Some patients with active lifestyles have skin that’s been overexposed to sun and wind, while others are genetically predisposed to early signs of aging. Many patients want to eliminate crow’s feet and superficial face lines and wrinkles around the eyes. Some are looking for improvements in the fine lines around the mouth and others are looking to remove “age spots,” pigmentary changes in the skin. One of the most common requests we hear is “for the outward appearance to reflect the more youthful energy I feel inside.” Patients who request one or any combination of these improvements are seeking information about skin resurfacing.
Skin resurfacing is the removal of the outer layer of the skin – using abrasion, chemicals or a laser – uncovering a more youthful beauty hidden just underneath the surface. The best way to see what skin resurfacing can accomplish is to look at before and after photos. Skin resurfacing is performed to restore a more youthful appearance and less fatigued look.
At your initial consultation, Dr. Lopez will thoroughly evaluate your bony and soft tissue anatomy as well as the form and function of your face and neck. An overall assessment of the face provides the basis for what one may expect from skin resurfacing. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of cosmetic surgery. Dr. Lopez uses a variety of resurfacing techniques that he individualizes to each patient.
As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and routines is essential to a successful final result. Following your consultation we continue our discussion at the preoperative appointment.
At your preoperative appointment Dr. Lopez will provide all the instructions for you to follow before and after surgery. Patients who have only a limited anatomical area (such under the eyes) resurfaced remain awake. For full-face skin resurfacing, patients are generally asleep. Surgery time estimates depend on the size of the area we are addressing, therefore surgery estimates are variable. If you are having a combination of procedures your surgery will take longer. Recovery time from the anesthetic takes about an hour and you will be discharged about four hours from the time of admission.
PREOPERATIVE SKIN RESURFACING INSTRUCTIONS
- Please avoid any aspirin, aspirin-containing products, or ibuprofen (Advil, Aleve, etc.) for two weeks prior to and two weeks following your surgery. See our “Medication List” for products to avoid prior to surgery. If you are on any medications that affect bleeding (such as coumadin or warfarin) please notify the office immediately.
- Please refrain from tobacco products for six weeks and alcohol for one week prior and three weeks following surgery. Along with delayed wound healing, persistent skin redness and other complications may persist when tobacco and alcohol are not discontinued.
- Please notify us of all routine medications and significant health history. We ask that you remain on your daily medications unless instructed otherwise. At the preoperative appointment you will be told which daily medications to take with just a sip of water on the morning of surgery.
- At your preoperative appointment you will be given prescriptions for use following surgery including an oral antibiotic, antiswelling medication, antibiotic ointment and pain medications. Please obtain these prescription medications before your surgery so you will have them ready for use when you return home after surgery.
- We will ask you to take Arnica, a natural herb that significantly decreases bruising, before and after surgery. We will also ask you to take Vitamin C (ascorbic acid), which helps promote healing, before and after surgery.
- You may not eat or drink after midnight the evening before the procedure unless instructed otherwise. You may brush your teeth. Your procedure will be cancelled if you do not follow these instructions.
- Remove all make-up and nail polish before arriving for your procedure.
- Someone will need to drive you home after your surgery and stay with you that evening. Transportation to the office for dressing removal the day following surgery is also required.
When you wake up from surgery you may notice a soft, bulky dressing. This dressing is covering a moist gel-type dressing underneath. Following your skin resurfacing, it is common for the skin to “weep” as the old skin exfoliates and the new skin reappears. The soft bulky dressing will catch this drainage. Our nurses will be there when you awaken to assist you in meeting the discharge criteria: to drink liquids, walk with a steady gait, void and manage your discomfort. The nurses will review all instructions you will need for care following your skin resurfacing.
Skin resurfacing is done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment. Patients having surgery must stay in the immediate San Antonio area overnight.
You will be asked to see Dr. Lopez the following day after surgery for a dressing change. Although most patients describe this first dressing change as relief rather than discomfort, you are encouraged to take your pain medication about an hour prior to arrival. At this visit we will teach you how to change the dressing yourself the next morning. Changing the dressing yourself allows you to take a much-anticipated shower between dressing changes. You will be asked to discontinue the dressings on postoperative day three and switch to ointment at that time. You will return to the office on approximately postoperative day seven when we will often change the wound care from the application of ointment to a moisturizer with sunscreen.
POSTOPERATIVE SKIN RESURFACING INSTRUCTIONS
Keep dressing dry and intact the evening after surgery. Notify Dr. Lopez if the dressings become loose or fall off. If the dressing should fall off, cover the skin with the recommended ointment until you see Dr. Lopez for your first appointment. We will replace the dressing and review instructions for changing from dressing to ointment, most commonly on postoperative day three. It is uncommon for patients to complain of significant pain with dressing change.
- Most patients complain of discomfort more than pain. Use pain medication (Vicodin) as directed/as needed. Vicodin contains Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.
- Start your antibiotic (Keflex) when you get home and one at bedtime. It is not uncommon to have a low-grade fever for 24 hours following surgery.
- Take Vitamin C (ascorbic acid), which helps promote healing, for two weeks following surgery.
We will also ask you to take Arnica, a natural herb that significantly decreases bruising.
- You will begin taking the antiviral medication, Valtrex, as directed the day before surgery. If you have a history of herpes exposure you will take 1000 mg three times a day for two weeks, if you do not have a history of herpes then you will take 500 mg two times a day.
Advance diet from liquids to soft food (oatmeal, French toast, yogurt, soup, pasta) to your regular diet as tolerated. You have no diet restrictions. Often the anesthesia you received can make your stomach feel uneasy for the first 24 hours so avoid large meals.
Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. 7-10 days off work is recommended.
Bruising can be camouflaged at two weeks postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. It is ok to apply sunscreen, cosmetics or facial creams two weeks after surgery. Avoid unprotected prolonged sun exposure for three months following facial resurfacing to prevent pigmentation changes.
Following facial resurfacing, it takes time for the swelling to subside and for the skin to heal. Most patients return to work two weeks following surgery, depending on the degree of privacy one is trying to maintain. At three weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.
Final results following facial resurfacing are not apparent for one full year following surgery. Dr. Lopez will want to see you 3, 6 and 12 months after the surgery to sure that you are healing as anticipated.