SOME INFORMATION FOR OUR PATIENTS ABOUT CHEMICAL, LASER, OR ABRASIVE SKIN RESURFACING
(CHEMICAL PEEL, LASER RESURFACING AND DERMABRASION)

INTRODUCTION

CHEMICAL PEEL, LASER RESURFACING AND DERMABRASION of the skin are terms used to describe procedures which remove or modify outer layers of skin in order to improve or eliminate areas which may be finely wrinkled, inelastic, excessively pigmented, scarred or rough. Chemical peels, laser skin resurfacing, and dermabrasion all achieve results in basically the same way. Layers of skin are removed and as the healing process progresses, a new, healthier looking skin emerges. What differentiates the various resurfacing methods is the way in which the skin’s layers are removed. Chemical peels involve the application of a caustic solution, laser resurfacing uses a focused beam of laser light energy, and dermabrasion utilizes a high-speed rotary wheel. In general, the stronger the solution applied, the deeper its penetration and therefore the more significant the result. Treatment depth with laser resurfacing and dermabrasion must also be precisely controlled. Problems or complications following skin resurfacing are related to these same depth of treatment factors; and must be controlled by a comprehensive preoperative preparation of the skin, a precise surgical procedure, and controlled postoperative wound healing. In addition to the information contained here, during your consultation and examination, we will review specific factors which pertain to your individual case. (As you review this information, please write questions in the margins that we can address during your consultation.)

Skin resurfacing is most useful for: 1) finely wrinkled skin due to aging and accumulated photo damage; 2) certain types of pigmentation irregularities; 3) certain types of minor scar irregularities;
4) as an additional modality to maximize the results of other cosmetic facial procedures such as face lift, brow lift or eyelid surgery. When excessive laxity or looseness of the skin is present, surgical procedures to remove the laxity should be done either before or after skin resurfacing for best results.

Aging, sun exposure, heredity and lifestyle factors including nutrition, alcohol consumption, and smoking all may contribute to facial wrinkling. Pigmentary changes of the skin such as blotchiness or brown spots may also occur with age or as a result of birth control pills, pregnancy, or genetic factors. Prior acne may have made the surface of the skin uneven. These problems, as well as certain other skin conditions, may be improved by skin resurfacing.

Surgical skin resurfacing can be performed to various depths within the epidermal (outer skin layer) and dermal (deeper) skin layers. Superficial treatment removes any or all of the epidermis down to the basal cell layer or to the level of the dermal-epidermal junction. Medium depth treatment destroys or removes tissues down to the level of the papillary dermis. Deep treatment destroys or removes tissue down to the level of the reticular dermis.

The epidermal layer of skin contains pigment cells (cells which darken the skin in response to ultraviolet radiation from the sun). In the skin resurfacing process, removal of some or most of these
cells to achieve the desired smoother result also produces lightening of the skin color in that area. Since the pigment cells no longer block sun rays effectively, protection from the sun following the procedure using sunscreens and other types of shields, including shading, is extremely important. Avoiding direct sun exposure during the most intense time of UV light, the middle of the day, is also strongly advised. Hence, a major consideration when considering skin resurfacing is that some protection is mandatory in exchange for achieving a more youthful or smoother appearing skin. In women, this is more easily achieved since make-up is applied as a routine, and sunscreen is readily applied either along with or within currently used cosmetics. Males need to apply sunscreen or blocks as a learned daily routine.

Since the areas treated by skin resurfacing are usually lightened in color compared to other areas, the fair-skinned patient will show less contrast between the treated and non-treated areas as compared to darker or olive skinned individuals. Certain skin types may be better suited to one type of resurfacing procedure versus another.

CHEMICAL PEEL SKIN RESURFACING PROCEDURES
Chemical peel consists of the application of a chemical solution, usually an acid, to the skin of the face or body. A chemical peel can be superficial, medium depth, or deep in terms of the levels of the epidermis and dermis treated. The goal of the chemical peel is to make the skin look smoother with a more regular color, but still leave the skin looking as natural as possible. Chemical peel is most commonly performed for cosmetic reasons. It may also however remove precancerous skin growths.

Alpha-Hydroxy Acids (AHAs), such as glycolic, lactic or fruit acids are the mildest of the chemical peel formulas and produce light peels. These types of peels can provide smoother, brighter looking skin with just a few superficial treatments and very little, if any, down time. These lighter peels are considered more complexion peels. They make the skin look brighter and fresher by stimulating exfoliation (cell turnover) and therefore must be repeated at varying intervals to maintain the effect. Repeated treatments can help to further improve the texture and overall health of the skin. They can also reduce the effects of aging and sun damage, including fine wrinkling and pigment irregularities. A topical skin maintenance program along with regular chemical peels is mandatory to achieve and maintain optimal results in terms of skin appearance and skin health. The advantage of light peels is that they minimally disrupt your schedule and you can look reasonably normal within a few hours or days. Make-up can be worn the same day and you can easily go back to work the same day.

For patient’s who have deeper or more severe problems, a medium depth chemical peel may need to be performed with trichlorocetic acid, TCA for short. Fine surface wrinkles, superficial blemishes, and pigment problems are commonly treated with TCA. The Obagi Blue Peel and the Biomedic Pigment Peel Plus are medium depth chemical peels typical of this type of treatment. Specially trained and medically supervised paramedical estheticians perform both superficial and medium depth chemical peels in our practice.

Deep chemical peels can also be performed with TCA or a powerful acid called phenol. My preference however, is to use laser resurfacing for deep skin treatments as I feel that this process is more precise, controlled, and predictable than deep chemical peeling with other agents. There clearly is a place however, for deep chemical peels in certain situations. Localized moderate depth wrinkles around the mouth for instance, can be treated with Phenol or a deep TCA peel at the time of other surgical rejuvenation procedures. Clearly, the lightening of skin pigment following deeper treatments becomes a more significant issue, and localized treatments do tend to have more visible differences in pigment and more contrast in the transition areas between treated and non-treated skin. When the chemical peeling solution is applied to the skin, it penetrates through the epidermis (outer layer of skin) and partially and variably through the dermis (deeper skin layer) depending on the depth of the treatment. As the healing progresses, the skin is left smoother, healthier and more youthful than before the treatment.

LASER RESURFACING
In laser resurfacing, sometimes called “laser peel”, a erbium: yag or carbon dioxide (CO2) laser is used to remove areas of damaged or wrinkled skin, layer by layer. The procedure is most commonly used to minimize the appearance of fine and medium depth wrinkles, skin roughness and pigment irregularities. However, it is also effective in treating facial scars caused by injury or accident, and scars caused by acne. Laser resurfacing may be performed on the whole face or in specific regions such as the vertical lines around the mouth. Often, the procedure is done in conjunction with other cosmetic procedures, such as a face lift or eyelid surgery. Men and women of all ages may benefit from laser resurfacing. The best results from the procedure are typically seen in individuals with fair, healthy, non-oily skin.

Laser skin resurfacing is most effective for eliminating wrinkles and skin damage caused by photo aging. Overall improvement that can be anticipated with a single treatment is approximately 50-70%. Laser resurfacing does not remove deep furrows. These lines come from decades of contracting muscles of the face to form smiles, frowns, and raised or knitted eyebrows. Laser resurfacing can tighten skin to some degree, especially the thinner skin of the upper and lower eyelids, but does not replace surgical skin tightening procedures.

It will not completely remove all facial flaws or prevent aging. Lines that occur as a result of natural movements of the face including smiling, squinting, blinking, talking and chewing will inevitably recur.

An erbium: yag or CO2 laser generates invisible light that is absorbed by water. Water makes up approximately 80% of the skin cells. In laser resurfacing, a beam of laser light energy is used to vaporize the layers of damaged skin with accurate precision. It is clear that laser resurfacing may offer a number of advantages over other resurfacing methods. I prefer to use the laser for most deep facial skin resurfacing applications because it is more precise and controllable than other methods, allowing me to treat deeper and finer rhytids, or wrinkles differentially. The erbium: yag or CO2 laser can resurface skin that is weathered or has precancerous changes. The laser can precisely remove the heavily damaged outer layers of skin and fresh, new, undamaged skin will grow back and heal in approximately 7-10 days. Final healing and results of the procedure may take up to 6 months. Patience in the judgement of the final outcome is an important concept to be aware of when awaiting the results of a resurfacing procedure.

Maintenance of the results from laser resurfacing is mandatory for best overall longevity. Maintenance includes an aggressive topical skin rejuvenation program including topical Retin-A, light alpha-hydroxy acid peels, sunscreen of the appropriate strength to prevent further sun damage as well as adherence to basic skin care principles that include cleansing and moisturizing.

DERMABRASION
Dermabrasion or dermaplaning helps to refinish the skin’s top layers through a method of controlled surgical scraping. The treatment softens the sharp edges of surface irregularities, giving the skin a smoother appearance. Dermabrasion is most often used to improve the look of facial skin left scarred by accidents, acne or previous surgery, or to smooth out fine facial wrinkles such as those around the mouth.
Dermabrasion uses a small, rapidly spinning wheel with a roughened surface similar to fine-grained sandpaper to abrade the skin, removing its upper layers. The procedure involves “sanding” the affected area to give it a more even texture. The technique does not change the underlying scar tissue itself, it makes the scars less visible by making the surface more uniform. Several procedures may be required to obtain the optimal result, although a single dermabrasion treatment may very well produce a very substantial improvement.

Care following dermabrasion treatment of the skin is similar to other skin resurfacing procedures, including chemical peels and laser resurfacing.

Facial rejuvenation surgery may be performed as an isolated procedure, or more frequently done in conjunction with other cosmetic procedures of the face. It may be performed under local or general anesthesia depending upon the extent of the procedure being performed, medical indications or patient preference. In general, I do believe, along with our board certified anesthesia colleagues, that for longer and more complex procedures, general anesthesia is a better and safer choice than local anesthesia alone or local anesthesia with sedation.

The purpose of all types of cosmetic surgery is to improve your appearance as much as possible. This change will hopefully improve your quality of life by improving your self image in a very positive way. By addressing and improving those specific areas which detract from your appearance, leaving the positive aspects of your appearance undisturbed, this type of surgery results in an overall improvement in your appearance. Cosmetic surgical procedures are not magic. They are detailed procedures designed to improve specific aspects of your appearance. They can do no more than that. Whether you are happy with the results of cosmetic surgery will depend largely on how well you communicate to us which specific aspects of your appearance you are unhappy with and how well we communicate to you what a surgical procedure can and cannot do toward alleviating the problem. Plastic surgery does not perform transforming miracles. A combination of art and science, plastic surgery is not an exact science. Some of the factors involved in producing the result (such as your healing characteristics) are not totally within your or our control, and therefore, it is impossible to warrant or guarantee the results of your surgery. How predictable the result of your surgery will be depends on a number of factors such as the condition of your skin, the presence or absence of facial fat beneath the skin, the "age" characteristics of the skin, numbers and types of wrinkles present, and the nature of underlying bony structure of the face, as well as hereditary and hormonal influences.

It is not possible by cosmetic surgical procedures to make someone who is 50 years old appear 30 years old or younger. Although this may seem obvious, through misconception or misinformation, these ideas reach the public. All surgical procedures, which involve an incision in any area, must leave a scar. While these scars are usually inconspicuous and easily camouflaged by makeup or hairstyle, they are nevertheless permanent and cannot be erased.

After talking with you and examining you, I will make every effort to clearly and precisely give an opinion about whether a specific surgical procedure can significantly improve your areas of concern with a high degree of reliability and a minimal level of risk. All cosmetic surgical procedures involve some trade-offs. I will try to outline these clearly for you and answer any questions you might have. The final decision regarding having the surgery is yours, and I encourage you to consider it carefully and deliberately.

At Your Initial Consultation
When I visit with you in the office, I will review your past medical history, as well as your desires regarding skin resurfacing. Age is not a limiting factor in determining who can have skin resurfacing, as long as your general health is good. We will review extensively the information contained here, as well as more specific information with respect to your needs. After examining your face, I can much more precisely define recommendations for you.

I will discuss with you which of your goals skin resurfacing may or may not meet, and which resurfacing procedure would best suit your needs. You should arrive at the consultation prepared to provide complete information about previous surgical procedures including cosmetic facial peels or dermabrasion, any abnormal skin conditions, medications that you are taking or have taken, skin allergies, and acne or facial injuries that you have sustained, as these may influence the overall outcome of your surgery.

In this consultation, I would expect you to be frank in discussing your expectations with me. Do not hesitate to ask any questions that you may have. I will be equally frank with you, explaining the factors that could influence the procedure and the results.

I cannot make the decision for you regarding whether to undergo surgery or not. I can only advise you regarding the surgical options and anticipated outcomes I would expect for you based upon your individual anatomy, desires, and realistic expectations. I will define goals in a surgical plan at this initial consultation. Follow up appointments will include time to ask further questions or review the procedure so that you are comfortable with its nature and implications. I will educate you and define the operative scenarios and choices available to you, but you must make the final decision regarding the surgical procedure.

When a decision is made to proceed with surgery, preoperative photographs will be taken. These photographs are essential to the planning, execution, and follow-up of your procedure. They are taken with you in the standing position (the position in which you are most often seen). You are lying down during the procedure and I refer to these photographs frequently, as your tissues appear very differently than when you are standing.

Surgical fees for the procedure will be discussed with you. They depend upon the nature and the extent of the procedure being performed. All fees for cosmetic surgeries are payable in advance and include the cost of surgery as well as all postoperative follow up care. Additional fees are required for the surgical facility and anesthesia care, and will be collected on the day of your preoperative visit at the surgery center.

BEFORE YOUR SKIN RESURFACING PROCEDURE
Before any skin resurfacing procedures can be performed, the skin must be evaluated and classified. The results of this analysis determine your preconditioning treatment. IV Seasons Skin Care Clinic offers a variety of products specifically prepared to meet those needs. These range from a short series of glycolic acid peels and home care products, to a faster course of skin preparation that would include Retin-A or Renova and may be paired with a skin bleaching agent. All of this pretreatment depends upon your skin type. In order to gain optimal results from your skin resurfacing procedure, this initial preconditioning phase is mandatory.

Before skin resurfacing procedures, you must avoid sun exposure for at least 6 weeks prior to the surgery. Tan or sunburned skin may absorb laser light unpredictably or allow differential penetration of chemical peel solutions before they reach their target. I prescribe a topical Retin-A product for at least 6 weeks prior to the procedure, as Retin-A speeds the turnover of epidermal skin cells. It will prepare the skin for faster, more efficient healing and allow for more predictable results with less risk.

Our nurse and office manager will make all arrangements regarding scheduling of your surgery and will give you specific instructions as well as reconfirm these with you by telephone and/or letter. Since both of our schedules must be coordinated with the surgical facility and anesthesia schedules, please allow our personnel a reasonable amount of time to make these arrangements. They will make every attempt to accommodate your requests.

Good general health is mandatory for a problem free and predictable recovery from any surgical procedure. Wellness and good general health result from proper diet, regular exercise and appropriately timed medical evaluations focused on preventative medicine. Good nutrition, vitamin and herbal supplements, as well as adherence to holistic health principles are important concepts in maintaining wellness. Certain supplements, although generally beneficial, may have adverse effects during surgery. Please advise us about all your medications and supplements, so we may advise you regarding their safety in regard to your surgical procedure.

We believe that good nutrition is an important component to excellent surgical outcomes. Multiple studies show that most Americans aren’t getting the recommended daily intake of necessary vitamins and minerals, much less the optimal amount. These suboptimal levels of nutrients have been linked with major diseases from heart disease to cancer.

We use a three phase healing program with supplements to help you recover more quickly and with less downtime. We have you start this a week or so ahead of time to ensure that you are boosting your body’s immune system and removing anything that could interfere with anesthesia or increasing bleeding. Immediately following surgery we give you nutrients that help reduce pain and inflammation and detoxify the anesthesia and other medications. The third phase has additional healing nutrients to support your recovery.

Routine laboratory tests including blood counts and blood chemistries, a pregnancy test when applicable, and an electrocardiogram if you are over 50 years old, will be performed prior to surgery. These tests are performed routinely to screen for any abnormalities, which might complicate your anesthesia or surgery.

Do not take any aspirin or any drug containing aspirin for at least two weeks prior to your surgery. Aspirin may retard platelet function, a blood component that is important to normal blood clotting mechanisms. There are many drugs which contain aspirin. Before taking any drug, check the label carefully to assure that it contains no aspirin.

Do not eat or drink anything 8 hours prior to surgery. Safety in the administration of anesthesia or sedation requires that your stomach be absolutely empty for this interval of time before surgery.
Shower or bathe normally the evening prior to surgery.

You should wear loose fitting, comfortable clothing the day of surgery. A loose fitting shirt with buttons in front is preferable to any type of clothing that must be put on over the head. Please be sure that you have all of your questions answered prior to going into the surgical facility. I prefer that you make an additional appointment in the office if necessary to answer questions regarding your surgery. On the day of surgery, I will visit with you briefly immediately prior to surgery. Any final questions will be answered at that time.

Arrange for someone to drive you home at the appropriate time following your procedure, and arrange for someone to stay with you the night of surgery.

THE DAY OF SURGERY
Skin resurfacing procedures may be carried out under local or general anesthesia depending upon the size and the location of the area to be treated. Small areas can be treated with local anesthesia and IV sedation. Full face resurfacing requires general anesthesia. If a chemical peel is being performed, the solutions are freshly and precisely mixed immediately prior to application and very carefully and evenly applied to the treated areas. With laser resurfacing, the amount of energy used and the number of passes utilized in treating the skin is dependent upon the depth necessary to address your specific areas of concern.

I usually prescribe sedation or premedication prior to your being brought to the operating room. In order to minimize total necessary doses of drugs, sedation is best administered through an intravenous line rather than given in shot form into your muscle. It is normal to be slightly excited or apprehensive immediately prior to the surgery, and this will be alleviated quickly once your intravenous line is inserted. Our anesthesiologist will speak with you and answer all of your questions regarding your anesthetic.

Prior to moving to the operating room, I will ask you to sit up briefly, so that I can mark your surgical site, to use as guidelines during your surgery. Once in the operating room, you will then be positioned comfortably, and will have no recall of further events during your surgery.

At the completion of your operation, you will be transferred to the appropriate recovery area where you will remain until you awaken. I purposely like for you to remain drowsy, since you will be much more comfortable. After an appropriate interval of observation, usually a few hours, you will be allowed to leave with someone to drive you home and stay with you the evening of the surgery.

You will have been given prescriptions for pain medication and antibiotics with instructions for each at your preoperative visit.

AFTER YOUR SKIN RESURFACING PROCEDURE

Since I want you to remain drowsy and comfortable the evening of your surgery, fill your prescription for pain medication before surgery and take one immediately on arrival at home. Pain medication is best taken with a small amount of food and not on an empty stomach since nausea may occasionally occur. Make yourself comfortable, not necessarily in bed; a couch or comfortable chair is fine. You will continue to be drowsy and will awaken intermittently during the evening. Use the pain medication as directed to remain comfortable. Intermittent cold compresses for the first 48 hours after surgery may help with swelling and discomfort. Do not try to eat any heavy foods the evening of surgery. Liquids or light foods are preferable. You may resume a normal diet the next morning. Should you experience any nausea the evening of surgery, drink small amounts of liquids only: no food until morning. Antinausea medications are generally not needed; any nausea experienced from the medications used in surgery will usually be gone the next morning. If you have a history of nausea after anesthesia, please inform your anesthesiologist the morning of surgery and you will be given anti-nausea medications during the procedure that will help minimize this occurrence after surgery.

Patients often find their appearance scary at first. Treated areas look and feel as though they have been burned. They will be red and raw, and the skin will blister and ooze a clear or yellow fluid for 7-10 days, depending on the depth of the treatment. During the first week or so, the skin must be cleaned and dressings changed several times a day to stop dry scabs from forming, reducing the chance of infection, and promoting efficient skin re-growth. Skin resurfacing procedures can activate a Herpes virus infection in susceptible individuals, so an anti-viral drug is prescribed for everyone with a history of cold sores. Antibiotics are also given to reduce risk of bacterial infections.

Discomfort following the procedure is most significant the first few hours and decreases rapidly thereafter. Have all your medication prescriptions filled prior to the day of your surgical procedure. Understand the reasons for taking them and the directions for frequency of use. You will need to take all of your antibiotics and antivirals in the pre and postoperative period as directed.

The preconditioning skin treatments that you have undergone were in preparation for efficient healing in this immediate postoperative period. In the first 3 weeks, your skin will be bright pink to red in color. The redness is a positive sign that the healing process is progressing and a new layer of collagen is being laid down. You can safely apply make-up as a concealer after approximately 10-14 days and we will help you with this process. Depending upon how you feel, you may be able to return to work at 2-3 weeks. You will also feel much more comfortable.

After approximately 4 weeks, the redness will begin to fade significantly and you will begin to appreciate your improved appearance. It is important to remember that the redness will fade gradually. Although the color will continue to diminish with every passing week, some pinkness may remain for 4–6 months. You will not see the final results from your skin resurfacing procedure for 4–6 months. Please do not judge your results too soon, as these changes dramatically as your healing progresses.

Resume normal tasks of daily living as rapidly as possible. The pain from the procedure decreases to about half of its intensity each 24 hours following surgery. Postoperative discomfort is most marked only during the first 24 hours and regresses rapidly thereafter. Resumption of normal activities, for example, lifting the arms to comb the hair and lifting objects of normal weight, speeds the recovery process and reduces the pain more rapidly. Immobility tends to cause continued discomfort and increased muscle spasms. The only limitation to activity is if you feel significant pain. Discomfort is normal with motion initially, and there is nothing that can be harmed by normal activity. Most patients are back at work in 5-7 days. Call the office for an appointment to be seen as directed following surgery.

You may resume light exercise at 3 weeks following surgery. This includes low impact activities at 1/3 duration of exercise, repetitions, amount of weight, and pulse rate. Your exercise tolerance should gradually increase to 2/3 intensity at 6 weeks, and be at full intensity by 8 weeks. This includes high impact activities such as running, horseback riding, and high impact aerobics.

Postoperative Healing

Postoperative healing requires some mandatory down time as part of the surgical recovery process. Post surgical healing requires the body to repair the surgical wound (whether in the skin, fat, muscle or bone) with scar tissue. The bruise and tissue fluid in the wound is gradually replaced by stronger scar or fibrous tissue over a period of 6-8 weeks. Until the time that the healing area is strong enough to maintain tissue integrity, the wound is held together by the sutures (stitches) placed at the time of surgery. Too much wound tension (stress) before the strength of the healing tissue is satisfactory; can cause disruption of the incision. I place sutures very precisely to account for these healing characteristics to maximize your postoperative activity, comfort, and safety. However, your inherent healing characteristics significantly dictate these parameters. Stretching, movement, massage, and return to normal activities of daily living in the early postoperative recovery allow for the optimal return to your full normal life style.

After the initial burst of high energy healing and the “bulking up” of scar tissue, the wound enters a maturation phase, and the scar tissue becomes thinner, less red, and stronger. The maturing and stabilization of scar tissue occurs over a period of 6 to12 months. Long-term changes tend to be subtler, slower, and less evident than short-term changes that occur in the first 6 to 8 weeks.

There are no absolute parameters regarding return to postoperative activities and one must adjust for variation in pain tolerance, invasiveness of surgery and healing variations.

In general, you cannot speed up the healing process, only slow it down by too much activity too soon. Overexertion can lengthen the period of time for pain to decrease, swelling and bruising to resolve, and the final surgical results to be evident. Healing occurs for up to one (1) year, sometimes longer. The latter changes tend to be subtle and gradual, and therefore not nearly as dramatic as in the initial 6 to 8 weeks.

Please be patient with your own healing. Any change in your appearance affects your perception of self-image and requires an adjustment period of days to weeks. It is normal to have mild feelings of doubt or a low mood during this period in the first 1 to 3 weeks following surgery. These feelings are then rapidly replaced by positive feelings as healing progresses and you adjust to your improved appearance.

If you should have any other questions or problems, please contact our office at
(303) 443-2277.

LIMITATIONS, RISKS and POSSIBLE COMPLICATIONS of SKIN RESURFACING
In any surgical procedure, there are factors such as the patient’s individual healing characteristics, which are not totally under our control. Untoward effects or complications are very unusual, and I will discuss them with you, not to alarm you, but to thoroughly inform you and to aid your decision regarding surgery. Since some factors in the surgical setting are outside of our control, I can give no absolute guarantees as to the results of your surgery.
The skin resurfacing process lightens the skin, but the exact degree of lightening or pigmentation may vary from area to area, and depends mainly on the depth of treatment and the type of skin treated. Areas with different degrees of pigmentation usually become more even over a period of weeks to months. Very occasionally, “touch-up” treatments to certain areas may be required.

Hypertrophic or excess scarring occurs extremely rarely, but is possible. If you have a history of forming unsatisfactory scars in any areas in the past, I must certainly be made aware of this.

Any nevi or moles that are present in the area to be treated may darken significantly following the procedure. When these are present, we will often recommend excision or removal of the moles either
before or after the procedure.

Telangiectasias are small “spider-like” blood vessels which when present in the area to be treated, may appear more prominent following the procedure as the skin is lightened.

Prominence of skin pores may be slightly more apparent following the procedure, especially if you have prominent pores preoperatively.

A line of demarcation between the treated and untreated areas will always be present. During the skin resurfacing treatment, we “feather” or blend these treated areas so that this line is as inconspicuous as possible.

Any change in your appearance affects your perception of self-image and requires an adjustment period of days to weeks. It is normal to have mild feelings of doubt or low mood during this period in the first one to three weeks following surgery. These feelings are then rapidly replaced by positive feelings as healing progresses and you adjust to your improved appearance.

CONCLUSION
Skin resurfacing procedures are extremely useful and effective in improving or eliminating fine wrinkling and other skin abnormalities as previously described. The newly regenerated skin has a much smoother, more youthful appearance and retains this improvement long-term if maintained properly.

During your office consultation, additional or more detailed information regarding all of the areas mentioned in this information sheet will be provided you, as well as an opportunity for you to ask in-depth questions. Please review this information carefully and write down any questions you may have.