LASERS AND PEELS
Candidates For Laser Surgery and Chemical Peels
As noted previously, the facelift operation itself will not remove the fine, spider web-like wrinkles of dry, weathered skin which are most noticeable along the cheekbones, lower eyelids, and outer corners of the eyes (“crows feet”). Nor will it remove the transverse crease of the forehead, the vertical wrinkles of the upper and lower lips, or the wrinkles of the midcheek itself. Laser surgery and chemical face peeling is often necessary to achieve the smoother look that most patients are seeking from either eyelid or facelift surgery, since the procedures themselves cannot pull the skin tight enough to remove these lines. A laser surgery or chemical peel can be expected to give additional improvement and enhance both the facelift and the eyelid surgery itself.
We are fortunate that today, there are a number of laser and peeling techniques available that produce a range of mild to profound improvements in the skin. This spectrum of laser and peeling techniques allows me to select a particular solution to best satisfy a patient’s particular needs.
There is also evidence that laser or peeling will improve the splotchy pigmentation of facial skin that sometimes accompanies and follows pregnancy, contact dermatitis, or acne. The “chloasma” (melasma), the splotchy cheek pigmentation that comes with pregnancy, may also be noted with the use of birth control pills. The dark circles which some patients have under their eyes may also be alleviated by a chemical peel. Sometimes a chemical peel is used in the treatment of pre-cancerous sun-damaged spots called actinic keratoses. In some special cases, chemical peeling or laser surgery may actually be preferable to dermabrasion for acne scarring.
The laser or peeling procedure itself may be done as an isolated procedure around the lips or under the eyes, or it may be used in conjunction with other facial rejuvenation procedures.
Laser surgery involves the use of specialized CO2 or Erbium laser equipment.
The chemical peel procedure itself involves the application of a special mixture of chemicals to the skin with cotton swabs. This is done after preparing the skin by removing all soaps and oils. Initially, the application of the peel causes a sting, but in a matter of a few seconds, the sensation subsides. Normally, some discomfort returns within the next thirty minutes after the peel is applied, and remains for a few hours afterward, but by the next morning there is little or no discomfort. The peel area tends to swell more than one would think, but this swelling disappears in three to five days.
The chemical peels routine recommended by me (Dr. Fedok) are either a combination medium depth peel – 35% TCA and Jessner’s Peel or a Baker’s Formula phenol based peel. Patients are therefore offered a choice of peel procedures that offer a range of moderate to profound improvements and minimal to significant “downtime”.
These procedures may be thought of as a deep sunburn, where the top layer of skin blisters and peels off in a two-to-three day period, revealing a fresh deep pink layer underneath. The “blistered” skin develops a crust that needs to be loosened and washed off with frequent washings every day. In addition, this crusty layer must be kept moisturized.
Normally, after the area has peeled and reveals the deep pink color, female patients can begin to wear make-up (to subdue the pinkness) about ten days after the peel is applied. The make-up should be a water-based, non-allergenic variety so that it does not irritate the new, sensitive skin. Patients are also able to return to work and social activities at this time. The pink or red cast will subside gradually over the next three to six months. There is evidence to suggest the skin will heal more quickly after laser surgery than chemical peeling.
Exposure to Sun
It is especially important for patients to avoid direct exposure to the sun in the first three to six months following application of a chemical peel. One can apply sunscreen, so as not to burn the still-sensitive skin and continue to enjoy normal outdoor activities like golf and tennis. The ultraviolet exposure from the sunlight has the possibility of causing irregular or blotchy pigmentation (hyperpigmentation) of the peeled area. In addition, patients should avoid, if possible, taking birth control pills or any other Estrogen-containing medicines until the pink subsides for the same reason. This is a minimal risk factor in aggravating brown pigmentation and I do not require that patients discontinue their hormones if the hormones are necessary to prevent “hot flashes” and no irregular brown pigmentation occurs.
The results of the laser surgery or chemical peel are quite dramatic and well worth the effort when indicated. The degree of improvement is not transient, will last for many years, and only very occasionally needs to be redone.
Not everyone who has fine wrinkles or irregular skin pigmentation is an acceptable candidate for laser surgery or chemical peel. Patients with fair complexions tend to do better than those with dark ones. In fact, patients of Asian or Mediterranean descent are not good candidates for chemical peel due to the possible marked difference in coloration between the peeled and non-peeled areas. Also, thick, rough, more deeply etched skins may require the two-stage approach (two chemical peels or laser treatments) to achieve the best results.
The formula for the chemical peel solution has been developed for thirty years and proven safe when used properly by physicians. I prefer to use the open and wet dressing technique after the peel, because it allows for easy review of the healing process and is more comfortable for the patient. I do not apply tape over the area.
With the technique I use for the chemical peel, it would be very rare to have any facial scarring result, unless the patient does not follow my instructions exactly. Considerable swelling does occur with chemical peeling and is a normal part of the healing process. Patients should be prepared for this and be emotionally mature enough to accept this temporary distortion of their appearance in order to achieve the desired improvement. Remember, in general, surgery improves sags and bags, peeling improves the wrinkles.
Where Surgery Can Be Completed
Laser surgery and the chemical peel procedure can be completed at either of the mentioned surgical facilities as an outpatient. Frequent visits to the office will be required in the first two weeks so that I may closely monitor your healing process.
WHY CHOOSE DR. FEDOK?
- Immediate-Past President of the American Academy of Facial Plastic and Reconstructive Surgery
- 30+ Years of Experience
- Facial Plastic Surgery Specialist
- High Expertise
- Individualized Care