Laser Resurfacing
We, at the Texas Institute of Dermatology, offer several state-of-the art lasers for skin resurfacing and rejuvenation.
Laser resurfacing is one of the most common treatments used for skin rejuvenation, wrinkles and acne scars today. Like many things in cosmetic surgery, laser resurfacing goes by several names: wrinkle laser, laser abrasion, laser peel, laser rejuvenation, and several others. All of these terms mean the same thing: they refer to the use of the laser to treat aged skin, fine wrinkles and acne scarring.
How does it work?
Briefly, the laser beams will pass through the skin and make several microscopic holes. There is a direct relation between depth of laser penetration and its rejuvenation effect; the deeper the laser beams can go, the better the results will be. Following the laser procedure, the skin stem cells are activated to produce new collagen formation deep in the skin as well as regenerate the epithelial layer on the surface. Thus a good laser resurfacing can provide your skin a younger look.
Laser resurfacing makes it possible to remove a lifetime of sun damage and blemishes from your skin. Healthy skin and a more youthful appearance can be restored in a safe comfortable office procedure. The C02 laser was the first resurfacing laser.
How Laser Resurfacing Renews Your Skin Fractional Co2 Skin Regeneration
First, the resurfacing laser will remove all the epidermal damage caused by sun and aging. With extreme precision the laser removes keratoses, premalignant lesions, age spots, and epidermal blemishes.
Second, the upper dermis is sculpted smooth by the laser.
Deeper wrinkles are reduced or eliminated. Acne scars are reduced and re-contoured. New epidermis will grow from cells within the follicles that have never been exposed to the sun’s damage.
This takes just four to five days. Thus, your skin is literally “renewed.”
Third, the laser stimulates the growth of healthy new collagen and elastin fibers Fractional Co2 Ablationwithin the skin. This will continue for six to twelve months after resurfacing. During this time the skin will continue to improve. Fifteen to thirty percent firming can be achieved. Loose eyelids and lax skin is tightened. Resilience and elasticity are restored. Any remaining wrinkles will continue to improve for over six to tweleve months.
Laser Resurfacing: The Good News
Laser resurfacing can improve fine wrinkles and acne scars. Some lasers (the CO2 and erbium) accomplish this by vaporizing superficial damaged skin cells and allowing the stem cells to regenerate new skin. As a result, it will smooth your skin texture, improve your complexion, and possibly your skin color. Fine wrinkles will be removed and dynamic (deeper) wrinkles will be improved (see Wrinkles for an explanation of dynamic and fine wrinkles). Acne scars will appear less obvious.
The CO2 laser will also tighten your skin by two methods: a) shrinkage of the extracellular matrix that can be seen immediately after the procedure, b) the laser stimulates new collagen production.
Laser Resurfacing: The Bad News
Fractional C02 is your best option to reduce fine lines, get rid of aged spots and look about 10 years younger. Unfortunately, laser surgery is not a panacea. Your wrinkles and acne scars will improve but will not simply vanish, and more than one treatment may be required to achieve the result you desire. Because of a deeper penetration, C02 laser is more painful than AFL/IPL. Also, recovery from some laser procedures is not a snap; the redness may typically last for days (more below).
Laser Surgery: How and Why It Works?
To understand why the laser works, you must first appreciate some basics about your wrinkles and acne scars. Wrinkles and acne scars share one very important feature: they are lower than the surrounding skin. Because of this, light casts shadows in them, making them visible. Look in the mirror to convince yourself. 
You will see that everywhere there is a wrinkle or acne scar, there is a shadow. If all wrinkles and acne scars were flush with the level of the skin, the eye would not see them because there would be no shadow. Laser resurfacing works because it makes the wrinkles (acne scars) less visible by vaporizing the surrounding skin (as in the case of CO2) and by stimulating collagen production which makes wrinkles less deep (as in the case of the CO2). Because your skin is vaporized (due to the CO2 laser), it is like a burn. Your skin will be oozing and weeping for 1-2 days, since there will be lots of microscopic holes into your skin. The deeper your wrinkles and acne scars, the more treatments you will need. Shallow wrinkles and scars may be vanished with one treatment.
The FPL (Fluorescent Pulsed Light) or Intense Pulsed Light (IPL) laser is slightly different than the other two in several important ways. First, it does not actually vaporize away the top layer of the skin, so there is no open wound and no recovery period. You may put make-up on immediately and return to work. There is also no discomfort of the procedure, so you do not need to be anesthetized. IPL works by stimulating collagen formation within your skin without removing the older superficial skin layers. Therefore, one treatment with IPL is not enough. Some may notice improvement is skin texture, age spots as early as the first session. You may need 6-8 sessions to appreciate a significant difference.
Fractional or Non Fractional?
There is no doubt that Fractional C02 is less risky with much less downtime as compared to the traditional non-fractional C02. It offers a “fractional” approach to CO2 laser skin resurfacing, leaving tiny microscopic islands of untreated skin between the treated areas. As a result it can impressively repair aging, scarred, discolored and sun-damaged skin with a limited amount of downtime. The fractional Co2 is very effective in reducing lines and wrinkles, and it tightens the skin, possibly reducing the need for future tightening procedures, such as facelifts. Results of a fractional C02, done by an expert, are comparable to a traditional C02. Therefore, we at the Texas Institute of Dermatology highly recommend fractional C02 laser.
Fractional C02 Laser
Benefits of Fractional C02:
- All areas of the skin, including face, neck, hands and body can be treated
- Wrinkles, discoloration, including sun spots, brown age spots and hormonal facial discoloration (melasma) can usually be effectively treated
- The skin is tightened, reducing skin laxity and folds
- Future skin tightening procedures may be avoided or postponed
- Uneven discoloration, sometimes including areas that are too light, can be improved
- Both red and brown spots can be improved
- Precancerous lesions are reduced
- Scarring of all types including acne scarring, burn and surgical scars can be improved, sometimes quite dramatically
- Stretch marks can be improved
- Large pores and skin roughness can be improved
- Warts
- Syringoma, Sebaceous Hyperplasia and pimples around the eyes can be removed
Fractional procedures ablate discrete columns of tissue, deposit heat and promote regeneration throughout the underlying layers of the skin. Short comfortable treatments deliver the consistent results, rapid recovery and minimal downtime that patients want. We use the industry’s most versatile CO2 system available. Our fractional C02 system provides a full spectrum of resurfacing and surgical capabilities with a single-platform interface. With multiple spot sizes and delivery options, the laser offers excellence in Skin resurfacing.
The fractional CO2 laser beam heats and vaporizes the skin tissue, instantly removing the superficial layers of the skin. Each fractional micro spot creates a thermal zone. Intact cells around the treated area help during the healing process. This process induces cell regeneration. Immediate tightening and textural improvement is seeing after one week of the procedure. The result is a smoother, clearer and more youthful appearance of the skin. There is an immediate tightening. The fractional C02 removes sun spots, reduces pore size, wrinkles, acne scars via soft tissue coagulation, and other textural irregularities. There is a progressive improvement of the skin appearance due to the continued collagen production for resulting in added improvements for 6-9 months following the treatment.
Advanced capabilities and intuitive functionality of fractional C02 laser allows clinicians to deliver customized treatments with dynamic and long-lasting results.
The fractional C02 laser is used for treatment of scars, fine lines, texture, dyschromia (skin color changes) and deep wrinkles.
What is Advanced Fluorescent Light Technology (AFT) ?
Benefits of AFT:
- Smoother skin and reduced pore size
- Reduce irregular skin pigmentation
- More even skin tone
- Diminish unwanted redness
- Anti-aging (“turn back the clock”)
- Reduce acne breakouts
- Remove vascular lesions (red spots)
- Erase unwanted spider veins
- Reduce fine lines
- Improve nearly any skin imperfection
- Reduce dark hairs in light-skinned individuals
Treat many different problems:
- Rosacea
- Vascular lesions
- Cherry angiomas
- Telangiectasia
- Lentigines
- Hyperpigmentation
- Sun damage
Intense Pulsed Light (IPL), the traditional form of pulsed light, has been used for 12 years on over two million people to treat facial redness, fine wrinkles, flushing and pigmented problems on the face, neck, hands and chest. We utilize a patented form of Intense Pulsed Light technology, about which magazines often write growingly, called Advanced Fluorescent Light Technology (AFT). AFT prevents the harmful shorter wavelengths of light from hitting the skin. Instead of trying to filter out or reflect the bad light, AFT technology converts all shorter wavelengths to longer, usable, and therapeutic wavelengths. This is why our AFT laser treatments can restore a more youthful appearance to your skin with no down time, mild discomfort, and minimal risk.
The cool tip of the hand piece delivers a warm flash of bright light energy to about one square inch of skin. The device “Photo Rejuvenates” skin by shining intense bursts of light on it for a split second and delivering one flash every two to four seconds. A series of light pulses is delivered to the skin.
This bright light is scientifically tailored to cause the destruction of: unsightly and unneeded spider veins; unhealthy skin infiltrates, like certain bacteria and microorganisms; and damaged cells that signal sun damage (brown spots). The destruction of these items is relatively easy to accomplish with the right type of light. At the same time, studies show that Intense Pulsed Light heats the dermis to above 65 degrees Celsius, which activates the skin to produce a wrinkle-filling material called collagen over the course of 5-12 weeks.
Basically, this light from the Alma will reduce the unwanted effects of aging, but only a little bit each time the skin is treated. Various settings are available, and are chosen depending on your skin type and treatment goals. Most often, three to five treatments are needed, with treatments spaced 3-6 weeks apart.
Carbon Dioxide Vs. Erbium Laser Vs. AFT/IPL: Which One is Right for You?
Choosing a laser is a very personalized decision and depends on how much improvement you want and how much recovery time you can afford. AFT/IPL is the most popular laser.
If you are looking for a laser to treat your fine wrinkles and aged spots and you want to see the results after one or two sessions, the fractional C02 is the right choice for you.
The fractional carbon dioxide (CO2) laser resurfacing is more effective than Erbium (Fraxel) and AFT (works well on deeper wrinkles and scars) and can surprise you by its immediate effect on resurfacing and skin tightening. The Fractional C02 laser, however, imposes more recovery. Typically, one comes on a Friday to receive the laser treatment and rest at home for 2-3 days before going back to work. Your face will be red for about 7 days; the redness can last for weeks (rare).
Erbium Fraxel provides more modest improvement, less recovery time but it’s less efficient than C02. Therefore, we offer fractional C02 and AFT lasers; AFT laser is an upgraded form of IPL.
If you are patient and prefer less down time, AFT is a great choice. AFT lasers offer less improvement among the three, but have the huge advantage of imposing no recovery time. Multiple AFT/IPL treatments are necessary for obtaining a result close to a Co2 laser. After an AFT laser, you may put your make-up on and return to work immediately. Because AFT imposes no recovery and is effective for wrinkle reduction in some people, it enjoyed a period of great popularity. However, you may see little improvement with each session of AFT; multiple treatment sessions are necessary.
Analyzing the Different Lasers:
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Fractional Carbon Dioxide (CO2 laser)
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Erbium
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AFT / IPL
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Improvement in Dynamic Wrinkles
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60-80%
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30-70%
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10-40%
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Improvement in Fine Wrinkles
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90-100%
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70-80%
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20-50%
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Improvement in Acne Scars
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20-40%
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15-25%
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10-30%
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Effect on Spider Veins
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May worsen
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May worsen
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May improve
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Discomfort of procedure
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Significant
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Moderate
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None
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Recovery
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3-6 Days
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3-5 Days
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None
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Redness
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1-4 Weeks
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1-2 Weeks
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None
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Final Result Seen
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4-6 months
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4-6 weeks
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4-6 weeks
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Cost (Full Face)
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$2799
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$2799
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$379
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Cost (Single Area)
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$999
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$999
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$159
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Preparation for CO2 or Erbium Laser Resurfacing:
Preparing your skin for laser resurfacing is critical to optimizing your result and recovery. Retin-A, glycolic acid, Kojic acid and bleaching agents (hydroquinone) available through our office will help prepare your skin for the CO2 laser resurfacing. (No preparation is necessary for the AFT laser). They will reduce your risk of discoloration, speed healing, and optimize your cosmetic result. You should use these products consistently for at least six weeks prior to your procedure. After your skin heals from the laser, you should resume these skin care products throughout your period of redness.
Recovering From Your CO2 and Erbium Laser Surgery (AFT Laser Recovery is Immediate):
- Anesthesia: Sedation or topical anesthesia
- Length of surgery: 15-30 minutes.
- Length of stay: Outpatient (home same day).
- Discomfort: Anticipate 1 day of prescription pain medication.
- Swelling: lasts 3-10 days.
- Dressings: Treated areas will appear as abrasions. They will weep, and ooze for the first 3 days when uncovered.
- Healing: Your skin will heal in 4-8 days following Co2 laser. It will then appear sunburned. The only problem is that this “sunburn” takes awhile to fade. Redness will improve over days to weeks following CO2. Once your skin heals you can wear camouflage make-up to conceal the redness. Interestingly, as much as everyone hates to be red, the longer you are red, the better your final result.
- Presentable in public: You will be presentable with makeup in about 4 days.
- Sun protection: SPF 30 or higher for 6 months, you need to stay away from sun for at least 2 weeks after the procedure.
- Resume skin care: You may resume skin care products after your skin has healed.
- Final result: Will be seen within nine months; your skin will constantly produce new collagen after the fractional C02 laser.
- Next laser treatment: Typically, you need to wait about 6 months between laser treatments.
CO2 Laser Resurfacing Procedure:
The CO2 Laser allows us to use a high-energy beam to vaporize scars, lines, wrinkles and other skin imperfections, layer by layer. The laser affords a level of precision, control and accuracy that is not available by other methods. The laser setting for the face can only be used up to the jaw line because of difficulties in healing if used on the skin of the neck with high settings. (We treat the neck in a separate session with extreme caution). This procedure is performed on an outpatient basis. You cannot drive yourself home after treatment.
Preparing for Laser Skin Resurfacing:
Please have the supplies listed below on-hand before your laser resurfacing. They will assist in making your recovery more comfortable.
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Antibacterial soap
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Post-operative ointment-White Petrolatum
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For hand washing
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A post-resurfacing ointment especially formulated to relieve post-operatively discomfort and minimize redness. You need to bring one tube at the day of surgery.
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Gauze Pads
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Straws
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Non-sterile large 4×4; we will provide these for you.
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To be used if swallowing is a problem.
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| Benadryl Allergy, 25mg
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Bottled Water
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If restless or itching, you may take two, then one every four hours thereafter. Benadryl may make you sleepy, so take with caution.
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For drinking, at least 640z. per day. Drinking at least 8-10 eight oz. bottled water per day will enhance the healing process by replacing fluids lost from oozing and as a natural diuretic to help decrease swelling. Start to drink plenty of water at least 2 weeks before the laser surgery.
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Extra Strength Tylenol
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Small – Water Mist Bottle
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May take two every four hours starting before the laser as needed for pain.
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To be filled with the same cold vinegar and water solution used to soak resurfaced areas. Mist resurfaced areas as needed to relieve burning sensation between soaks.
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| Hydrocortisone 1% Cream
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Small – Water Mist Bottle
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May be used for itching or discomfort only as directed by Dr. Ghohestani.
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To be filled with the same cold vinegar and water solution used to soak resurfaced areas. Mist resurfaced areas as needed to relieve burning sensation between soaks.
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| Antibiotics
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Reading Material/Videos
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We may call you in an antibiotic prior to your surgery day to be taken when you get home from your procedure. Please follow all medication instructions!
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It is important to keep your mind occupied during the healing process.
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| Valtrex, 500 mg
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XL Shirts
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| This is an antiviral agent which you will start taking the day before surgery. It is normally taken as 500 mg twice a day starting the day before surgery and continued twice a day for the following 7-10 days.
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(With button-up fronts or large opening to slip over your head easily)
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| Vicodin
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Snacks/Healthy Foods
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A pain medication we will call in for you prior to your surgery. It should be taken no more than once every six hours after surgery as needed for pain. Most patients use Vicodin only the first day and then are quite comfortable taking Extra Strength Tylenol for discomfort thereafter .
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Foods low in sodium and high in nutritional value. Foods high in sodium could put you at risk for unnecessary swelling and discomfort. Foods high in nutritional value will provide much needed vitamins, complex carbohydrates and protein. A diet high in nutritional value will promote healing and help with the rejuvenation process.
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Artificial tears
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Fruit
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May be used as needed in the eyes to rinse exudates and soothe eyes while swollen and not closing well we will provide to you.
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Eating fruit will you’re your healing process; try to eat pine apple, apple and celery.
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Recovery from fractional CO2 Laser Resurfacing:
The exfoliation of skin requires new skin to grow from the deeper layers. During the first two weeks, a significant amount of redness and weeping of the skin can be expected. An ointment is applied during the first 7 to 10 days to keep the skin moist. Patients must refrain from wearing make-up during the first two weeks. The skin may continue to show signs of pink or redness for several weeks following surgery. We will assist you in helping to prepare the skin for treatment as well as applying camouflage make-up during the second week. Swelling may also occur and should resolve within the first couple of weeks. The skin heals extremely well over time and sun exposure should be avoided during the first six weeks following treatment.
Facial Skin Resurfacing FAQ’s
How does it work?
CO2 laser produces pulses of infrared light lasting only thousandths of a second each. These pulses vaporize micro-thin layers of skin without charring it. By successively treating and wiping the skin we can assess our laser peeling as it smoothes, tightens and clears the skin. As the new outer layer of skin grows, the body’s natural healing mechanism stimulates new collagen formation. The result is smoother, healthier looking skin with a natural, youthful glow and fewer wrinkles and scars.
What parts of my face can you resurface?
Any part of the face can be resurfaced. Most patients want full face, peri-oral (around the mouth), or peri-orbital (around the eyes) resurfacing; or treatment of traumatic or acne scars.
Am I awake during the procedure?
For the entire procedure you are fully awake.
Does it hurt?
Discomfort is usually minor both during the procedure and throughout your recovery phase.
Where is the procedure performed?
In-office with Dr. Ghohestani. You will be at our office generally for about 2 hours depending on the sites treated, we first apply a topical anesthesia and then reapply within 20 minutes.
What to expect after the surgery?
Immediately following the surgery, the technician will apply a dressing to your skin. Swelling and “crusting” of the skin are normal. Ointments will keep the supple and will be applied for 7-10 days following the laser surgery. The redness of the skin that persists after the initial healing phase ill usually fade in about 4 to 6 weeks. Avoidance of extremes in temperature and any activities that would cause stress to the healing skin should be avoided. Following a healthy diet and a healthy lifestyle is strongly recommended. It is imperative that you follow the postoperative instructions.
Will I be uncomfortable afterwards?
Usually not. We instruct you on keeping your face moist and pain-free during the post-op period. It is important to follow the printed aftercare instructions. This will minimize your risk for infection and ensure the shortest healing time.
When can I go back to work?
Normally, if you receive the laser C02 treatment on Friday; you will be able to go back to work on Monday or Tuesday.
How long will I be red?
You will have new surface skin in 7 to 10 days. Redness after that can be covered by a special tinted make-up. Depends upon your skin type, usually in 7 to 20 days most redness is gone. Your new skin will be very sensitive to ultra-violet light and you must avoid sun exposure until fully healed. You need to cover your skin, wear a hat and use a good sun screen if your have to go outdoors.
What about skin color and resurfacing?
People with light and medium complexions are the best candidates. Darker complexions require greater caution to prevent temporary darkening (hyperpigmentation) afterwards. For darker skin types, Dr. Ghohestani may test the skin 2 weeks prior to the procedure.
How much improvement will I get?
Most patients see between 60 and 100 % improvement in wrinkles, coloring and scars. When done for aging skin it typically makes someone look like they did 10 to 15 years earlier.
How long does it last?
With good skin care (sunscreens, skin-care products, moderation in sun-exposure, etc.) improvement will last for years. Remember: the clock starts again after your procedure – do your best to preserve your improvement!
What does it cost; will insurance cover it?
Full Face Resurfacing with Topical Anesthesia costs about $2799 for full-face. Peri-Orbital Resurfacing (Upper or Lower Eye Lid) costs $999. Fees are subject to change and not reimbursable by insurance.
How do I get started?
Contact our office at 210-698-6777 and schedule a personal consultation with Dr. Ghohestani, our world-renowned dermatologist to discuss your specific needs. He will address your concerns, answer your questions, and recommend the best treatment option for you. Before and after photos of satisfied patients are available, to show you the beautiful skin that is possible, no matter what your age or skin condition.
Why should you choose Texas Institute of Dermatology for your laser resurfacing?
At the Texas Institute of Dermatology, we want you to have an excellent outcome and to feel that your needs and concerns have been promptly addressed in a caring and sensitive fashion. We strive diligently to ensure your satisfaction, your comfort, your privacy, and your safety. All treatments are supervised or performed by a dermatologist with many years of successful experience in a large variety of procedures. Many treatment modalities are available, and we can recommend the one or two that are most likely to meet your needs; we’re here to meet your needs and help you realize your aspirations. At our clinic in San Antonio, Texas, we serve communities throughout the Bexar County and the Kendall County, including San Antonio, Boerne, Leon Spring, Ralph Fair Ranch, Canyon Lake city; many of our patients also come from San Marcos, New Braunfels, Kerrville, Austin, Wimberley and Corpus Christi.
The precise heating ensures a safe, effective, fast treatment with no downtime.Vacuum and specially designed rollers for the Mechanical Massage smooth out the skin to facilitate safe and efficient heat energy delivery. The net result increases the metabolism of stored energy, increases lymphatic drainage and reduces or shrinks the size of the actual fat cells and fat chambers.
Fat cells, surrounded by fibrous cords, are located under the skin. As fat cells enlarge, they push up against the skin while the fibrous cords pull down. This creates an uneven surface or dimpling, referred to as cellulite. Cellulite is more visible on thighs and buttocks. Many cellulite treatments, including massages or cellulite creams, are not as effective as they claim.Liposuction has been used for cellulite treatment. However, uneven suctioning may worsen the cellulite.
