Cosmetic Laser Surgery, Is It For You?

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A High-Tech Weapon in the Fight Against Aging Skin

In recent years, lasers have shed their science fictional image to become a surgeon's and dermatologist's most promising weapon in the fight against aging skin. According to the American Academy of Cosmetic Surgery in Chicago, nearly 170,000 Americans, men and women, underwent laser resurfacing of the face in 1998, up from 138,891 in 1996--a 64 percent increase. That's nearly twice the number of the more traditional surgical facelifts performed in the same year.

Laser resurfacing is a very controlled burning procedure during which a laser vaporizes superficial layers of facial skin, removing not only wrinkles and lines caused by sun damage and facial expressions, but also acne scars, some folds and creases around the nose and mouth, and even precancerous and benign superficial growths. In a sense, the laser procedure creates a fresh surface over which new skin can grow.

While the Food and Drug Administration does not regulate how surgeons carry out these procedures, it is responsible for clearing lasers for marketing for the uses requested by the device's manufacturer.

Lasers in Cosmetic Surgery

Since their 1958 discovery, lasers have become a powerful industrial tool, but their applications in medicine have been truly revolutionary. One reason, says Richard Felten, a senior reviewer in FDA's Center for Devices and Radiological Health, is that lasers used as surgical tools can cut through tissue without causing excessive bleeding. In fact, lasers actually can coagulate tissue to stop bleeding. "That's something a knife can't do," Felten says. Also, for many internal procedures, surgeons can get the laser's energy to reach areas within the body more easily than with a scalpel. And finally, the wavelengths of the laser light itself lets surgeons use the device selectively on very specific types of tissues, such as port wine stains or hair follicles, without affecting nearby tissue.

But using lasers for facial skin resurfacing was discovered almost by accident, Felten says. In the course of treating acne scars with a laser, surgeons noticed that after resurfacing the skin around the scar to make the scar less visible, small adjacent wrinkles were greatly diminished.

Collagen is the principal protein of the skin, tendons, cartilage, bone and connective tissue. It is a key fibrous protein in the skin's connective tissue, and it helps give the skin its texture. Natural aging and such factors as sun damage and smoking help break down the collagen layer so that the skin's once smooth surface develops wrinkles. New, more youthful collagen actually forms after laser treatment.

Lasers cannot rejuvenate skin on other parts of the body nor can laser treatment lift or remove sagging jowls or smooth out "crepey" or sagging neck skin. These conditions only respond to traditional cut-and-stitch surgical methods.

Is Resurfacing for You?

Not everyone makes an ideal candidate for laser resurfacing, Perkins explains. "Certain people with very sensitive skin cannot tolerate the medications and lubricants used on the skin during healing." Perkins also feels that the darker-skinned ethnic groups are not candidates because the laser treatment alters the color of skin too dramatically and unpredictably. Alster, on the other hand, believes that in the hands of a very experienced surgeon, people with darker skin tones, although not ideal candidates, can benefit from surgery.

Dr. Tina Alster, director of the Washington Institue of Dermatologic Laser Surgery, however, warns anyone not mentally prepared for resurfacing or who expects instant results is not a good candidate "This is not easy in-easy out surgery," she says. "Potential patients have to realize that there will be bruising and swelling and they will be holed up in the house for seven to 10 days," she says. "They will have a crusty, oozy, bruised, scabbed, raw-appearing face." Further, they should not expect unflawed skin. "I can't deliver that," she says. "I am not able to give unlined, unscarred skin." Patients, however, can expect a 50 percent or greater improvement.

They must also plan on at least 10 days of healing before applying any makeup. For satisfactory healing, that means following rigorous after-care treatment, including proper skin cleansing, the application of a skin lubricant, and the frequent changing of dressings.

What Are the Risks?

As with any medical procedure, patients may experience certain complications--most temporary--including a prolonged redness of skin, tenderness, easy flushing, and some pigmentary changes, like hyperpigmentation, when the skin appears darker than normal, says Rox Anderson, M.D., director of the Laser Center at Massachusetts General Hospital in Boston.

Other risks are more serious, and possibly permanent, including hypopigmentation, or lightening of the skin. "Somewhere between one to two years after treatment it becomes clear that there is a permanent lightening of the skin color where the resurfacing was done," he says.