June 2, 2009 When she looked in the mirror, 48 year-old Margaret Miglia didn’t like what she saw. To combat the fine lines and brown spots that began to appear on her face with age, she sought help at the University of Michigan Cosmetic Dermatology and Laser Center where she received a new, non-surgical skin resurfacing treatment using a fractionated carbon dioxide laser.
“Previous laser treatment for wrinkles and other textural issues like acne scarring used to create significant wounding,” says Jeffrey Orringer, M.D., director of the U-M Cosmetic Dermatology and Laser Center. “While results were terrific, the downtime for patients was substantial, and the risks were significant. Then, as technology improved, the pendulum swung the other way, providing lower risks, but with less pronounced results. This new treatment offers both improved results with much fewer side effects.”
In developing this new treatment method, traditional carbon dioxide lasers were modified into a fractional format. The carbon laser beam is broken into numerous microscopically thin beams that strike the skin and vaporize sun damaged or scarred tissue. This causes the skin to tighten, and during healing, produce collagen – the protein responsible for skin structure and appearance.
“The little micro-beams essentially vaporize small columns of tissue that take about two to three days to seal back up,” Orringer says. “During that time, as the skin heals back together, the lost volume essentially creates a tightening of the skin. In addition, around those columns of skin where the beam delivers heat, a very reproducible wound healing mechanism is created, which leads in part to the formation of new collagen in the skin.”
In addition to smoothing fine lines and wrinkles, Orringer says patients who undergo fractionated carbon dioxide laser treatment can expect a more even skin tone, as well as results that last for years, not weeks or months.
“Collagen, the molecule that this procedure is really trying to get the body to produce, has a half life of about 15 years. We would expect that, to the extent that patients’ improvement is based on collagen production, their results would last a very long time,” he says.
For Miglia, she couldn’t be happier. “I had the procedure done two and a half weeks ago and I love it. The experience for me was not really painful at all. It was more like a really bad sun burn. My skin is smooth. The brown spots on my face are gone,” she says. “It makes me feel much younger. It just feels good to look in the mirror.”
The procedure takes about 45 to 90 minutes. Patients will arrive about an hour in advance of their appointment. A topical anesthetic cream is applied to the area being treated and allowed to soak for in for about an hour.
Patients are then given tiny injections of lidocaine to additionally numb the most sensitive parts of the face.
To ensure wrinkles are eliminated as close to the eyes as possible, patients are given protective eye shields so the laser can be applied to the skin up to the eyelash line.
“Patients are generally treated in two passes. The first pass acts very deeply on the skin, working on deeper lines, atrophic scars and the like,” Orringer says. “The second, more superficial pass, typically focuses more on blending skin tones and getting rid of sun spots and uneven pigmentation.”
Recovery and results
While the immediate effects of laser treatment include redness, swelling and oozing of clear fluids called serum, initial healing essentially occurs within three to four days. The serum, which contains proteins that help the skin to heal, continues to seep out onto the surface of the skin periodically during the first couple of days as the microscopic holes begin to seal off. Orringer says by the third or fourth day there’s essentially no wound care required other than applying a thick moisturizer. Redness gradually dissipates in about one or two weeks for most patients.
“Patients experience an immediate improvement during treatment associated with the laser heating their skin. The collagen contracts making the skin appear immediately tighter,” Orringer says. “However, even better is the type of improvement related to collagen production which takes several weeks to a couple of months to fully appear. Patients will continue to see improvements in their skin for the first three to four months following treatment.”
As with any surgical procedure or medical treatment, there are risks. For fractionated carbon dioxide laser treatment, Orringer says the risks are fairly small. “Concerns like infection and scarring or discoloration of the skin are certainly theoretical possibilities, and it is something that patients should always discuss with their treating physician,” he says.
For those who are considering undergoing fractionated carbon laser treatment, Orringer stresses that they should consider the setting in which they intend to undergo the procedure.
“Who will be performing the treatment? Which exact device will be used? And, especially, what is the training level of the team that’s going to be doing the procedure?” he says. “Regulation of laser use varies widely from state-to-state. This is a moderately invasive procedure that in some places is legally performed by non-medical personnel. Though the treatment is very safe when performed by experienced doctors, complications may occur. In my opinion, patients should seek out a physician with specialized training in laser therapy.”
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