
The procedure will also be of interest to patients who also had their facial skin resurfaced by one of the other methods who would like to improve their condition further or who are satisfied with the results but want to resurface delicate skin surfaces like the neck or the back of the hands that were not treatable with other methods.
The safety factor also allows us to accept as candidates for treatment persons of darker skin color (black, hispanic, mediterranean, asian etc.)
If you have reason to believe that you have a condition that may benefit from Erbium laser resurfacing, a preoperative consultation is required in order to establish a proper diagnosis, rule out any medical condition that may make you an unsuitable candidate, and to adequately describe the preoperative skin preparation, the procedure itself and detailed postoperative instructions. I will also give you my prognosis as to your chances of improving your particular condition. Because this part of my parctice is more time consuming, please be sure to ask my secretary for a “Laser Consultation” instead of a regular appointment. If you are consulting for a very simple procedure it may in some cases be performed immediately after consultation.
The CO2 Vs Erbium controversy:
As a patient, you should be aware, there is a controversy among skin laser surgeons regarding the relative merits of these two very different technologies. CO2 advocates claim their device is more effective for aged patients with severe sun damage and that CO2 will cause contraction of collagen fibers. On the opposite side of the debate, it is said that final results will be similar in expert hands but with a lower risk of complications for ERBIUM patients. Concerning collagen contraction, we should not confuse thermal effect on protein structure with the formation of new collagen that seems quite similar according to recent studies. Many experts find ERBIUM superior for delicate skin sculpting because its wavelength of 2.94 microns allows a very specific ablation of this skin component. (Acne scars, for example). Personally, I have more than ten years' experience with the Erbium laser system and I am sincerely convinced that it has the highest ratio of benefits to potential side effects.
Preoperative and post operative instructions:
Read carefully the instruction sheet you were given during your consultation
Avoid smoking, alcohol, anticoagulants such as aspirin, vitamin E, natural herb products
Clean the skin twice a day with lukewarm water and the prescribed skin cleanser, and use the prescribed moisturizer four times a day to prevent dryness.
For small treatments like cosmetic resurfacing of small benign lesions, post-op care is very simple:
You must apply the prescribed antibiotic ointment twice a day for 10 days and cover with a non-stick dressing twice a day. You must avoid forming a dry crusted scab and the treated area must remain moist at all times. Avoid local friction against clothing.
A moist wound environment will allow faster healing and a better cosmetic result because the new epidermal cells will easily migrate on the surface instead of digging under a thick crust, and this will decrease the risk of a saucer-shaped scar.
In the first 24 hours, the treated area may bleed. Apply firm, constant local pressure with 1 or 2 fingers, without interruption for 20-30 minutes and this will usually stop bleeding. Call the office for further instructions if bleeding persists.
A new alternative for treating wrinkles and superficial acne scars without removing the epidermis (non-ablative resurfacing)
Although Erbium laser is safe and effective, many patients have an extreme fear of all invasive medical procedures or simply cannot afford the luxury of two weeks downtime following the procedure.