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
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
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
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.
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
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.
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
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
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
Remove all make-up
and nail polish before arriving for your
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.
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
- 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
- Start swelling medication (Medrol Dosepak)
when you arrive home and at bedtime. Then follow
package directions. Take with food.
- Take Vitamin C (ascorbic acid), which helps
promote healing, for two weeks following
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
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.
1) What is skin resurfacing?
Skin resurfacing is the removal of the outer layer of
the skin - using abrasion, chemicals or a laser -
resulting in smoother and less wrinkled skin.
2) What's the difference between laser,
dermabrasion, and chemical peel?
- Chemical Peels
Applying acid solution removes the top layers
and allows smoother regenerated skin to emerge.
Chemical peels, which can be used alone or in
combination with other skin resurfacing, can be
effective on fine wrinkles caused by sun damage,
superficial skin color changes such as age spots
and signs of premature aging such as the fine
lines around the eyes. Chemical peels can be
used alone or in combination with other skin
Chemical peels offered range from mild no downtime
peels to moderate TCA (trichloroacetic acid peels).
Dermabrasion is a facial sanding technique used
to treat deep scars and wrinkles, raised scar
tissue, and some severe cases of cystic acne.
Top layers of skin are "sanded" with a
high-speed rotating brush or a diamond-coated
Sometimes people get confused between dermabrasion
and microdermabrasion. Dermabrasion, which is considered
a surgical procedure, is typically more effective on
raised scar tissue, acne and chicken pox scars and some
of the deeper forehead wrinkles. Dermabrasion can be
used alone or in combination with other skin resurfacing
Microdermabrasion is a mini-peel achieved by
projecting aluminum micro-crystals onto the skin. "Power
Peel", "Euro Peel", "Parisian Peel" and "Derma Peel" are
all forms of microdermabrasion. Microdermabrasion is
safe for all skin types.
- Laser Resurfacing
A laser is a high-energy beam of light that
selectively transfers its energy into tissue to
treat the skin. Laser light beams vaporize the
top layers of skin to lessen the appearance of
wrinkles, scars and birthmarks or to generally
resurface facial skin. Laser resurfacing can be
used alone or in combination with other skin
Lasers make it possible to change tissue without
making an incision. Lasers can be used to vaporize
tumors, close blood vessels, selectively reduce
pigmentation, or even treat skin wrinkles. Dr. Lopez can
treat birthmarks or damaged blood vessels, remove
port-wine stains, and shrink facial "spider veins"
without major surgery.
After Dr. Lopez has indicated that a laser can be
helpful in the surgery, he will explain the laser of
choice and what can be accomplished. Dr. Lopez will
decide on the appropriate method, dictated by the nature
and extent of the surgery. Dr. Lopez will give you his
best judgment for the particular procedure.
3) Are there different kinds of lasers?
Yes. It is important for you to realize that lasers have
specific applications. The choice of the laser depends
upon many factors, including the surgeon's experience,
acceptable healing time, the size of the area to be
treated, and the expectations of the patient. Dr. Lopez
will decide if a laser is appropriate, and which laser
is best for the situation.
4) Which laser is best for me?
The only way to know for sure is a consultation with a
board certified facial plastic surgeon such as Dr. Lopez
that specializes in all of the above skin resurfacing
techniques. It is not uncommon to use a combination of
approaches to achieve an optimal result. At the time of
your consultation Dr. Lopez will examine your skin to
assess factors that could affect the outcome of the
surgery and to determine the proper procedure for your
For example, a patient who wants improvement in the
lines around the lips might benefit from a simultaneous
procedure of laser resurfacing and dermabrasion. A
patient with acne scars may achieve the best result with
optimal blending from a full-face laser combined with
dermabrasion of the deepest acne scars and a TCA peel of
the neck. The choice of which approach is right for you
depends on many factors including the nature of the
defect (traumatic scar, premature aging, pigmentary
changes, acne scarring, etc.), the anatomical location,
skin type, medical history and more.
5) What can you treat with laser surgery?
Facial plastic surgeons are experienced in the use of
the laser and are the best source of information as to
whether laser surgery is appropriate for your condition.
Here are a few applications for lasers.
- Laser Skin Peeling
Lasers can be used to reduce wrinkles around the
lips or eyes, even the entire face, softening
fine wrinkles and removing certain blemishes on
- Laser Removal of Birthmarks and Skin Lesions
- Port-wine stain birthmarks respond
remarkably well to laser treatment. The abnormal
blood vessels that cause these marks are reduced
in size by the laser. This results in a
lightening of the treated area. Skin growths,
facial "spider veins," warts and some tattoos
respond to laser surgery. Most situations take
more than one laser treatment, however some
respond to a single treatment.
Dr. Lopez often uses the minimum laser intensity
possible. The low intensity requires many treatments.
However, the low intensity also preserves as much of the
healthy tissue as possible. This produces an
aesthetically pleasing result and minimizes the recovery
6) Why isn't all surgery performed with lasers?
Many procedures can achieve the best results only with
the use of laser. Likewise, some procedures are better
performed without the laser. The laser is not always the
best tool for surgery. The choice of using a laser or
other surgical methods is carefully made Dr. Lopez, who
has to consider the results, the possible complications
and the alternatives. Always remember that there are
very few "right" and "wrong" answers with laser surgery.
7) Will laser skin resurfacing help with my deep,
pitted acne scars?
It depends on the scars. Sometimes combining a full face
laser resurfacing with dermabrasion of the deepest acne
scars is the best approach. Other times, resurfacing by
itself is not enough. Preparatory surgery such as scar
excision or the use of fillers such as fat injections
prior to dermabrasion may be needed to achieve an
optimal result. Excision of multiple deep, pitted acne
scars may be performed over several sessions. These must
be evaluated on an individual basis.
8) Will laser surgery lift my sagging skin?
Laser and all skin resurfacing techniques are employed
to change the surface texture. Laser resurfacing is not
performed to correct sagging skin.
9) What kind of results can I expect from laser
It depends on what we're working with and what the
patient is trying to achieve. Laser is not a perfect
science. Even in the best of hands, one can not expect
100% improvement. However, after reviewing realistic
expectations, most surgical outcomes make patients very
10) When will I look "normal" after laser
You will be presentable at one to two weeks. You may put
make-up on two weeks following laser surgery and resume
most all daily activities. The lasered areas are quite
pink and this pinkness lasts for eight to twelve weeks.
You will look great at three months and even better at
six months. Your final result is evaluated at one year.
11) Does my history of a cold sore on my lip affect
my laser resurfacing?
Cold sores are actually a viral infection. All patients
are pretreated with an antiviral medication to prevent
the recurrence and spread of cold sores while the
lasered area heals.
12) Can you laser all skin types?
Yes! However, careful selection for blending reasons
must be done. Some patients can very easily be more
prone to post laser hyperpigmentation (variations in
skin color). This can be managed with bleaching creams
and agents, however, sun avoidance and judicious use of
sunscreen is most important.
13) Will I still look like "me" after surgery?
Many of my patients report that when they return to
their normal life, their friends comment, “You look
great. Are you getting more sleep?" or "You look less
stressed and tired”. Dr. Lopez will not change the way
you look, just enhance it.
14) Will laser resurfacing get rid of these deep
frown lines between my eyes?
Several modalities exist to treat frown lines, one of
which is laser. Some patients opt for a less invasive
treatment such as Botox or fillers, which achieve
temporary results. Other patients want more permanent
correction such as a browlift with permanent treatment
of those muscles that cause the deep frown lines.
15) Will I be awake during laser resurfacing?
For most patients, a limited anatomical area such as
around the mouth (perioral) or one or two scars,
patients remain awake. For full-face skin resurfacing,
patients are generally asleep.
16) How much pain will I have with laser resurfacing?
Understandably, after any surgical procedure, some
discomfort can be expected. All patients are provided
with prescriptions for pain medication. Pain is well
managed with medications. Patients who undergo full face
skin resurfacing complain much more about wanting to
have a clean face and keeping the face moist with
ointments or dressings than they do about pain.
17) What does it feel like after surgery?
It depends on the amount of skin resurfacing you have
done. Lasered skin is covered with a moist jelly-like
dressing. Patients complain more about wanting to wash
their face than discomfort. If you are asleep for the
procedure, our nurses will be right by your side as you
wake up to attend to any needs you have.
18) Do I go home after surgery?
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.
19) How long will pinkness and swelling last?
Postoperative swelling begins to resolve at the end of
the first week. Full resolution of swelling may take two
to three weeks. The pinkness associated with skin
resurfacing can last six to eight weeks. For that
reason, patients use make-up to camouflage the pinkness
until it settles.
20) How long should I stay in San Antonio following
Most patients stay in San Antonio about seven to ten
days following surgery. After that it's ok to fly or
travel long distances.
21) When can I return to work?
Most of Dr. Lopez’s patients take about two weeks off of
work. After two weeks, most of the residual bruising and
swelling can easily be camouflaged with make-up.
22) When can I exercise?
Dr. Lopez prefers that aerobic activities be avoided for
two weeks after surgery. In addition, heavy weight
lifting or more strenuous workouts should be avoided for
three weeks postoperatively. It is extremely important
to avoid bending, lifting or straining during the early
postoperative period as these activities can increase
swelling and delay healing.
23) Will I bruise and swell afterwards and how long
will it last?
Unfortunately it is impossible to do surgery without
causing swelling. Dr. Lopez does everything possible to
minimize the amount of swelling that occurs. Generally,
postoperative swelling begins to resolve at the end of
the first week. Bruising is extremely variable. Patients
that have a tendency to bruise will generally bruise for
about 10 days. Patients that don’t tend to bruise may
have minimal if any bruising. Complete resolution of
bruising and swelling may take two to three weeks.
However, bruises may be camouflaged fairly easily at
seven to ten days with a concealer stick.
LASER RESURFACING PREOPERATIVE INSTRUCTIONS
24) Should I do anything before to prepare for
You will have a preoperative appointment with Dr. Lopez
and his staff to go over the preoperative instructions.
25) Why do I need a preoperative appointment?
This is an essential appointment to prepare you for your
upcoming surgery. Dr. Lopez will take preoperative
photographs at the visit as well as go over the
procedure again to ensure that everyone is on the same
page. All questions that you have will be answered on
that visit as well. You will often times be given your
prescriptions on the preoperative visit day.
26) What else can I do to do to prepare for surgery?
Dr. Lopez likes to have patients that have well
controlled blood sugar to drink three eight ounce
glasses of pineapple juice for at least one week before
surgery. Pineapple juice can help minimize the
postoperative swelling. Patients that use tobacco will
be asked to stop for six weeks before and six weeks
following surgery. Tobacco has properties that impede
wounds from healing. Dr. Lopez will encourage tobacco
users to not resume smoking at all after surgery; in
fact many of his patients have used the surgery as their
impetus to quit smoking.
27) What about my daily medications before surgery?
In general you will be allowed to take most of your
daily medications. Medications that thin the blood such
as ibuprofen, vitamin E, and herbal supplements need to
be stopped two weeks before surgery. You can continue
to take a multivitamin. Aspirin needs to be stopped
three weeks before surgery. Dr. Lopez will provide a "Medication
List" that reviews all medications and supplements
to avoid prior to surgery.
28) Do I need any special prescriptions before
Dr. Lopez will generally give you a prescription for an
antibiotic, a pain medicine, antibiotic ointment, as
well as an anti-swelling medication. Dr. Lopez does
prefer patients to start Arnica, a natural herbal
substance, the day before surgery on order to minimize
bruising. He also asks you to start Vitamin C before
surgery. You will also be placed on an antiviral
medication to start the day before your surgery.
LASER RESURFACING POSTOPERATIVE INSTRUCTIONS
29) What should I expect after laser surgery?
After the surgery, you will probably experience some
swelling and skin redness for several days. Antibiotic
ointments may be used during the healing process. It is
important for you to follow all the post-operative
directions, particularly in using sunblock and avoiding
30) What do I look like when I wake up from surgery?
Following the procedure, you will have a soft head wrap
around your head and under your chin. This helps
31) What does it feel like when I wake up from
Most patients report only mild to moderate discomfort,
which may be associated with some numbness, itching,
tightness or a pulling sensation. These postoperative
symptoms subside with time. We will make sure you are
not nauseated or queasy. Our nurses will be right there
with you as you wake up from surgery to give you special
32) Tell me more about the treated area after laser
Dressings vary depending on the size of area that is
lasered. You will notice a gel like substance on the
dressings that we will change for you the day following
the procedure. You will be asked to switch to an
ointment about three days following surgery. You will be
asked to return to the office about seven days from the
surgery date for evaluation of healing and to switch to
a moisturizer with sunscreen. It is uncommon for
patients to complain of significant pain.
33) What medications do I take following surgery?
Dr. Lopez will ask you to take the following medications
starting the day of surgery:
1- An antibiotic - generally Keflex for one week
2- Pain medicine - Vicodin or Percocet to take as
3- Antibiotic ointment- to place on the incision sites
at least three times a day
4- Antiswelling medication- for patients that are not
diabetic a Medrol dosepak will be given
5- Vitamin C for one week following surgery to promote
6- Arnica- place under the tongue three tabs three
times a day before meals for two weeks.
7- Antiviral medication- generally Valtrex which is
started the day before surgery and is
taken for two weeks
34) When do I start taking these prescriptions?
Patients take their pain medication as needed. Begin
taking vitamin C one week before surgery. You can begin
taking Arnica and Valtrex the day before surgery. The
antibiotic and swelling medications begin when you
arrive home following surgery. Unless you are notified
otherwise, resume all daily medications when you arrive
home from surgery.
35) When can I shower?
As long as you keep your head dry, you may bathe at any
time following the procedure. Approximately two days
following laser surgery, one may shower and gently wash
36) Are there any food to avoid following surgery?
No. Dr. Lopez encourages you to eat a well-balanced
diet. You may notice that saltier foods can cause you
to swell for a longer period of time.
37) When is my first postoperative appointment?
You will be asked to see Dr. Lopez the next day
following laser surgery for removal of head wrap. You
will need someone to drive you to this appointment.
38) Are there any instructions about regular daily
Sleep with head of the bed elevated or use two to three
pillows for one week. Facial fullness, headache and
disrupted sleep are very normal postoperative symptoms
and will decrease as the healing process occurs.
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.
39) How long does healing take?
The full impact of the laser may not be apparent for a
month or two, especially with vascular deformities.
Healing and evaluation of the final result takes one
full year. However, after three months, most patients
have about 90% of their final result.