eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Cosmetic Surgery

Skin Resurfacing: Laser Surgery: Follow-up

Author: Neil Tanna, MD, Staff Physician, Division of Otolaryngology-Head and Neck Surgery, George Washington University Medical Center
Coauthor(s): Steven B Hopping, MD, FACS, Clinical Professor of Surgery, George Washington University Hospital; Director, Center for Cosmetic Surgery
Contributor Information and Disclosures

Updated: Mar 21, 2008

Future and Controversies

BOT is a useful adjunct to LSR for hyperdynamic facial lines such as crow's feet. These lines are furrows caused by the repeated pull on the skin of underlying facial mimetic muscles and are differentiated from rhytides, which are caused by age-related dermal laxity and gravity. BOT temporarily paralyzes such muscles. The authors have had excellent results with combined treatment of interbrow furrows (corrugator muscles) and crow's feet (orbicularis oculi muscles). As explained to patients, the laser works on the skin part of the problem, and the BOT works on the muscle component.

Transconjunctival blepharoplasty (TCB) and periorbital LSR surfacing are an excellent combination because they address the 2 most common problems of the aging lower eyelid: TCB for pseudoherniated fat and LSR for mild skin laxity. Because the skin-muscle complex is undisturbed during a retroseptal TCB, immediately resurfacing the lower eyelid skin is safe. Similarly, performing forehead LSR concurrent with subgaleal or subperiosteum browlift procedures (eg, endoscopic browlift) is safe. The author does not perform concurrent LSR on skin that has been incised, such as after a traditional upper eyelid blepharoplasty.

The combination of rhytidectomy and LSR is another excellent option. Appropriate patients are those with severe facial elastosis, poor dermal recoil, and actinic damage. The author prefers to accomplish the facelift first followed by the laser resurfacing at 3-4 months. This practice allows the physician to laser resurface the rhytidectomy scars. Resurfacing of newly undermined skin (eg, as with non–deep plane approaches) is risky because full-thickness skin loss may result.

The clinical effects of LSR, thought primarily to result from heat-induced immediate collagen tightening and initiation of a wound-healing response to injury, may result, in part, from cytokine secretion at the cellular level. In 2000, Nowak et al evaluated the effect of pulsed carbon dioxide laser energy on keloid and normal dermal fibroblast secretion of growth factors in an in vitro model.

At a fluence of 4.7 J/cm2 (commonly used in LSR), secretion of basic fibroblast growth factor (bFGF) was stimulated and that of transforming growth factor beta-1 (TGFB1) was inhibited in both keloid-producing and normal dermal fibroblasts. The known ability of bFGF to promote organized collagen bundles may account for the observed clinical and histologic effects with LSR.

In addition, the inhibition of TGFB1, which causes tissue fibrosis, may have a protective role in minimizing scar production during the healing process. The laser can be considered a biostimulator that initiates a wound healing response. Research into precisely controlling the wound healing response with different sources of biostimulation will change the way skin surgery is performed.

 


More on Skin Resurfacing: Laser Surgery

Overview: Skin Resurfacing: Laser Surgery
Treatment: Skin Resurfacing: Laser Surgery
Follow-up: Skin Resurfacing: Laser Surgery
References
[ CLOSE WINDOW ]

References

  1. West TB, Alster TS. Effect of pretreatment on the incidence of hyperpigmentation following cutaneous CO2 laser resurfacing. Dermatol Surg. Jan 1999;25(1):15-7. [Medline].

  2. Alster TS. Cutaneous resurfacing with CO2 and erbium: YAG lasers: preoperative, intraoperative, and postoperative considerations. Plast Reconstr Surg. Feb 1999;103(2):619-32; discussion 633-4. [Medline].

  3. Alster TS. Side effects and complications of laser surgery. In Alster TS: Manual of Cutaneous Laser Techniques, ed 2. Philadelphia, Lippinco. 2000;pp 175-187.

  4. Alster TS, Lupton JR. Treatment of complications of laser skin resurfacing. Arch Facial Plast Surg. Oct-Dec 2000;2(4):279-84. [Medline].

  5. Newman JP, Koch RJ, Goode RL. Closed dressings after laser skin resurfacing. Arch Otolaryngol Head Neck Surg. Jul 1998;124(7):751-7. [Medline].

  6. Nowak KC, McCormack M, Koch RJ. The effect of superpulsed carbon dioxide laser energy on keloid and normal dermal fibroblast secretion of growth factors: a serum-free study. Plast Reconstr Surg. May 2000;105(6):2039-48. [Medline].

  7. Utley DS, Koch RJ, Egbert BM. Histologic analysis of the thermal effect on epidermal and dermal structures following treatment with the superpulsed CO2 laser and the erbium: YAG laser: an in vivo study. Lasers Surg Med. 1999;24(2):93-102. [Medline].

  8. Walsh JT Jr, Flotte TJ, Anderson RR. Pulsed CO2 laser tissue ablation: effect of tissue type and pulse duration on thermal damage. Lasers Surg Med. 1988;8(2):108-18. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

laser skin resurfacing, LSR, laser abrasion, laser skin rejuvenation, cosmetic skin resurfacing, laser surgery, skin resurfacing, photodamaged skin, rejuvenated skin, collagen production, laser surgery, Er:YAG, Er:YAG laser

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Neil Tanna, MD, Staff Physician, Division of Otolaryngology-Head and Neck Surgery, George Washington University Medical Center
Neil Tanna, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Medical Society of the District of Columbia
Disclosure: Nothing to disclose.

Coauthor(s)

Steven B Hopping, MD, FACS, Clinical Professor of Surgery, George Washington University Hospital; Director, Center for Cosmetic Surgery
Steven B Hopping, MD, FACS is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society of Lipo-Suction Surgery, and Medical Society of the District of Columbia
Disclosure: Nothing to disclose.

Medical Editor

J David Kriet, MD, FACS, Associate Professor, Department of Otolaryngology-Head and Neck Surgery, Director of Facial Plastic and Reconstructive Surgery, University of Kansas School of Medicine
J David Kriet, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, AO Foundation, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Keith A LaFerriere, MD, Clinical Professor, Fellowship Director, Department of Surgery, Division of Otolaryngology, University of Missouri at Columbia
Keith A LaFerriere, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, and Missouri State Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Advanced Headache Intervention Consulting fee Consulting; Covidien Corp Consulting fee Consulting

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.