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.

BEFORE SKIN RESURFACING SURGERY

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

AFTER SKIN RESURFACING SURGERY

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

Wound care

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.

Medications

Diet

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.

Activity

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.

Final Result

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.

FREQUENTLY ASKED QUESTIONS

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 offered range from mild no downtime peels to moderate TCA (trichloroacetic acid peels).

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 techniques.

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.

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 condition.

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.

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 time.

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 resurfacing?
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 happy.

10) When will I look "normal" after laser resurfacing?
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 surgery?
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 surgery?
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 surgery?
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 sun exposure.

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 minimize swelling.

31) What does it feel like when I wake up from surgery?
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 attention.

32) Tell me more about the treated area after laser surgery.
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 needed
  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 healing
  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 the hair.

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 activities?
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.