Traitement des rides/cicatrices par le resurfaçage au Laser

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

What Is Laser Skin Resurfacing?

• Using a special scanner attached to a carbon dioxide laser, your dermatologist can delicately exfoliate your skin accurately layer by layer.
• The superficial layer of skin is removed and the deeper layer of skin is exposed. Here collagen is stimulated and a new layer of skin is formed over a period of time.
• With this precise control over the interaction between the laser energy and the skin, bleeding is eliminated and scarring, generally associated with other wrinkle treatments, is significantly reduced.

What Are The Indications For Laser Skin Re-Surfacing?

• Fine lines and wrinkles around the eyes and mouth
• Acne, traumatic, chicken-pox and surgical scars
• Deep laugh and frown creases.
• Photodamaged skin.
• Miscellaneous lesions and conditions.

Is Laser Skin Re-Surfacing Suitable For Me?

• Your dermatologist will record your medical history, age, skin type (including pigmentation) and desired results into consideration to determine whether you are a suitable patient for Laser Skin Res-surfacing.
• Be sure to mention any past or present viral infection, sun sensitivity, drug (eg. roaccutane) used within the past year, problem with wound healing or prior chemical peels or dermabrasions to your dermatologist.

How Many Time Must I Come For Skin Re-Surfacing Procedure?

• This depends on the type and depth of the wrinkle or scar you have. One or more treatment sessions may be required.

When Can I Do My Laser Skin Re-Surfacing?

• Your dermatologist will usually schedule a test patch (about 3 cm in diameter) for you before conducing the full laser skin re-surfacing.
• The reason why a test patch is done is to ascertain the risks of hyperpigmentation and scarring you may have.

When Can I Do My Full Laser Re-Surfacing?

• If all goes well with the test patch (allowing 6 – 8 weeks postoperatively to look for adverse effects), and you remain committed to have the laser treatment, your dermatologist will schedule you for full laser re-surfacing.
• The whole procedure usually take less than 1 hour.
• You can expect to go home immediately after treatment.

How Long Does It Take For The Laser Wound To Heal?

• Following the laser re-surfacing procedure you may expect, slight swelling and redness on the treated sites.
• The initial redness fades in a few weeks to light pink, which can be easily camouflaged with cosmetics. The redness usually disappears completely in one to three months for most patients.
• Generally patients enjoy a short recovery time after laser skin re-surfacing.

When Can I Return To Work?

• You can return to work as soon as you feel comfortable.
• Most patients prefer to wait until their laser-treated area can be covered with cosmetics (usually by day 7) before returning to work.

Are There Special Precautions To Follow After The Laser Re-Surfacing Treatment?

• It is important to avoid direct sun exposure for several months following the laser treatment.
• Your dermatologist will advise you to use a sunscreen.
• Some patients may experience transient hyperpigmentation (increased pigmentation) or hypopigmentation (decreased pigmentation) on the laser treated areas. These pigmentary changes usually resolves in several months.

What Type Of Anaesthesia Do I Need?

• Local Anaesthesia

1. Usually you will need local anaesthesia for laser skin re-surfacing treatment.

• Topical Anaesthesia

1. Some patients will need topical anaesthesia only.
2. Topical anaesthetic cream applied under occlusion 1 – 2 hours prior to the laser re-surfacing treatment may provide pain relief during the treatment (non injection is needed).

Instructions For Skin Care After Laser Skin Re-Surfacing

You have been treated with carbon dioxide laser skin re-surfacing. The treated skin is very delicate and should be treated with care.

• Care of the Treated Skin

1. Keep the dressing on the treated skin dry for 24 hours following the laser skin re-surfacing treatment.
2. Remove the dressing 24 hours later:
3. For test patch only: you can do your own cleansing and change the dressing at home.
4. You may be asked to come back to the Clinic the next day to change your wound dressing.
5. If the wound dressing is stuck to the wound, soak the dressing in saline solution to loosen it. DO NOT forcibly tear away the dressing.
6. Clean the wound with cotton balls soaked with the prescribed cleansing solution. Apply gentle pressure and clean the laser wound and the edges of the laser wound thoroughly.
7. Remove all crusts, and scabs by soaking them with the cleansing solution.
8. After cleaning the laser wound, dry the wound with sterile gauze.
9. Apply the antibiotic ointment prescribed to you with cotton applicators.
10. Cover the wound with non-adherent dressing provided. Secure the dressing with tape.
11. Apply antibiotic ointment to the treated area 1 or 2 or more times (as instructed by your dermatologist) daily for 7 days or until the skin surface is completely healed.
12. You may experience some discomfort and pain immediately after the laser re-surfacing treatment. For adults take two tablets of paracetamol every six hours for pain (make sure you are not allergic to it.)
13. If swelling occurs on the treated skin apply an ice pack wrapped in a soft cloth over the wound dressing.

• Precautions To Take Following Your Laser Skin Re-Surfacing Treatment

1. Avoid direct exposure to sunlight.
2. DO NOT rub, scratch or pick at the treated skin.
3. DO NOT apply cosmetics until the crust/scabs on the wound have disappeared.
4. Avoid swimming and contact sport before the laser wound heal.
5. If the laser treated skin shows signs of infection (e.g. presence of pain, redness, swelling or pus), notify your dermatologist or the Nurse-in-charge of the Operating Theatre at the National Skin Centre immediately.

What To Expect After Laser Skin Re-Surfacing Treatment Of My “Wrinkles”?

• Wrinkles are removed by destroying and removing the top layer of skin.
• When the skin laser wound heals, it becomes tightened and the wrinkles line disappear or become less prominent.

What Are The Side Effects And Possible Complications Of Laser Skin Re-Surfacing Treatment?

• Pain

1. You may fee mild pain during the laser skin re-surfacing procedure.

• Laser Wound Healing

1. Laser treatment cause a superficial burn on the surface of the skin which takes several days to heal.
2. This is associated with some skin swelling, oozing and crusting on the treated skin.
3. It usually take 4 – 10 days for the skin to heal.

• Erythema (Redness)

1. Redness is usual and should not be regarded as a complication of laser treatment.
2. It typically last 2 – 3 months and can be camouflaged with cosmetics.

• Hyperpigmentation (Increased Pigmentation) (Post-inflammatory hyperpigmentation)

1. Hyperpigmentation following laser treatment is most often seen in patients with dark skin colour tones but it can occur in patients with light colour skin tone.
2. Pigmentation may be minimized by applying a bleaching cream prescribed by your dermatologist.

• Milia and Acne

1. Milia and acne may occur, especially if occlusive ointments are used after laser treatment.

• Herpes Simplex Infections

1. Herpes simplex infections can occur in patients who had a past history of cold sores. You should report any signs of herpes simplex infections (presenting as blisters and erosions) to your dermatologist immediately.

• Scarring

1. The risk of scarring may be increased in patients who have recently been treated with oral retinoids (e.g. roaccutane). It may occur in those who develop secondary bacterial infection after laser treatment.
2. Secondary bacterial infection may occur if the laser wound is not properly cleansed and dressed.
3. Consult your dermatologist immediately if there is any signs of scarring or bacterial infection.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

National Skin Centre. Singapore