SKIN RESURFACING IN NEW ORLEANS
Skin resurfacing refers to procedures that rejuvenate the skin by removing the outer layers of skin, stimulating the natural production of collagen, evening out skin tone, and smoothing away wrinkles. Dr. Velargo performs CO2 laser resurfacing, deep chemical peeling, and dermabrasion. Dr. Hendrick also performs CO2 laser resurfacing.
As a rule, surgery (facelift, blepharoplasty, etc.) improves sags and bulges, while resurfacing procedures improve wrinkles.
Resurfacing can sometimes produce a dramatic improvement in the texture of the skin of your face as well. Certainly, it is not indicated for every patient. Therefore, we will give you our opinion as to whether we feel you are a candidate for these procedures. These procedures generally cause the skin to have a more youthful fullness replacing the “old” wrinkles. In short, resurfacing procedures are a rewarding and frequently dramatic exchange of “prunes for peaches.”
Skin resurfacing may be done as an isolated procedure (for example, around the lips, around the eyes, or the entire face), or it may be used as an indispensable adjunct to facelifting (rhytidectomy) and eyelid plastic surgery (blepharoplasty) in an overall facial rejuvenation program. These procedures may be performed in a delayed manner or, in select cases, simultaneously with facelifting or blepharoplasty as in the Renaissance Lift™, which is offered exclusively by Dr. Velargo.
Some skin types are more favorable for skin resurfacing than others. Fair complexions tend to do better than dark ones. Thick, tough, more deeply etched, or oily skins may require a two-stage approach for the best results (i.e., a second procedure or “touch-up” of several areas at a later time). Like painting a roughly textured wall, deep creases may require a touch-up procedure to reach maximal benefit.
Skin pores are the surface openings of the oil glands. Neither dermabrasion, laser, nor a peel, is designed to alter them. A pore is the surface opening of an oil gland or hair follicle. Attempts to reduce its size may lead to the development of a “pimple.”
Skin resurfacing is considered a surgical procedure. Therefore, the risks that apply to surgery must be considered. Since skin resurfacing is considered a cosmetic procedure, it is not covered by insurance.
Please inform us if you have taken Accutane.
WHAT CAN SKIN RESURFACING ACCOMPLISH?
Skin resurfacing can:
- Smooth rough and “leathery” skin
- Smooth fine lines and wrinkles
- Brighten the skin, lightening hyperpigmentation, brown spots, and sun damage
- Smooth scars
- Improve acne scars and blemishes
- Stimulate natural collagen production for an overall enhancement of the skin
- Be the “icing on the cake” when used as an adjunct to facial rejuvenation surgery
Resurfacing alone is not indicated for treatment of sagging tissues, however. Although the new skin has better elasticity after skin resurfacing, sagging still requires surgery. Even so, we have seen additional tightening in the skin in many patients after resurfacing.
WHAT HAPPENS DURING SKIN RESURFACING?
Different parts of the same face generally require differing types and depths of treatment. For example, the thin skin of the eyelids may not tolerate the same depth of treatment that the thicker skin of the forehead, nose, lips, and chin may require. Additionally, some areas of the face and different skin types respond more favorably to chemical peeling than others. An experienced surgeon like Dr. Velargo will know how to vary the type and depth of the treatment to meet your specific needs.
TYPES OF SKIN RESURFACING
Laser skin resurfacing with the CO2 laser (both ablative and fractional CO2 laser) use light energy to treat the skin. Fractional technology is less invasive because it leaves islands of untreated skin to help facilitate the healing process.
Dr. Velargo and Dr. Hendrick are skilled at assessing the needs of each individual patient to determine which type of CO2 laser treatment is indicated. CO2 laser treatment is often performed on the face, neck, and chest and is also part of our hand rejuvenation program.
Drs. Velargo and Hendrick utilize a Matrix LS-40 CO2 laser system. As is the case with most technology, there is an art to operating it. In order to obtain the maximum benefit, experience is required. CO2 lasers, like any technology, must be used for the “right reason.” The “right reason” is that the doctor must feel that the CO2 laser is superior to other forms of treatment for a patient’s unique condition.
Drs. Velargo and Hendrick are experienced in counseling their patients appropriately. Dr. Velargo performs other forms of facial rejuvenation such as deep chemical peels and dermabrasion should the doctors feel that these are superior methods for treating your unique condition.
CO2 laser resurfacing is performed in the outpatient procedure room at our clinic and is generally well-tolerated with oral sedation, the use of topical anesthesia, the use of our cooling machine, and select nerve blocks if absolutely necessary.
Dermabrasion should not be confused with microdermabrasion. The latter is utilized by non-medical aestheticians to “buff,” “polish,” and exfoliate the most superficial of skin layers. Dermabrasion is a surgical procedure in which a device removes the top layers of skin down to the dermis. The body reacts by creating new skin over a period of days.
When the skin has an irregular or uneven texture from acne scarring or from previous injuries, dermabrasion may provide some improvement. The technique of dermabrasion is similar to sanding a scratch from a wooden table in that the work is actually done on the elevated areas in an attempt to take them down closer to the level of the defect. When successful, this diminishes the high-low junctions, which are responsible for casting shadows when light strikes the face from an angle, leaving the skin somewhat smoother and tighter than before.
When the texture of the facial skin is very irregular from excessive or deep scarring, a second treatment may be required 6-12 months after the initial treatment. Following dermabrasion, the more superficial defects might be completely removed, while those that are moderately deep may be improved but not removed. Some of the deeper or “ice-pick” type scars may not be improved at all.
In some cases, a second dermabrasion within 6-12 months can provide additional improvement to those moderately deep scars. Dermabrasion can be done a third time, but there is a limit. Prior to surgery, it is difficult to predict the degree of improvement, and each patient’s skin responds to the same treatment by the same surgeon in a different manner. Because of his training, Dr. Velargo is very experienced in dermabrasion, which is a dying art in facial plastic surgery.
Dermabrasion may be performed in the outpatient procedure room at our clinic and is generally well-tolerated with oral sedation and local anesthesia. Should you desire general or twilight anesthesia, the procedure can be performed at an outpatient surgery center in the community.
Chemical peels vary by formula and depth. The deep chemical peel procedure utilizes a special formulation of phenol and croton oil, among other ingredients. A “chemical peel” involves the careful application of a scientifically formulated solution to the skin, which later causes the top layers to separate and shed (like a blister), taking with it the sun-damaged and wrinkled layers.
Deep chemical peeling is an art and requires extensive experience in the formulation, concentration used, amount applied to each area of the face, and the manner in which it is applied. Most importantly, deep chemical peeling requires extensive experience in post-operative care. By training with one of the early innovators in deep peeling techniques, Dr. Velargo is more than qualified to perform this procedure.
Deep chemical peels are only performed in a monitored setting because of the ingredients used during formulation. All patients are connected to cardiac monitors, and an IV is started. It can be performed in the outpatient procedure room at our clinic or in an outpatient surgical facility in the community. If performed without general anesthesia, the solution stings as it is applied, but this is short-lived (a matter of seconds).
Later discomfort can be eased with appropriate medications. The skin may recover more quickly from a mild or light chemical peel (e.g. TCA, glycolic acid, or salicylic acid), but there are fewer benefits.
Acne scars are dealt with by a combination of methods. For large deep pits, direct excision and replacement with a more favorable linear scar may be indicated. For smaller pits and ice picking, Dr. Velargo implements a modified CROSS technique. CROSS stands for “Chemical Reconstruction of Skin Scars.” Unlike traditional CROSS methods, which utilize TCA, Dr. Velargo prefers to use a stronger chemical peeling agent called phenol.
In the same setting as CROSS, Dr. Velargo then performs a dermabrasion or CO2 laser. In this manner, collagen growth is promoted more so in the pitted scars themselves. Thus, the goal is to obtain more level skin. Acne scars are very difficult to treat, and Dr. Velargo stresses that the goal of surgery is improvement, not perfection. More than one treatment is the rule rather than the exception.