Laser Skin Resurfacing

Laser treatments can address specific concerns about the skin on the face and neck. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon to help determine whether a laser treatment is appropriate for your concerns. A Laser is a Powerful, Targeted Form of Light Used for Skin Rejuvenation A laser is a powerful form of light of a single wavelength that targets specific molecules in tissue. This allows specific areas of tissue to be treated without affecting the surrounding areas. There are Multiple Types of Lasers Used for Skin Rejuvenation Many lasers are used in for skin rejuvenation. Each treats specific features of the skin. Among the most used lasers are resurfacing lasers and vascular lasers. A device commonly believed to be a laser is Intense Pulsed Light Therapy (IPL). It is not, however, a laser but a device that delivers energy to the skin at multiple wavelengths – as opposed to one – at the same time. Resurfacing Lasers Can Provide the Most Obvious Skin Rejuvenation Results Resurfacing lasers such as the CO2 laser and Er:YAG laser can provide some of the most obvious skin rejuvenation results of any laser. These lasers can treat signs of photoaging such as age spots, sunspots, and fine and moderate wrinkles. These lasers target the water molecule, heating it up and vaporizing skin precisely and at a controlled depth. The skin then heals with a more youthful appearance. In contrast with the CO2 laser and Er:YAG laser, non-ablative resurfacing lasers such as Nd:YAG heat up the water in skin without vaporizing it. Ablative lasers are more effective than non-ablative lasers in treating signs of photoaging. However, the recovery is often a few days longer with ablative lasers, which many individuals feel is well worth the results. Both ablative and non-ablative lasers are now manufactured to deliver treatment in a fractional form. This means that the laser is not one single column of energy but many small columns. This leaves intact skin in small areas between these columns, which allows the treatment site to heal more quickly and with a lower risk of side effects. Strict sun avoidance is important for weeks to months after treatment with any resurfacing laser. This includes wearing hats and applying a mineral-based sunscreen of SPF30 or greater to the site after healing is complete. Harmon Facial Plastic Surgery offers fractional CO2 laser resurfacing treatments for some skin changes related to aging, because we feel it best balances providing an effective and safe treatment. A detailed conversation is had with everyone interested in this treatment about the expected results and potential risks with this procedure. Vascular Lasers Treat Skin Features Caused by Blood or Blood Vessels Vascular lasers such as pulsed dye lasers target the molecule hemoglobin, which is present in blood and blood vessels. Vascular lasers are often used to treat bruising, minute blood vessels in the face, dilated veins near the surface of the skin, rosacea, and other vascular abnormalities of the skin. It can soften scar tissue and improve redness of some scars. Intense Pulsed Light (IPL) is Less Effective but Has Less Down Time IPL delivers light in a wide range of wavelengths - as opposed to a single wavelength with a laser - to the skin. It is a non-ablative treatment (like the Nd:YAG laser) for skin conditions such as bruising, age spots, and sun spots. There is usually little to no down time after treatments. The risk of complications is usually less with IPL versus lasers. However, it is less effective than lasers and often requires multiple treatments. The Expected Recovery and Risks Differ for Each Laser The recovery and risk profile differs for each of the lasers above. It is important to have a detailed conversation with a specialist who understands the expected recovery and risks for every laser treatment as well as someone who can determine which laser treatment(s) may benefit you. Can Early Laser Treatment of Surgical Incisions Improve Healing? There are multiple factors that optimize surgical incision healing, from proper surgical technique, proper closure technique, sun avoidance and protection, and the application of antibiotics and moisturizers. However, an unsightly scar may still develop despite optimal closure and appropriate post-operative incision care. Lasers can improve the appearance of a scar. However, there are no strict guidelines dictating when to treat surgical sites with a laser. Laser treatment of incisions usually starts at a minimum of 6-8 weeks after surgery. Could earlier treatment of incisions alter the chemical cascade during healing and prevent scar formation? One of the most important differences between scar and normal tissue is the orientation of the support framework on which the skin heals (1, 2). Early laser treatment may result in a "shift" of the molecular signaling during healing, leading to the development of a more "normal" support framework. The most common lasers used to treat incisions are called fractional resurfacing lasers, which include the Erbium:YAG and CO2, which is the laser used by Dr. Jeffrey Harmon at Harmon Facial Plastic Surgery (3, 4). Studied as early as 1956, treatment of incisions 7 days after surgery or even during surgery with a resurfacing laser have shown some of evidence of their effectiveness (5 - 8). For example, the dermatologists Dr. Ozog and Dr. Moy have published on the use of a fractional resurfacing CO2 laser immediately after surgery to stimulate healing and prevent scar formation. They performed a randomized, blinded, split-scar – split scar means half the scar was treated and half the scar was not - study on 10 patients with linear incisions and found improvement in the appearance and texture of scars on the treatment side on evaluation 2-3 months after surgery (7 – 8). A French physician utilized a diode laser on incisions immediately after they were created and found some benefit to healing (9 – 11). While promising, the above referenced studies involved very few patients and relatively subjective scoring of the appearance of the scars. More research is required to identify the optimal laser and the optimal timing of laser use to reduce or prevent scarring after surgery. In the meantime, appropriate surgical technique, closure, and appropriate incision care after surgery are the best approaches to reducing the risk of excessive or abnormal scarring after surgery. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about age-related changes to your face and/or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us References 1. Capon A, Mordon S. Can Thermal Lasers Promote Skin Wound Healing? Am J Clin Dermatol. 2003: 4(1): 1 – 12. 2. Namazi MR, Fallahzadeh MK, Schwartz RA. Strategies for prevention of scars: what can we learn from fetal skin? Int J Dermatol. 2011; 50(1): 85 – 93. 3. Ollael S et al. Use of Lasers in Acute Management of Surgical and Traumatic Incisions on the Face. Facial Plast Surg Clin North Am. 2011; 19(3): 543 – 550. 4. Mirmanesh M et al. Peri-Procedure Laser Scar Therapy Protocol: A Pilot Survey of Plastic Surgeons' Practices. Aesth Plast Surg. 2017; 41(3): 689 – 694. 5. Laubach HJ et al. Skin Responses to Fractional Photothermolysis. Lasers in Surgery and Medicine. 2006; 38: 142 – 149. 6. Greenbaum SS, Rubin MG. Surgical Pearl: The high-energy pulsed carbon dioxide laser for immediate scar resurfacing. J Am Acad Dermatol. 1999; 40: 988 – 990. 7. Ozog DM and Moy RL. Discussing Fractional Carbon Dioxide Laser and Other Physical Treatments for Scar Prevention With Patients. JAMA Dermatol. 2015; 151(8): 815 – 816. 8. Ozog DM and Moy RL. A Randomized Split-Scar Study of Intraoperative Treatment of Surgical Wound Edges to Minimize Scarring. Arch Dermatol. 2011; 147(9): 1108 – 1110. 9. Capon A et al. Laser Assisted Skin Closure (LASC) by Using an 815-nm Diode-Laser System Accelerates and Improves Wound Healing. Lasers Surg Med. 200; 28(2): 168 – 175. 10. Capon A et al. Scar Prevention Using Laser-Assisted Skin Healing (LASH) in Plastic Surgery. Aesth Plast Surg. 2010; 34: 438 – 446. 11. Capon A, Iarmarcovai G, Mordon S. Laser-Assisted Skin Healing (LASH) in hypertrophic scar revision. Journal of Cosmetic and Laser Therapy. 2009; 11: 220 – 223.

Laser resurfacing of the face can address wrinkles and other irregularities of the tone and texture of the skin resulting in a softer, more youthful appearance to the face. Good skin care after treatment with a resurfacing laser is essential. The following post describes this process. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. The Skin Heals in an Average of Seven to Ten Days After Laser Resurfacing The first seven to ten days are essential to the healing process after laser resurfacing of the face. The top layers of the skin are healing. It is essential to avoid the sun during this time. It is also essential to keep the treatment areas moist and clean. A Skin Protectant/Moisturizer Such as Aquaphor© is Applied While Healing It is important to keep the treated skin moist while healing. A moisturizer such as Aquaphor© is applied to the skin twice daily until the top layers heal. The Face is Cleaned with Water and a Gentle Cleanser While Healing The face is generally washed with lukewarm water and a gentle facial cleanser while healing. A solution of diluted vinegar is sometimes used as well. Antibiotic and Anti-Viral Medications are Taken Every patient takes antiviral medications and antibiotics to reduce the risk of a bacterial infection and/or the activation of a dormant viral infection that also causes cold sores. A Moisturizer and Sunscreen are Applied After the Skin Has Healed The healing process does not end after seven to ten days. A slight pink hue often develops in some areas after the skin has healed, which usually fades during the first few months after treatment. It is important to avoid prolonged sun exposure for months after surgery during this time. It is important to keep a moisturizer on the skin in addition to wearing a hat and sunglasses and applying a mineral-based sunscreen. A good moisturizer is the Skinceuticals© product Epidermal Repair. My patients apply Epidermal Repair to the treated skin for approximately three months after the skin has healed. Trust Your Face to a Facial Plastic Surgeon It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style, and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us to learn more! Contact Us

One of the most common concerns people express about their face as they age is the presence of smoker's lines, or peri-oral rhytids, around the mouth. These stubborn lines are difficult to treat. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck. I Utilize a Dual-Pronged Approach: Resurfacing and Nano-Fat Transfer Dr. Harmon often utilize a dual-pronged approach to treating peri-oral skin, including rhytids. The first prong involves the use of a refined form of an individual's own fat, called nanofat. Nanofat is placed under the skin around the mouth. The second prong is a fractional CO2 laser, which is used after injecting nanofat. This laser resurfaces the skin which, along the with nanofat components, can encourage more organized collagen deposition, thereby improving the appearance of wrinkles and overall skin quality and texture (1, 2, 3, 4, 5, 6). This approach can better address the actual changes going on in the skin – called histological changes – when compared with utilizing only one of the two prongs or hyaluronic acid filler to simply fill in the lines. This 58-year-old patient came to Dr. Harmon to address sagging cheeks and jowls, loose tissue in her neck, facial wrinkles, and a lengthened upper lip. An extended deep plane facelift, neck lift, and lip lift were performed. Lip filler was added to balance out her bottom lip with her top lip. Finally, the patient underwent treatment with a fractional CO2 laser in addition to nano-fat grafting of the wrinkles around her mouth. The patient is thrilled with her results only a few months after surgery. Trust Your Face to a Facial Plastic Surgeon It is important to seek a double board-certified, fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck. Why Choose Dr. Harmon The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good. Dr. Harmon is a double board-certified facial plastic surgeon. Dr. Harmon values making patients feel welcomed, listened to, and respected. Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology. Dr. Harmon earned his medical degree from the University of Cincinnati. Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati. Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City. Request a Consultation Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon's credentials, style and approach. Build a relationship with our dedicated team. Do not stop at searching "plastic surgery near me." Get in touch with us today to learn more! Contact Us References Akbari F, Hadibarhaghtalab M, Parvar SY, Dehghani S, Namazi MR. Toward facial rejuvenation; A clinical trial to assess the efficacy of nano fat grafting on wrinkles. J Cosmet Dermatol. 2024 Feb;23(2):600-606. La Padula S, Ponzo M, Lombardi M, Iazzetta V, Errico C, Polverino G, Russo F, D'Andrea L, Hersant B, Meningaud JP, Salzano G, Pensato R. Nanofat in Plastic Reconstructive, Regenerative, and Aesthetic Surgery: A Review of Advancements in Face-Focused Applications. J Clin Med. 2023 Jun 28;12(13):4351. Tonnard P, Verpaele A, Carvas M. Fat Grafting for Facial Rejuvenation with Nanofat Grafts. Clin Plast Surg. 2020 Jan;47(1):53-62. Tonnard P, Verpaele A, Peeters G, Hamdi M, Cornelissen M, Declercq H. Nanofat grafting: basic research and clinical applications. Plast Reconstr Surg. 2013 Oct;132(4):1017-1026. Tran VVT, Jin X, Hong KY, Chang H. Effects of Nanofat in Plastic and Reconstructive Surgery: A Systematic Review. Plast Reconstr Surg. 2024 Sep 1;154(3):451e-464e. Uyulmaz S, Sanchez Macedo N, Rezaeian F, Giovanoli P, Lindenblatt N. Nanofat Grafting for Scar Treatment and Skin Quality Improvement. Aesthet Surg J. 2018 Mar 14;38(4):421-428.